50 yo.

man with Tuberculosis

Bachelor of Science in Nursing- Level II

Section E
Patient

• A 50-year-old male recent immigrant from

Africa
• Brought to the emergency room with cough
productive of bloody sputum
• 2 months history of cough with less sputum
• Noticed an increased production of sputum
mixed with blood on a past several days
• Loses approximately 15lb
• Drenching night sweats 2 or 3 nights a
week for the past month
• Has 50-pack-year smoking history
Physical Examination

• Thin
• Frail
• Normal vital signs
• Head and Neck exam appears normal
• Neck and Axilla: no presence of palpable
adenopathy
• Lung: notable decreased breath sounds diffusely
• Chest x-ray: (+) cavitary infiltrate of the left upper
lobe
• 2+ results for AFB based on Philippine Standard
Treatment

• Combination of drug Rifampin and Isoniazid for 6 months as prescribed by the doctor
 What is the clinical condition of the man?

• The patient has Tuberculosis (TB)

Active
Tuberculosis

• TB spreads through the air when a person with TB of the lungs or throat coughs, sneeze, or
talks.
• Symptoms may include:
Bad cough that lasts 3 weeks or longer
Weight loss
Loss of appetite
Coughing up blood or mucus
Weakness or fatigue
Fever
Night sweats

Two kinds of TB infection:

Latent- bacteria remain in the body in an inactive state. They cause no symptoms and are
not contagious, but can become active.
Active- bacteria do cause symptoms and can be transmitted to others.
 What is the organism causing this condition?

• The patient is infected with Mycobacterium tuberculosis

Mycobacterium tuberculosis
Mycobacterium tuberculosis

• Causative agent of Tuberculosis

• bacillus
• Slow-growing obligate aerobe
• Non-spore-forming
• nonmotile
• Facultative intracellular parasite
• Grows in parallel groups called cords
• Retains many stain after decoloration with acid-alcohol, which is the basis of the acid-fast
stains used for pathologic identification
• Visible growth takes 3 to 8 weeks on solid media
• Two media are used to grow MTB Middlebrook's medium which is an agar based medium
and Lowenstein-Jensen medium which is an egg based medium
Colonies of Mycobacterium tuberculosis on Lowenstein-
Jensen medium.
• MTB is not classified as either Gram-positive or Gram-negative because it does not have
the chemical characteristics of either, although the bacteria do contain peptidoglycan
(murein) in their cell wall

• The high concentration of lipids in the cell wall of Mycobacterium tuberculosis have been
associated with these properties of the bacterium:

Impermeability to stains and dyes

Resistance to many antibiotics
Resistance to killing by acidic and alkaline compounds
Resistance to osmotic lysis via complement deposition
Resistance to lethal oxidations and survival inside of macrophages

One acid-fast staining method for Mycobacterium tuberculosis is the Ziehl-Neelsen stain.
When this method is used, the MTB. smear is fixed, stained with carbol-fuchsin (a pink dye),
and decolorized with acid-alcohol. The smear is counterstained with methylene-blue or certain
other dyes. Acid-fast bacilli appear pink in a contrasting background.
Mycobacterium tuberculosis. Acid-fast stain.
To collect sputum, follow these steps:
1.Collect your sputum in the early morning unless your health care provider gives you different
instructions.
2.Do not eat, drink, smoke, brush your teeth, or use mouthwash before collecting your sputum.
3.Make sure your first name, last name, and date of birth are on the label of the sample bottles.
4.Collect your sputum away from other people. If possible, go outside or open a window while you
collect your sputum.
5.Open a sample bottle. Do not touch inside the sample bottle or inside the cap.
6.Take a deep breath. Hold the air for a few seconds. Breathe out slowly. Take another deep
breath. Cough hard until sputum comes up in your mouth.
7.Spit the sputum into the sample bottle. Do this until there is enough sputum to cover the bottom
of the bottle.
8.Screw the cap on the sample bottle tightly so it does not leak.
9.Write the date and time you collected the sputum on the label of the sample bottle.
10.Seal the sample bottle in the plastic bag it came with. Do not put more than one sample bottle
in each plastic bag.
11.Make sure the test requisition paper is put in the pouch on the outside of the plastic bag (not
inside with the sample bottle).
12.After you finish collecting your sputum, wash your hands.
Tuberculin Skin Testing and Interferon-γ Release Assays

• To detect latent M. tuberculosis infection, a positive skin test is defined by induration.

• Skin testing is recommended for persons at high risk for developing tuberculosis and those with
possible latent infection who can be treated if the test is positive.
• The skin test is negative in at least 20% of active tuberculosis cases.
• Interferon-γ release assays may be used instead of skin testing.
Diagnosis

• Culture is the gold standard.

• Liquid broth cultures require 1 to 3 weeks to detect organisms.
• Nucleic acid amplification tests have sensitivities and specificities that approach culture.
• Three sputum specimens increase sensitivity.
• A radiograph showing a patchy or nodular infiltrate in the lung apices is highly suggestive,
especially if the infiltrate is cavitary.
• Pulmonary tuberculosis can occur in persons with normal chest radiographs.
Prevention

• Case finding and treatment is the most effective method of tuberculosis control.
• Hospitalized human immunodeficiency virus–positive patients with respiratory symptoms should
be admitted to negative-pressure isolation rooms. N95 masks are used for health care workers.
• Childhood bacillus Calmette-Guérin vaccination in high-burden countries decreases incident
tuberculosis.
Saliva and Sputum differentiation on microscopic examination

• Saliva smears are in general more likely to be negative or have an AFB density below the
threshold of microscopy detection than sputum smears. A negative result issued on examination
of such a specimen is misleading since it implies that a correct sputum specimen has been
examined.
• Sputum smear are classified as being either smear-positive pulmonary TB or smear negative.
Reference

MedlinePlus (2018). ”Tuberculosis,” Retrieved on August 18, 2019 from

https://www.medlineplus.gov/tuberculosis.html

J. Mclntosh (2018). “All you need to know about tuberculosis,” Retrieved on August 18, 2019
from https://medicalnewstoday.com/articles/8856.php

T. Herchline (2019). “Tuberculosis (TB),” Retrieved on August 18, 2019 from

https://emedicine.Medscape.com/article/230802

HealthLinkBC (2107). “Sputum Collection for Tuberculosis Testing,” Retrieved on August 18,
2019 from https://www.healthlinkbc.ca/sputum-tuberculosis-testing