Unknown

1
Unknown 135
2

• A 52 year old man who was released from a federal
  penitentiary one month ago is seen in the
  emergency department for three weeks of fever,
  cough and night sweats. He has no prior medical
  history and takes no medications. He drinks 5-6
  beers a night. He does not smoke.
• Vital signs are normal. There are crackles in
  the right upper lung zone the remainder of the
  examination is normal.
• Chest X-ray shows a patchy infiltrate in the
  right upper lobe with pleural thickening.

3

• Which of the following is the best test to
  confirm your suspected diagnosis in this patient?
• Bronchoscopy
• B) PPD skin testing
• C) Send three sputum samples for AFB and culture
  every eight hours for the next 24 hours
• D) High resolution CT scan of the chest
• E) Serum adenosine deaminase testing

4

• If the patient is diagnosed with tuberculosis,
  which of the following is the best management for
  this patient?
• Isoniazid for 9 months
• B) Isoniazid plus pyrazinamide for 3 months
• C) Isoniazid plus rifampin plus pyrazinaminde
  until culture sensitivities return
• D) Isoniazid plus rifampin plus pyrazinaminde
  plus ethambutol until culture sensitivities return

5

• Which of the following is the best test to
  confirm your suspected diagnosis in this patient?
• Bronchoscopy
• B) PPD skin testing
• C) Send three sputum samples for AFB and culture
  every eight hours for the next 24 hours
• D) High resolution CT scan of the chest
• E) Serum adenosine deaminase testing

6

• If the patient is diagnosed with tuberculosis,
  which of the following is the best management for
  this patient?
• Isoniazid for 9 months
• B) Isoniazid plus pyrazinamide for 3 months
• C) Isoniazid plus rifampin plus pyrazinaminde
  until culture sensitivities return
• D) Isoniazid plus rifampin plus pyrazinaminde
  plus ethambutol until culture sensitivities return

7
Diagnosis of suspected tuberculosis

• Gold standard is sputum AFB culture
• PPD skin testing may be negative 10-25 of the
  time in active TB
• Bronchoscopy should be delayed until sputum
  testing is complete to avoid unnecessary risk of
  spreading TB to health care workers
• CT scanning is not diagnostic
• ADA (adenosine deaminase) testing is helpful in
  pleural TB

8
Treatment of active tuberculosis

• Four drug therapy (INH, PZA, RIF, ETH)
• Daily, twice weekly or three times weekly all
  useful
• Three drugs not sufficient owing to resistance
• LTBI (positive PPD, normal CXR) INH alone
• Short course, two drug regimens no longer
  recommended

OBJECTIVE Manage suspected active tuberculosis