Case Study of Tuberculosis

Subject: A 23-year-old African American female

Problem: Improper follow up
The client was an attractive 23-year-old prostitute who worked a three county area in
Central Indiana. She was diagnosed with tuberculosis in the early eighties when she
presented to the hospital with a cough, weight loss, and night sweats. Her chest x-ray
showed cavitary lesions in the upper left lobe of her lung and there were many acid-fast
bacilli on sputum smear. She was admitted into the hospital into a negative pressure
room and placed on anti-tuberculosis drugs. After a seven day stay in the hospital, she
was released and sent home under strict orders that she was to stay in the house with no
visitors until she became smear negative.

When the TB control nurse from the local health department went out to do a home visit
three weeks later to follow up on the young woman, she found no one home. She
returned to the health department and told the administrator that it appeared that the
woman had moved since the house appeared to be in poor repair and the lawn had not
been mowed. She simply charted that she was unable to locate the patient and contacted
the ISDH and told them that the patient had apparently moved out of the county. The
cultures came back proving that the woman had tuberculosis.

The patient was lost for about four months and no real effort was made to find her.
Meanwhile, three cases of tuberculosis showed up in two other counties among young to
middle aged men, both white and African American. When the men were asked about
contacts, no information was given about possibly being around someone with the
symptoms of tuberculosis. Although some of the close contacts of the men tested
positive, no identification was made to an active case they had been exposed to.
Meanwhile, she showed up again in the emergency room of a hospital in a different
county from where she originally was diagnosed. She was seen by a physician and told
that she appeared to have pneumonia, was given a prescription for an antibiotic, and sent
home. She continued to be very sick and decided to move in with her brother until she
got better. Her brother had two small children living with him and his wife in their small
apartment.

During this time, routine skin testing was being on all children enrolled at the local Head
Start program in the county so the brother’s children received a TB skin test. Both tested
positive. He and his wife were contacted by the local health department and told that
they needed to be tested as well. He tested positive, but his wife was negative. When
asked if they knew anyone with the symptoms of tuberculosis, they immediately thought
of his sister. The name was familiar to the TB control nurse since she had made the
home visit four months earlier.