Mr. F, age 46 years, has had a persistent unproductive cough for several months that did...

Mr. F, age 46 years, has had a persistent unproductive cough for several months that did not respond to cough medications. Recently, he has developed a productive cough accompanied by fatigue, anorexia, and night sweats. Examination indicated abnormal chest sounds and weight loss. A chest radiograph showed a small cavity and infiltrate, the tuberculin test was positive, and the sputum sample contained a small amount of blood and numerous acid-fast bacilli, confirming the diagnosis of active tuberculosis.

1. Discuss the pathologic changes occurring during the development of active tuberculosis. (See Tuberculosis.)

2. Discuss the transmission of TB and the conditions predisposing to the development of TB. (See Tuberculosis—Diagnostic Tests.)

3. Discuss the treatment of tuberculosis and the precautions involved for health care personnel coming into contact with the patient. (See Tuberculosis—Treatment.)

4. Suggest how family members or co-workers can protect themselves.

Expert Solution

1) Pathologic changes in Tuberculosis (TB): Cough with sputum (3 weeks or more), pain in chest, blood in sputum (Hemoptysis), fatigue, weight loss, decrease in appetite, fever with chills and night sweats are observed in TB

2) Transmission of TB and Predisposing conditions

Tb is an airborne disease and spreads through droplets when a patient coughs or sneezes.
Anyone can get TB infection. Predisposing conditions fot TB are crowded areas like urban areas, schools, workplaces etc. People who have immunosupression like in HIV, treatment with steroids etc are at risk of acquiring TB.

3) Treatment for TB and precautions for healthcare workers:

TB is treated with antitubercular drugs like isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin which are the firstline drugs. 2 months of intensive treatment followed by 4 months of treatment is given. Fluoroquinolones and other antibiotics are the second line drugs used in treatment of latent TB and drug resistant TB.
Environmental protection like adequate ventilation and filteration of air has to be provided for healthcare workers. Personal protective equipments like mask, gown and gloves need to be used appropriately. Following hand hygiene is vital

4) Protection of family members and coworkers

Family members and coworkers need to be educated about TB and its mode of transmission. Teach them to follow hand hygiene and personal protection while handling these patients. Educate patient to cover nose and mouth while coughing and sneezing. Use separate kerchiefs and towels and dispose sputum safely. Nutritious diet will promote immunity. Good ventilation has to be maintained.

Nightingale answered 2 years ago

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