Question

A patient presents in the emergency room with symptoms that include mild fever (38°C), shortness of breath and productive cough with signs of blood in the sputum. The patient complained of a lack of appetite for a number of months. The patient has a history of IV drug use and has spent time in prison. The patient has reduced breath sounds on the left side and a chest X-ray showed the presence of lung infiltrates in the upper lobe of the lung. Acid fast bacteria were detected in sputum samples. A complete blood count shows significant reduction in the number of CD4+ T cells.

What is the diagnosis for this patient?

On the basis of the likely diagnosis, the patient was started on combination antibiotic and antiviral therapy; he was prescribed isoniazid, rifampin, pyrazinamide for 24 weeks. The patient complied well with his treatment and his CD4+ count stabilized but his cough worsened and lung infiltration continued to increase.

What is the reason for this disease progression and what could/would you change about his treatment based on these findings?

Answer 1

This patient has tuberculosis, a lung infection caused by mycobacterium tuberculosis.His sputum samples shows acid fast bacilli.Mycobacteria are rod shaped acid fast bacilli and under the microscope bacteria can retain color of the stain This bacteria can attack any parts of the body especially lungs.This patient has mild fever,shortness of blood,productive cough with signs of blood in sputum.The patient has low appetite and reduced breath sounds.There is reduction in CD4 .Acid fast bacteria are detected in sputum .All this suggest that patients has mycobacterium tuberculosis.

in this patient CD4 is reduced and this in turn reduces immunity of the individual.Low CD4 can stop progression of the disease.In this patient disease has progressed due to drug resistant strain of mycobacterium.In this patient isoniazid ,rifampicin and pyrainzmide are used to treat the disease. This can cause drug resistance.We have to use second line drugs for drug resistant TB.Some examples of second line dugs are levofloxacin,bedaquiline and linezolid.