Clinical Image, J Infect Dis Immune Ther Vol: 2 Issue: 1
Treatment and Management of Latent Tuberculosis Infection in Lethargic Patient
Sambasivarao Yaragalla1* and Sherwin James2
1Microbiology and Immunology, Spartan Health Sciences University, Community Health and Research Centre of Spartan, St. Lucia, Caribbean
2Department of Immunology, St.Judes Hospital, St. Lucia, Caribbean
*Corresponding Author : Sambasivarao Yaragalla
Microbiology & Immunology, Spartan Health Sciences University, Community Health and Research Centre of Spartan, St. Lucia, Caribbean
E-mail: siva@spartanmed.org
Received: March 15, 2018 Accepted: April 09, 2018 Published: April 16, 2018
Citation:Yaragalla S, James S (2018) Treatment and Management of Latent Tuberculosis Infection in Lethargic Patient. J Infect Dis Immune Ther 2:1.
Abstract
A 20-year-old Asian immigrant female medical student presented to a health clinic with a four months history of lethargic feeling and occasional cough at night. Her Past Medical History revealed tuberculosis and discontinued treatment prior to 24 weeks due to lack of health care awareness. Discontinuing treatment prior to completion can leave patients infectious and symptomatic [1]. A chest x-ray (CXR) was done in this patient and revealed elevation of the left hilum and minimal fibrocavitary changes in the immediate left infraclavicular area [2-4]. A Tuberculin Skin Test (TST) was placed which resulted in a 9 mm induration. Per hospital protocol, sputum specimens were collected for acid fast stain-culture and resulted in negative Acid Fast Bacilli (AFB) from pooled sample.
Keywords: Tuberculosis; Isoniazid, TST; Latent TB
Case Presentation
A 20-year-old Asian immigrant female medical student presented to a health clinic with a four months history of lethargic feeling and occasional cough at night. Her Past Medical History revealed tuberculosis and discontinued treatment prior to 24 weeks due to lack of health care awareness. Discontinuing treatment prior to completion can leave patients infectious and symptomatic [1]. A chest x-ray (CXR) was done in this patient and revealed elevation of the left hilum and minimal fibrocavitary changes in the immediate left infraclavicular area [2-4]. A Tuberculin Skin Test (TST) was placed which resulted in a 9 mm induration. Per hospital protocol, sputum specimens were collected for acid fast stain-culture and resulted in negative Acid Fast Bacilli (AFB) from pooled sample. Also HIV-1 Ab ELISA test was done to rule out Immuno deficiency of this patient and results were Negative for HIV-1 antibodies. She was diagnosed with latent Tuberculosis Infection (LTBI) (Figure 1). She received a total of nine months of Isoniazid (INH) treatment. The local health department monitored for hepatotoxicity with Liver profile test by checking with AST, ALT and other liver enzymes. She completed treatment successfully without side effects or adverse reactions. Also CXR was done after the treatment and revealed the left hilar elevation associated with old fibro cavitary areas in the left infra clavicular area compatible with old LTB CXR. Residual radiological lesions may persist even after successful treatment of tuberculosis [5]. There is No evidence of inflammatory infiltrates or any acute infection [6-9].
Figure 1: Tuberculosis Infection in Lethargic Patient.
Acknowledgements
we are sincerely thankful for Dr. Gurumurthy from Spartan health Sciences University for Institutional Review Board approval and completion of this case in the department of clinical science and Microbiology. We also thankful to Dr. Rajeev Pandey for CHARCOAS Board approval at Spartan university.
References
- Babiarz (2014) Tuberculosis treatment discontinuation and symptom persistence: an observational study of Bihar, India’s public care system covering >100,000,000 inhabitants. BMC Public Health 14: 418.
- Fox GJ, Dobler CC, Marais BJ, Denholm JT (2016) Preventive therapy for latent tuberculosis infection-the promise and the challenges. Int J Infect Dis 56: 68-76.
- Mayer K (2010) Synergistic Pandemics: Confronting the Global HIV and Tuberculosis Epidemics. Clin Infect Dis 50: S67.
- Manjareekaa M, Nanda S (2013) Prevalence of HIV infection among tuberculosis patients in Eastern India. Infect Public Health 6: 358-362.
- Menon B, Nima G, Dogra V, Jha S (2015) Evaluation of the radiological sequelae after treatment completion in new cases of pulmonary, pleural, and mediastinal tuberculosis. Lung India 32: 241-245.
- Centers for Disease Control and Prevention (2017) Treatment Regimens for Latent TB Infection (LTBI).
- Centers for Disease Control and Prevention (2013) Core curriculum on Tuberculosis: What the clinician should know, 5th ed. Atlanta, GA: US
- Centers for Disease Control and Prevention (2016) Latent Tuberculosis Infection: A Guide for Primary Health Care Providers.
- Centers for Disease Control and Prevention (2013) Latent TB Infection: Diagnosis and Treatment Guide.
