Overview. Case Presentation Diagnosis Treatment – Induction phase Treatment – Continuation Phase Treatment Monitoring Assessment of Transmission Outcome References. Case Presentation. 18 y.o Hispanic female presents with 2 day hx of postpartum normal vaginal delivery and abnormal CXR.
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18 y.o Hispanic female presents with 2 day hx of postpartum normal vaginal delivery and abnormal CXR.
No cough, mild fever, no unexpected weight loss
PPD 25 mm by history.
Pt sitting in bed in precaution room. In NAD, breathing comfortably.
VS: WT 108 lbs, T 99.5 (F)
HR 98-Pulse Reg--Resp18 BP 104/60
Resp: Symmetric chest wall motion. Neg for retractions or use of accessory muscles. No dullness noted on percussion. No palpable tenderness on palpation. BS with normal air movement, neg for rales and wheezes
Alk Phos 180
Serum Ca 9.9
O2 sat 100
Sputum smear – x3 pendingLabs
Because of the relatively high proportion of adult patients with tuberculosis caused by organisms that are resistant to isoniazid, four drugs are used in the induction phase for the 6-month regimen to be maximally effective.
Daily therapy with
Other issues: intermittent regimens, combination pills
Initial sputum culture results from our patient:
Because of the relatively small number of organisms remaining after 2 months of intensive phase treatment, most patients with tuberculosis can be placed on continuation phase treatment after 8 weeks of induction.
Induction Phase usually lasts 4 months (18 weeks) and can be give daily or twice weekly
q 2wk during induction
q month during continuation
2 month and 6 month films
monthly smear and culture
Skin rash, LFTs, Nausea, Color vision
Sputum culture results from our patient after 2 months of induction phase therapy:
1. Horsburgh CR, Burman WJ. Tuberculosis Treatment: Theory and Practice. In: Therapy of Infectious Diseases, ed Baddour L, Gorbach SL. Philadelphia PA; Saunders, 2003: 529-46.
2. Centers for Disease Control and Prevention. Treatment of Tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR 2003;52(no. RR-11):1-80.
3. Horsburgh CR, Feldman S, Ridzon R. Quality standards for the treatment of tuberculosis. Clin Infect Dis 2000;31:633-9.