-- History: *** exposures, travel, homeless, incarceration, IVDU, healthcare work, HIV, immunosuppressed
-- Clinical/Exam: *** fever, cough, sOB, hemoptysis, night sweats, weight loss, arthralgia
-- Data: *** CXR, AFB stains and cultures
-- Etiology/DDx: ***
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- Isolate if ** cough, dyspnea, hemoptysis and 1+ RF (and if CXR equivocal but immunosuppressed) - d/c if AFB smear neg x3 or on TB tx for 2 weeks and AFB smear neg x3 with clinical improvement
-- f/u IGRA, AFB cultures from sputum x3 if c/f pulmonary TB; bronch can increase yield
-- Before treating - LFTs, BMP (Cr), HIV, Hep A/B/C, DM, EtOH use, pregnancy test
-- Active TB - isoniazid, rifampin, pyrazinamide, ethambutol for 2 months followed by INH+RIF for 4 months
-- Latent TB - INH, rifapentine weekly for 12 weeks or RIF for 4 weeks
PDF coming soon!
While common and a leading cause of death worldwide, tuberculosis is rare in the United States. Initial infections are usually kept at bay by the immune system leading to a latent infection. Reactivation can happen if the immune system is weakened. Active infection leads to symptoms including cough, hemoptysis, fevers, night sweats, weight loss. TB can spread to any organ, but widely disseminated disease is usually limited to those with profound immunosuppression. Treatment is with atypical antibiotics (RIPE) and for prolonged periods. Latent TB is screened for via PPD testing or interferon-gamma release assay (IGRA), commonly known as quant-GOLD.