O the problem occurs with heavy or prolonged exposure

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o The problem occurs with heavy or prolonged exposure to an infected or immunocompromised person. The very young and the very old or debilitated are also more susceptible because of decreased host defenses Pulmonary TB presents with the classic symptoms of TB: cough with productive, purulent secretions, often with blood streaks.
o Other symptoms include wide temperature variations, malaise, fatigue, wasting, chest pain, and dyspnea. o Sweating, including night sweats, is common Lymphatic TB may present initially as unilateral, painless, cervical lymphadenopathy. o TB bacilli can also settle in the genitourinary tract, bones or joints, meninges, gastrointestinal (GI) tract, and pericardium. When these extrapulmonary sites are infected, the symptoms are often vague and difficult to define Goals of Treatment The initial goal of treatment in TB is an accurate diagnosis. o This requires a practitioner who understands the current guidelines for screening and puts TB high on the differential list for any pulmonary or other illness with vague presenting symptoms. o A second goal is the patient's completion of the recommended therapy, because failure to complete therapy can lead to drug- resistant TB. o Finally, the effectiveness of treatment must be evaluated. Effective treatment of TB is not only intended to treat the sick patient but also to prevent the transmission of M. tuberculosis to the public Patients who have positive sputum cultures at the beginning of treatment should have monthly cultures, and the culture should convert to negative. o A final chest x-ray is needed for documentation of baseline for future films, but the x-ray is not as important as the sputum examination The CDC and the Canadian guidelines recommend that three sputum specimens should be obtained if pulmonary involvement is suspected Nucleic acid amplification tests for the diagnosis of TB and to determine drug resistance is sensitive and provides a more rapid result than traditional culture. o Bronchoscopy may be necessary to obtain an accurate diagnosis. If presumptive treatment is the only option, the key indicators for response to therapy are the chest x-ray findings. o Improvement should be noted within the first 3 months of therapy. o If there is no improvement, then either resistance or inaccurate diagnosis must be considered. The CDC recommends that all patients with TB have testing for HIV infection at the time treatment is initiated, if not earlier Rational Drug Selection Risk Stratification o Although anyone may become infected with TB, some populations are identified as being at greater risk: children up to age 4 years, the infirm elderly, and immunocompromised patients, including those with HIV infection or AIDS and organ transplant recipients.
Foreign-born people are also at higher risk o In the United States and Canada, certain populations are identified as being at higher risk, specifically medically underserved, low- income populations, including high-risk racial or ethnic minority

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