CASE LEARNING OBJECTIVES
Identify the risk factors for developing active tuberculosis (TB) disease
Design a therapeutic plan for active TB disease in an immunocompetent and immunocompromised patient
Assess the effectiveness of therapy in patients being treated for TB
Design an appropriate regimen for the treatment of latent TB infection
"I have had a cough for a month. Two nights ago I woke up with a sharp pain in my chest and I coughed up some blood."
History of Present Illness
HS is a 52-year-old Hispanic female who presents to the emergency department with complaints of cough, productive of small amounts of yellow sputum within the last month. She has experienced increasing fatigue, occasional SOB on exertion, and mild, nonpleuritic, substernal chest discomfort. She has had periodic night sweats; last night her temperature was 38.9°C. Two nights ago, she noticed streaks of bright-red blood in her sputum without any particular odor or taste. The only medication she has taken is an over-the-counter cough preparation. Three months ago, the patient presented to a free clinic with fatigue, increased urinary frequency, and headaches. Evaluation revealed a diagnosis of type 2 diabetes and stage I HTN. A purified protein derivative (ppd) test, required for work clearance, was placed. She was noted to have a positive ppd test, but because her chest x-ray showed no active disease, she was cleared to work.
HTN diagnosed 3 months ago
Type 2 DM diagnosed 3 months ago
Depression diagnosed 9 months ago
Mother (age 77 years) is in good health. Sisters (ages 49 and 56 years) have HTN. Her father in Mexico died of lung disease 4 years ago at age 72 years. Her husband died of colon cancer 2 years ago.
The patient immigrated to the United States from Mexico 1 year ago. She lives with her son and his family. She has 2 daughters who still live in Mexico and has visited them on several occasions during the past year. She has recently started working at a day care.
Social drinker; (−) tobacco or illicit drug use
Allergies/Intolerances/Adverse Drug Events
Lisinopril 20 mg PO daily
Metformin 500 mg PO twice daily
Sertraline 50 mg PO daily
Calcium carbonate 1,000 mg PO daily
The patient reports a more-than-9 ...