Question

You are a medical assistant at a local hospital. You have been asked to give a presentation on the diagnosis and treatment of latent tuberculosis infection. The presentation will be open to the public so instead of presenting a real patient case, you decide to create a fictional sample case. Create a single case and list the characteristics of the person you will be testing and treating. Describe basic information about the patient including age, sex, lifestyle, and pertinent medical history. Take the audience through the typical diagnosis and treatment of TB. (See page 4 of the Latent Tuberculosis Infection guide below for two sample scenarios leading to latent TB.) Describe the person and their experience including their feelings and concerns at this time. Hospital personnel should leave the presentation understanding the physical and psychological consequences for the patient. Considering the research data available, answer these questions about your fictional patient with latent TB: Without treatment, what is your patient’s lifetime risk for TB reactivation? Your case patient has reported or has been diagnosed with another risk factor of developing active TB infection (e.g. – diabetes, HIV, organ transplant). How much does this factor increase their risk? Does it change the recommended treatment for this patient?

Advances in Diagnosis and Treatment of Latent Tuberculosis Infection
http://www.jabfm.org/content/27/5/704.full.pdf

Answer 1

Sample case presentation of Latent Tuberculosis infection:

Case Name: Mr. D.J

Age: 62 years

Sex: Male

Occupation: Worked in the coal mine. Retired 4 years back.

Past History: Known diabetes since 10 years.

Past Medical History: Affected with Mycobacterium Tuberculosis 8 years back and completed the full course of treatment.

Lifestyle: Sedentary active life before 4 years, But now limited to daily routine activities.

DIet: Normal American Diet.

Mr. D.J is a white male who is a known case of latent tuberculosis infection and is on treatment from last 2 months. His previous history of M. tuberculosis increases the risk of getting Latent TB infection. Initially, he was suffered from fever, recurrent cough with sputum. the primary physician advised for Mantoux Tuberculin Test. The results show false- Negative. Later, when his condition is worsened with weight loss, severe diarrhea and vomiting, he underwent the test of IGRA (Interferon -Gamma Release Assays) which shows the Positive result. Then he diagnosed with LTBI. The physician prescribed on Isoniazid for 9 months and is adherent to the treatment.

He is mentally worried about the perception of his condition. He is annoyed at being isolated and fear of death. Further his financial background increases his mental stress. The family members also feel depressed and anxious. Educated Mr. D.J about his condition and make him realize that his condition is controllable through proper drug regimens and adequate nutrition. Family Members are involved to support him physically, emotionally, and financially.  

If Mr.D.J is not on treatment, his immune system weakens much more and leads to life-threatening. Further, the risk factor of diabetes weakens the immune responses and increases the chances of reactivation of TB. TB also affects his glycemic control which increases the risk of peripheral neuropathy. So the drug pyridoxine should be added along with isoniazid for Mr. D.J.

The family members are screened for TB and all show negative results. The patient is evaluated monthly for adherence of drug, an adverse reaction to treatment therapy, and for the continuity of treatment.