What is the health care plan for pulmonary tuberculosis?

Answer 1

The original presumptive diagnosis of pulmonary tuberculosis (TB) is made through physical exam by MD/Pulmonologist, assessment of symptoms (chest pain, shortness of breath, productive cough, fever, night sweats, fatigue or bloody sputum), chest xray PA & lateral and submission of sputum specimens for smear, culture and sensitivity of acid-fast bacilli (AFB) daily for 3 days.

Patient should be considered contagious, and advised to eliminate contact with non-household individuals and the public, and, if necessary to leave home for medical appointments, to wear a mask . A contact investigation should ensue, including close contacts, the scope of which to generally depend on the results of the smears and how widespread patient's contacts have been in the past several months. TB skin testing should be done on close contacts, and others depending on length of time and frequency of contact. Chest xrays should be done on those with symptoms.

Prior to starting medications, baseline liver function studies, and visual acuity and color discrimination studies should be done. These tests as well as collection of sputum specimens should be repeated monthly. HIV counseling and testing should also be performed to rule out AIDS co-morbidity.

Treatment is initiated immediately once presumptive diagnosis of TB is made, while waiting for sputum results. Initial phase of treatment should include the medications INH, Rifampin, PZA and Ethambutol daily and lasts approximately 2 months. At this time, PZA is usually dropped from the medication regime. The medications should be administered through Directly Observed Therapy (DOT).

Chest xray and clinical evaluation should be repeated in one month following initiation of treatment to assess improvement and update treatment plan. In general, if patient has 3 negative sputum smears, shows clinical improvement and chest xray has improved, patient may be considered noncontagious.

Once known, if sensitivity results indicate that the TB bacillus is sensitive to all medications being used, Ethambutol may be discontinued. If, however, sensitivities are unknown, or indicate resistance to one or more drugs, Ethambutol must be used for the entire course of treatment.

The continuing phase of treatment consists of INH and Rifampin (and Ethambutol if indicated) for at least 4 more months. Monthly clinical exams by MD, chest xrays as indicated and length of time for sputum culture to convert to negative will determine any changes in medications and/or length of treatment.

Definitive diagnosis can be made based on clinical evaluations, chest xray results and at least one sputum positive for Mycobacterium Tuberculosis (MTB).

A final chest xray should be done approximately one month prior to end of treatment and should show maximum improvement. Based on xray results, clinical improvement and negative cultures, treatment should be considered completed.

Patient needs to be advised that, at any time in the future he/she develops signs or symptoms of TB, it is crucial that they return to MD/Pulmonologist.