This case will test your comprehension of the basic facts about Tuberculosis.

A 38 year old black male consults you because of cough, sputum production and mild hemoptysis. He has had evening rise of temperature for the past one month and claims to have lost 30 lbs. over a three month period. On exam he appeared to be chronically ill and wasted. Cavernous breath sounds are heard over the right apex. Chest x-ray shows fluffy infiltrates and some amount of contraction of the right upper lobe. There is a cavity in the superior segment of the right upper lobe. A working diagnosis of tuberculosis is made.

1. Which spontaneously expectorated sputum would be adequate for the mycobacteriology lab?

A.M. sputum    or    24 hour pooled specimen        Answer

Florescent staining is positive for organism. Ziehl-Neelsen stain shows acid fast bacilli.

2. Is Ziehl Neelsen stain specific for T.B.?   Answer

3. If the smear is positive, is there a need to send for culture?     Answer

He is a school teacher for first grade children and the physician decided to admit him to the hospital for care.

4. Do you agree with the decision for admission? What criteria should be used for admission?    Answer

The patient is quite concerned about his illness and asks the following.

5. If tuberculosis is a contagious illness, is my present problem contracted from someone else?   Answer

An intermediate strength PPD was applied. There is 12mm of induration in 48 hours.

6. How would you interpret his skin test results?   Answer

7. Does he has tuberculosis infection or disease?  Answer

The principal of the school where your patient teaches is quite concerned, particularly since his six year old daughter is in his class. He want to know the following:

8. How infective is tuberculosis?   Answer

9. How is it spread to children?  Are all the children going to develop infection?  Answer

The principal reports that his daughter is asymptomatic. She was evaluated by her pediatrician. Her chest x-ray is normal. PPD intermediate strength results reported to be 13 mm induration.

10. Does she have tuberculosis. How is it different from our patient's problem?    Answer

11. What is going to happen to the principal's daughter's tuberculosis infection?   Answer

An attending physician comes on rounds to see the patient with you. He wants to know the following:

12. Why is his disease in the superior segment of the right upper lobe?    Answer

13. How would you classify his disease?   Answer

14. What measures are you going to take to diminish the contagiousness?   Answer

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