Management of Tuberculosis
Management of Tuberculosis
Wilson is a 36-year-old migrant worker. He was admitted to the Hospital with a cough, unintended weight loss, and night sweats. He is staying with 6 friends in a one bedroom apartment near the strawberry field where he works. The ED physician suspects Tuberculosis (TB).
- What diagnostic testing will the Provider order to confirm a diagnosis of TB?
- What Isolation precautions do you expect to be put in place and why?
- Describe the recommended treatment regimen for TB, including the rationale for combination drug therapy.
- Identify the reason compliance to medication therapy is often a concern in the patient with TB.
- What should be done for Wilson’s 6 roommates?
SAMPLE ANSWER
Management of Tuberculosis
Clinical presentation for Wilson reveals that he may have tuberculosis. His symptoms include unintended weight loss, night sweats, and coughs. However, to get a clear diagnosis of tuberculosis, the practitioner needs to perform a Mantoux tuberculin skin test. It involves the injection of a fluid into the skin of a person’s lower arm. Alternatively, the practitioner can take samples of the patient’s sputum to confirm tuberculosis infection (Lange et al., 2018). The practitioner needs to provide airborne isolation precautions. This is because the germs causing tuberculosis are usually spread via air. Since the client is staying with 6 friends, he needs to be given a special room to minimize spread of tuberculosis bacteria (Rangaka et al., 2015).
The recommended regimen for tuberculosis involves four drugs. For intitial treatment, a patient is given rifampin, pyazinamide, isoniad, and either streptomycin or ethambutol. Ethambutol or streptomycin may be discontinued when the person is viewed to be fully susceptible. The use of combination therapy is considered essential as it helps in killing a high number of TB-causing bacteria in the body. The combination is also determined by whether the person has an active or latent form of the disease and whether the person is infected by human immunodeficiency virus (Lange et al., 2018).
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Compliance to tuberculosis treatment is a big concern for patients because the bacteria associated with the disease is very strong. Poor adherence to treatment may make people to be infectious for a longer period. They are also more likely to relapse or die. Moreover, taking drugs according to the prescriptions is viewed to control drug-resistant form of tuberculosis. In the scenario, Wilson’s roommates also need to undergo diagnosis to verify if they have tuberculosis or not. If they do not have the disease, Wilson needs to be isolated from them in order to minimize chances of being infected (Rangaka et al., 2015).
References
Lange, C., Chesov, D., Heyckendorf, J., Leung, C. C., Udwadia, Z., & Dheda, K. (2018).
Drug‐resistant tuberculosis: An update on disease burden, diagnosis and treatment. Respirology, 23(7), 656-673.
Rangaka, M. X., Cavalcante, S. C., Marais, B. J., Thim, S., Martinson, N. A., Swaminathan, S.,
& Chaisson, R. E. (2015). Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection. The Lancet, 386(10010), 2344-2353.
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