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?
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To confirm a diagnosis of TB, the provider will likely order the following diagnostic tests:
1. Chest X-ray: This can help identify any abnormalities in the lungs that may indicate TB infection, such as infiltrates or cavities.
2. Sputum smear and culture: Samples of sputum will be collected and examined under a microscope to check for the presence of the TB bacteria. Cultures will also be done to grow the bacteria and determine their antibiotic susceptibility.
3. Tuberculin skin test (TST) or interferon-gamma release assay (IGRA): These tests are used to determine if the individual has been exposed to TB bacteria. They help detect immune responses to TB infection.
4. Molecular tests: These tests, such as the GeneXpert MTB/RIF assay, can rapidly identify the presence of TB bacteria and determine if it is resistant to the standard TB drug, rifampicin.
The isolation precautions that are expected to be put in place for Wilson include:
1. Placing him in a negative pressure isolation room: This is to prevent the spread of TB bacteria to others in the hospital. Negative pressure rooms ensure that air flows into the room, preventing contaminated air from escaping into other areas.
2. Wearing a respiratory mask: Wilson should wear a fitted N95 respirator mask when leaving his room or when in close contact with others. This helps prevent the transmission of TB bacteria through respiratory droplets.
3. Educating healthcare workers and visitors: Everyone entering Wilson's room should be informed about the necessary precautions and use appropriate personal protective equipment (PPE) like gloves, gowns, and masks.
The recommended treatment regimen for TB typically involves a combination drug therapy called Directly Observed Therapy - Short Course (DOTS). This regimen lasts for six months and includes the following drugs:
1. Isoniazid (INH): Taken daily for six months. It kills the actively dividing TB bacteria.
2. Rifampicin (RIF): Also taken daily for six months. It kills the dormant or slow-growing TB bacteria.
3. Pyrazinamide (PZA): Taken daily for the first two months. It eliminates the TB bacteria that are most resistant to drugs.
4. Ethambutol (EMB): Also taken daily for the first two months. It assists in preventing the development of drug resistance.
The rationale for using combination drug therapy is to ensure effective treatment and prevent the development of drug resistance. Different drugs in the combination target different populations of TB bacteria at different stages of growth, reducing the chance of bacterial survival and resistance.
Compliance with medication therapy is often a concern in patients with TB due to various reasons, such as:
1. Long treatment duration: TB treatment lasts for a minimum of six months, and sometimes even longer for drug-resistant TB. This can lead to patient fatigue and a decreased motivation to continue taking medication.
2. Side effects: The TB drugs can have side effects, such as liver toxicity, peripheral neuropathy, and gastrointestinal disturbances. These side effects can be uncomfortable or even debilitating, leading to non-compliance.
3. Lack of understanding: Patients may not fully understand the importance of completing the full course of treatment or the consequences of non-compliance. Language barriers, educational levels, or cultural beliefs can contribute to this lack of understanding.
For Wilson's 6 roommates, the provider should consider screening them for TB infection. This can be done by performing TST or IGRA tests to determine if they have been exposed to TB bacteria. If any of the roommates test positive, further evaluation and treatment may be necessary. Additionally, the roommates should be educated about the symptoms of TB and the importance of seeking medical attention if they develop any symptoms.
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