Tuberculosis Notes

Tuberculosis

Signs/Symptoms:

• Fever
• Chronic cough (greater than 3 weeks) (>3 {WEEKS})
• Hemoptysis (coughing up blood)
• Night sweats
• Recent immigration from a high-risk country

Gold Standard Diagnostics:

• Positive sputum cultures

Chest X-Ray findings:

• Upper lobe consolidation
• Any positive results must be reported to the Department of Public Health.

Tuberculin Skin Testing (TST) also called "Purified Protein Derivative" (PPD) or "Mantoux" Skin Test:

• Method used to diagnose silent (latent) TB infections.
• Intradermal injection of PPD tuberculin.
• Absorbed into the skin.
• Re-evaluate in 48-72 hours for skin reaction.

Considered Positive (Contagious) If…

• 5 mm
  • For patients that are:
    • HIV-positive
    • Immunocompromised
    • Recent TB exposure
• 10 mm
  • For patients that are:
    • Homeless
    • Immigrants
    • Healthcare workers
• 15 mm
  • General public

Tuberculosis Treatment:

• Multi-drug regimen for 6-9 months.
• Often followed by a health department nurse to ensure adherence to medication regimen.
• Common multi-drug regimen medications: Isoniazid, Rifampin, Ethambutol, and Pyrazinamide.
• Test tip: PPD testing safe during pregnancy!

What if patients are asymptomatic but have a positive PPD test?

• We still treat these patients as they have silent (latent) TB infection.

When are patients considered "no longer contagious"?

• Must have three negative Acid-Fast Bacilli (AFB) sputum cultures.