Wilson is a 36-year-old migrant worker. He was admitted to the Hospital with a cough, unintended weight loss, and night sweats

Wilson is a 36-year-old migrant worker. He was admitted to the Hospital with a cough, unintended weight loss, and night sweats. He is staying with 6 friends in a one bedroom apartment near the strawberry field where he works. The ED physician suspects Tuberculosis (TB).
What diagnostic testing will the Provider order to confirm a diagnosis of TB?
What Isolation precautions do you expect to be put in place and why?
Describe the recommended treatment regimen for TB, including the rationale for combination drug therapy.
Identify the reason compliance to medication therapy is often a concern in the patient with TB.
What should be done for Wilson’s 6 roommates?

ANSWER
Diagnostic testing for TB

The provider will likely order the following tests to confirm a diagnosis of TB:

Sputum smear and culture: This is the most common test for TB. It involves collecting a sample of sputum (mucus from the lungs) and examining it for TB bacteria.
Tuberculin skin test (TST): This test is done by injecting a small amount of tuberculin (a protein from TB bacteria) into the skin. If the person has been exposed to TB, they will develop a red, raised bump at the injection site within 48-72 hours.
Interferon-gamma release assay (IGRA): This blood test is similar to the TST, but it is more specific for TB infection.
Isolation precautions for TB

The following isolation precautions will likely be put in place:

Airborne precautions: This means that Wilson will be placed in a private room with negative pressure ventilation. Negative pressure ventilation helps to prevent TB bacteria from spreading to other patients and healthcare workers.
Respiratory protection: Healthcare workers who enter Wilson’s room will need to wear a respirator mask, such as an N95 respirator.
Rationale for combination drug therapy for TB

TB is treated with a combination of drugs for several reasons. First, combination drug therapy helps to prevent the development of drug resistance. Second, combination drug therapy is more effective than monotherapy at killing TB bacteria.

The recommended treatment regimen for TB in adults is:

Isoniazid (INH)
Rifampin (RIF)
Pyrazinamide (PZA)
Ethambutol (EMB)
These drugs are taken for 6-9 months, depending on the severity of the infection.

Compliance with medication therapy in TB

Compliance with medication therapy is often a concern in patients with TB because TB treatment is long and complex. Patients may need to take multiple medications every day for several months. This can be challenging, especially for patients who have limited resources or who are facing other challenges, such as poverty or homelessness.

What should be done for Wilson’s 6 roommates?

The provider will likely order a TST or IGRA for Wilson’s 6 roommates to check for TB infection. If any of the roommates test positive, they will need to be treated for TB.

In addition, the provider will likely educate Wilson’s roommates about TB and how to prevent its spread. This includes teaching them about the importance of good hand hygiene and covering their coughs and sneezes.

Here are some additional tips for helping Wilson and his roommates comply with medication therapy:

Provide clear and concise instructions about how to take the medications.
Answer any questions that Wilson or his roommates have about the medications.
Break down the medication regimen into smaller, more manageable steps.
Set up reminders to take the medications.
Provide support and encouragement to Wilson and his roommates.
By taking these steps, you can help Wilson and his roommates successfully complete their TB treatment and prevent the spread of TB.