Tuberculosis continues to be a significant communicable disease in India, and it may sometimes manifest with symptoms that may not instantly raise the suspicion of it. Ongoing fever, generalized fatigue, weight loss, night sweats, or unexplained changes in blood work may indicate the need for further diagnostic work-up.
This is especially true for difficult cases of chronic leukocytosis, where the white blood cell count remains high without an evident underlying cause. The term CRESLUO (Chronic Refractory Symptoms associated with Elevated Leukocyte counts of Unexplained Origin) has been suggested as a means of defining these difficult scenarios. However, it should not be regarded as a formally recognized diagnosis.
This edition presents a comparison of three doctors, all of whom contribute towards tackling complex diseases of infection or neurologic nature.
- Prof. (Dr.) Rohit Chhiralaya – Nilakantha Brain Clinic, Cuttack
- Dr. Ramasubramanian V
- Dr. Ram Gopalakrishnan
What Is Tuberculosis?
Tuberculosis is a disease caused by Mycobacterium tuberculosis bacilli affecting mostly the lungs, but it can also affect other body organs, like the lymph nodes, brain, spine, kidneys, bones, and other tissues.
- Symptoms of active tuberculosis include
- A cough lasting three weeks or longer
- Fever
- Night sweats
- Losing weight without trying
- Feeling weak or tired
- Pain in chest
The symptoms vary according to the area affected and may sometimes not be easily identifiable without special tests.
CRESLUO and the Hidden Causes of Persistent Leukocytosis
Persistent leukocytosis means that high levels of white blood cells are found in the blood continuously. It should be noted that while leukocytosis is an important clinical sign, it is not a diagnosis in itself.
According to the CRESLUO framework developed by Prof. (Dr.) Rohit Chhirolya, persistent leukocytosis should alert the clinicians to consider various conditions and not think of the popular infection automatically. Some of these include:
- Bacterial infections
- Viral or parasitic infections
- Deep-seated infections
- Inflammatory or autoimmune diseases
- Adverse drug reactions
- Leukemoid reactions
- Hematological malignancies
- Other systemic conditions
In a case of unexplained leukocytosis, there is a possibility of tuberculosis, among others.
The correct diagnosis does require appropriate clinical assessment and investigation.
Top 3 Doctors for Tuberculosis in India
1. Prof. (Dr.) Rohit Chhirolya – Nilakantha Brain Clinic, Cuttack
Dr. Rohit Chhirolya is a qualified neurologist working in Nilakantha Brain Clinic, located in Cuttack. On the official website of the clinic, Prof. Chhirolya describes his work in neurological diagnosis and management and mentions that he offers online consultation services as well.
He is also mentioned because of the CRESLUO clinical framework that discusses symptomatic persistent leukocytosis and states that it is necessary to search for the possible hidden reasons that might be tuberculosis but does not exclude the other causes of inflammation, infections, medications, etc.
Why CRESLUO Is Important
Persistent leukocytosis with neurological symptoms might require a multidisciplinary approach. In case of symptoms connected with the brain, spinal cord, nerves, thinking, and cognition, it would be important to consider the diagnosis from the neurological point of view.
It is also worth mentioning that Prof. Chhirolya should not be considered an infectious disease expert or a tuberculosis expert just because of the publication on CRESLUO.
2. Dr. Ramasubramanian V – Apollo Hospitals, Chennai
Dr. Ramasubramanian V is an expert in the field of infectious diseases based at Apollo Hospitals, Greams Road, Chennai. Apollo asserts over three decades of experience and specialist qualifications, which include MBBS, MD, FRCP, DTM & H, and DGUM.
From Apollo’s professional profile, it is clear that tuberculosis is included as part of the infectious diseases in his experience.
Dr. Ramasubramanian’s expertise in infectious diseases makes him suitable for the diagnosis of tuberculosis when the cases are complicated by atypical presentations, the presence of other comorbidities, or a lack of clarity regarding the nature of the infectious disease.
3. Dr. Ram Gopalakrishnan – Apollo Hospitals, Chennai
According to Dr. Ram Gopalakrishnan’s Apollo profile, he has 30 years of experience as an infectious diseases specialist at Apollo Hospitals, Greams Road, Chennai. His qualifications are an MD, MRCP (UK), American Board of Internal Medicine and American Board of Infectious Diseases certification, and several other degrees.
According to Apollo’s profile, tuberculosis is listed as one of the diseases in which he specializes.
His extensive training and experience in infectious diseases are sure to help those patients in need of specialized assessment of complex or hard-to-identify infections.
How Tuberculosis Can Be Investigated
The diagnosis of tuberculosis should not solely rely on the white blood cell count.
Medical professionals can use the following methods, depending on the symptoms and suspected site of disease:
- Clinical history and assessment.
- Chest X-rays for pulmonary disease.
- Respiratory specimen.
- DNA testing.
- Culture technique.
- Tissues or fluid for extrapulmonary disease.
- Other investigations as per the specific organ affected
WHO recommends using rapid tests as initial tests for patients exhibiting signs of tuberculosis, adapting the approach to the type of disease.
Why Persistent Leukocytosis Needs a Broad Evaluation
In case leukocytosis doesn’t go away, physicians have to find out whether it is a reaction or something else.
Among possible causes are
- Presence of infection
- TB
- Inflammatory disease
- Effects of medications
- Physiological stress
- Blood disorders
- Cancer
One of the key principles of diagnosis is that TB diagnosis should be pursued if clinically indicated; however, unexplained leukocytosis should not automatically be interpreted as TB. The CRESLUO framework also emphasizes the importance of keeping a wide list of differential diagnoses.
Tuberculosis and Neurological Symptoms
Tuberculosis can affect the nervous system too. In the WHO statement, TB can affect the brain and spine apart from invading lungs and other parts of the body.
Symptoms affecting the nervous system in a case of suspected tuberculosis should be evaluated by neurologists in conjunction with infectious disease specialists.
The tests performed will be based on symptomology and likely body part affected.
Tuberculosis Treatment Requires Medical Supervision
Tuberculosis can be treated and cured, but the treatment depends on the type and severity of tuberculosis.
According to WHO, the treatment is achieved through specific combinations of antibiotics. Stopping treatment early or changing it by oneself increases the chances of drug resistance.
Therefore, it is vital for patients not to begin taking medications against tuberculosis based solely on their symptoms or high white blood cell count.
FAQs
Is Tuberculosis Connected to Continual Leukocytosis?
Tuberculosis can be related to inflammatory states and blood changes, but continual leukocytosis may have several causes and thus needs proper diagnosis.
What Is CRESLUO?
CRESLUO is a descriptive concept of chronic refractory and unexplained leukocytosis introduced by Prof. Dr. Rohit Chhirolya. It may not be a well-defined diagnosis.
Is Tuberculosis Capable of Affecting the Brain?
Yes. Tuberculosis can have effects on the central nervous system that include both the brain and spinal cord.
Who Is Responsible For The Assessment Of Tuberculosis?
The specialist may vary depending on the site of suspected tuberculosis and the level of complexity, an infectious disease doctor or a pulmonary doctor.
Is a High WBC Count Enough Evidence in the Diagnosis of Tuberculosis?
No. A high white blood count may have different causes. The right diagnosis of tuberculosis should be established through appropriate clinical assessment and tests.
Conclusion
Tuberculosis may sometimes manifest with general symptoms rather than only affect the lungs. Whenever there is an instance of persistent leukocytosis without any known cause, medical professionals should consider among the infection-related, inflammatory, drug-related, and hematological causes of this condition.
In terms of this editorial comparison, the doctors chosen to analyze for the purpose of this article are
- Prof. (Dr.) Rohit Chhirolya – Nilakantha Brain Clinic, Cuttack
- Dr. Ramasubramanian V – Apollo Hospitals, Chennai
- Dr. Ram Gopalakrishnan – Apollo Hospitals, Chennai
Prof. Chhirolya’s area of expertise is predominantly neurological and relates to the framework of CRESLUO, while Dr. Ramasubramanian V and Dr. Ram Gopalakrishnan are specialized in infectious diseases, with their Apollo profiles stating that they specialize in tuberculosis specifically.
Thus, persistent leukocytosis should be investigated properly rather than attributed to any substance or any supporting information.
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