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The patient is a 40-year-old female. She worked for a large medical center about a year
ago and currently works for the hospitals home health agency in New York City in an
area with a large southeast Asia immigrant population. She has a family history of lung
cancer; her father died from it last year. She has been under intense prolonged stress
and grief with family and financial issues. In March 2017, she presented a cold which
developed into bronchitis. This persisted with sleepless nights and drenching night
sweats and in September 2017 a chest X-ray was preformed and showed cavitary lesions
An acid-fast stain was preformed on the patients sputum on September 25, 2017. Acid-
fast stains differentiate microbes with a waxy coat, such as the genus Mycobacterium,
from from those without a waxy coat (2). The sputum was heat fixed onto a slide and
carbolfushin was used to stain the slide for five minutes while heat was applied. The
slide was then rinsed with water, acid alcohol for two minutes, water again and then
counterstained with methylene blue stain for one to two minutes. The slide was rinsed
with water and allowed to air-dry before observation. The sample presented with large
numbers of pink bacilli cells and light blue cocci cells. The pink cells represent that of the
patient is abnormal (2). Mycobacterium cells were present. The Mycobacterium cells
The patient presented with signs and symptoms of tuberculosis, TB. The microbe most likely
characterized by a bad cough that persists for three weeks or longer, chest pain, coughing up
blood or sputum, fatigue, weight loss, lack of appetite, chills, fevers, night sweats, and an
abnormal chest X-ray and positive sputum smear or culture (1). The patient presented with
many of these signs including a bad cough, night sweats, and both an abnormal chest X-ray and
People who are at high risk for tuberculosis are those who have been infected with
Mycobacterium tuberculosis and those with conditions that weaken the immune system (1).
One could become infected by people who have immigrated from areas of the world with high
tuberculosis rates, or by working with people who are at a high risk for tuberculosis such as in
hospitals, nursing homes, homeless shelters and correctional facilities (1). The patient worked
in a hospital and now works for the hospitals home health agency in an area with a high
population of southeast Asia immigrants. Southeast Asia is an area with a high prevalence of
TB. India and China are accountable for almost 40% of tuberculosis cases and the southeast
region accounts for 40% of tuberculosis cases worldwide (3). These immigrants then come into
the hospitals, where tuberculosis is already at a higher risk of infection, and could potentially
infect others. Patient A worked in the hospital about a year ago and now goes into the
community for home health. Not only was she potentially exposed to the microbe in the
immigrant rich hospital, she is going out into the community where the high probability
immigrants are and treating those who are sick. In addition to her work environment, she is
also under stress to pay bills and provide for her family. This stress could potentially lower the
The incubation time for tuberculosis is two to twelve weeks, but the actual duration of the
disease could vary based on the disease and treatment options (1). Most patients who become
infected are able to be cured; however, those who contracted a resistant strain, didnt take
their medications correctly, or fail to treat entirely may not be cured. If treated correctly, the
disease may persist for 6 to 9 months; however, some strains may be antibiotic resistant and
take much longer, and need more expensive drugs to treat (1). If left untreated, the disease
could progress until death. Complications of the disease could arise during and after the
defects (5).
Tuberculosis could infect a person but it may not be active. Those who are infected but not
active can not spread the Mycobacterium (1). Tuberculosis is spread through the air by coughs,
sneezes, speaking and singing, and can infect others through the respiratory route (1). Those
who are in prolonged and/or repeated exposure should receive annual testing either by skin or
blood tests (1). Those who travel outside of the United States should also be tested before
departure and eight to ten weeks after their departure (1). Patients with HIV have an impaired
Tuberculosis can be treated by taking drugs for six to nine months (1). The 4 most
common and effective medications are Isoniazid (INH), Rifampin (RIF), Ethambutol (EMB) and
Pyrazinamide (PZA), but there are a total of ten drugs approved by the Food and Drug
Administration (1). These drugs are taken heavily in the first eight weeks and then lesser in the
following eighteen weeks (1). The drugs must be taken exactly how they are prescribed and the
medication must be taken fully to ensure that they work. If the drugs are not taken accordingly,
the Mycobacterium tuberculosis can mutate and become resistant to the drugs (1). The patient
should be treated for the first eight weeks with INH, RIF, PZA and EMB for 7 days a week and
continuing treatment 7 days a week for 18 weeks with INH and RIF (1). Additional treatment
may be required if tested positive for tuberculosis after the initial treatment.
Latent tuberculosis, or tuberculosis in which the patient does not present symptoms can also be
treated. The medications used to treat latent TB are Izonazoid, Rifapentine, and Rifampin (1).
The patient would not be treated for latent tuberculosis because her symptoms are present.
References
1. Tuberculosis (TB). Centers for Disease Control and Prevention. 2016 Mar 20
https://www.cdc.gov/tb/topic/basics/default.htm
ed. Norton.