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ATT-Induced Liver Dysfunction: A Serious Concern in TB Management

Understanding ATT and Its Role

Anti-tuberculosis therapy (ATT) is the standard treatment for tuberculosis, typically involving a combination of drugs like isoniazid, rifampicin, pyrazinamide, and ethambutol. While these drugs are effective, some of them carry a known risk of liver toxicity.

What Is ATT-Induced Liver Dysfunction?

ATT-induced liver dysfunction refers to liver damage that occurs as a side effect of TB medications. It often presents as elevated liver enzymes (transaminases), and in some cases, may progress to jaundice or even acute liver failure if left unmonitored.

Symptoms to Watch For

  • Nausea and vomiting
  • Abdominal pain (especially in the right upper quadrant)
  • Jaundice (yellowing of eyes and skin)
  • Fatigue or general weakness
  • Dark-colored urine

Who Is at Risk?

Patients at higher risk for liver toxicity from ATT include:

  • Those with pre-existing liver disease (e.g., hepatitis B or C)
  • People with poor nutritional status
  • Elderly individuals
  • Those who consume alcohol regularly
  • HIV-positive individuals
  • Monitoring and Management
  • Baseline Liver Function Tests (LFTs) should be done before starting ATT
  • Routine monitoring is important, especially during the first two months
  • If significant liver injury occurs, drugs may need to be paused and reintroduced gradually under expert guidance
  • Modified regimens or hepatoprotective agents may be considered

Why Early Detection Matters

Delays in recognizing liver dysfunction can lead to serious complications and jeopardize TB treatment. Timely action can prevent permanent damage and allow patients to safely complete their course of therapy.

If you or someone you know is undergoing TB treatment and experiencing symptoms of liver dysfunction, consult an infectious disease specialist immediately.

Dr. Chhavi Gupta
MBBS, MD, DM (AIIMS, New Delhi)
Senior Consultant – Infectious Diseases
Yashoda Super Speciality Hospital, Kaushambi
📞 For Appointments: +91 8851 346 424
🌐 drchhavigupta.com

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Understanding Multidrug-Resistant Tuberculosis (MDR-TB): Causes, Symptoms, and Treatment

Tuberculosis (TB) remains a significant global health challenge, but an even greater concern is Multidrug-Resistant Tuberculosis (MDR-TB). MDR-TB is a form of TB that does not respond to at least isoniazid (INH) and rifampicin (RIF), the two most potent first-line anti-TB drugs. This makes treatment more complex, expensive, and prolonged, increasing the risk of complications and transmission.

Causes of MDR-TB
MDR-TB primarily develops due to:

  • Incomplete or improper TB treatment – When patients fail to complete their full course of TB medication, the bacteria may develop resistance.
  • Incorrect prescription of TB drugs – Using the wrong drug combinations, incorrect dosages, or poor-quality medications can contribute to resistance.
  • Person-to-person transmission – MDR-TB can spread through the air from an infected person to others, making early detection and treatment critical.

Symptoms of MDR-TB
The symptoms of MDR-TB are similar to drug-sensitive TB but may persist despite standard treatment. Common symptoms include:

  • Persistent cough lasting more than three weeks, often with mucus or blood
  • Fever and night sweats
  • Unexplained weight loss
  • Fatigue and weakness
  • Chest pain and difficulty breathing

MDR-TB Can Develop at Any Site of Infection
While TB commonly affects the lungs, MDR-TB can also develop in other parts of the body, including the lymph nodes, spine, brain, kidneys, and joints . Extrapulmonary MDR-TB may cause symptoms depending on the infected site, such as severe back pain in spinal TB or swelling in lymph node TB.

Diagnosis of MDR-TB
To confirm MDR-TB, specialized laboratory tests such as *GeneXpert, Line Probe Assay (LPA), or Culture and Drug Sensitivity Testing (DST) – are performed to detect drug resistance. These tests help in selecting the appropriate treatment regimen.

Treatment of MDR-TB
MDR-TB treatment is longer and involves second-line antibiotics. The regimen includes:

  • Bedaquiline, Delamanid, Levofloxacin, Moxifloxacin, or Linezolid, depending on drug susceptibility testing.
  • Treatment duration ranges between 6 to 24 months.
  • Strict adherence – to treatment is essential to prevent further resistance.
  • Nutritional support and overall health management – play a crucial role in recovery.

Prevention of MDR-TB
Preventing MDR-TB involves:

  • Completing the full course of TB treatment – as prescribed.
  • Early diagnosis and prompt treatment – of drug-resistant cases.
  • Infection control measures – like wearing masks, improving ventilation, and avoiding crowded places.
  • BCG vaccination – in children to prevent severe forms of TB.

Conclusion
MDR-TB is a serious public health threat, but early diagnosis and proper treatment can help control its spread. Awareness, adherence to medication, and preventive measures are key in the fight against MDR-TB.

For expert consultation on TB and infectious diseases, visit Dr. Chhavi Gupta, MBBS, MD, DM (AIIMS, New Delhi), Senior Consultant in Infectious Diseases at Yashoda Super Speciality Hospital, Kaushambi.