This case will test your comprehension of the preventive aspect of 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. Sutum is positive for AFB. The patient was started on INH, Rifampin,Pyrazinamide and Ethambutol.

He has a 33 year old wife, 5 year old daughter, 65 year old father and 62 year old mother. They all reside in the same household. His son is 15 years old and has been living in California for the past two years.

1. What steps will you take to evaluate the family?    Answer

The family has been evaluated and the following information is made available to you. The wife is asymptomatic. She has a normal chest x-ray and 11 mm induration with intermediate strength PPD.

2  How would you classify her?   Answer

3. Is she a candidate for prophylaxis and why?   Answer

The daughter is asymptomatic. Her chest x-ray is normal and she has 5 mm induration with intermediate strength PPD.

4. Is she a candidate for INH prophylaxis?   Answer

The father has recently been diagnosed with multiple myeloma. His chest x-ray reveals diffuse osteoporosis but normal lung fields. His symptoms are related to multiple myeloma. PPD results 5 mm induration.

5.  Is he at higher risk of developing tuberculosis because of his diagnosis of multiple myeloma?   Answer

The mother is asymptomatic. She has a normal chest x-ray and her PPD results 14 mm induration. She was reported to have a positive PPD five years ago.

6. Is she a candidate for INH prophylaxis?   Answer