What are the screening questions to determine if a patient is at risk for tuberculosis (TB)?

TB is an airborne pathogen and a persons habits and living conditions can put them at greater risk for contracting the disease. Some of the screening questions used to determine if a patient is at risk for TB include if they are IV drug users,  if they have HIV, if they are the resident of a correction or homeless facility, if they have had close contact with someone with infectious TB or if they have just traveled to or from a country with a high incidence of TB. If a patient is determined to be at high risk for TB infection, then a test need to be run in order to determine  if they are infected or are carriers of the infection.

What are the signs and symptoms of TB?

The primary state of TB usually doesn’t cause symptoms (NIH, 2010, p.1) As the disease progresses, symptoms will emerge and may include cough with mucus, cough with blood, excessive sweating, especially at night, a general fatigue, fever, and unintentional weight loss. More sever symptoms may also occur, including difficulty in breathing, chest pain and wheezing. The exact symptoms of TB can vary in intensity and between individuals.

Examination of a patient with TB may also reveal physical signs that are associated with the disease. These can include a clubbing of the fingers or toes in advanced cases, tender or enlarged lymph nodes, fluid around the lungs or usual crackling sounds when breathing (NIH, 2010, p.1).

What are the screening guidelines and treatment modalities for individuals with a positive Purified Protein Derivative (PPD) screen?

The Purified Protein Derivative, or PPD, screen is used to diagnose a patient with TB. The procedure includes injecting a small amount of PPD extract under the top layer of the patients skin. A positive result can be ascertained in 48 to 72 hours when the patient returns to their healthcare provider to have the area checked. If a swelling of a an appropriate firmness is present, usually 15 mm or more, then the patient may be positive for TB. However, more tests should be run to find out whether the patient does indeed have an active TB infection.

If it is determined that a patient does indeed harbor an active TB infection, then treatment is prescribed in the form of pharmaceutical drugs. Typically a combination of 4 are given to the patient until lab tests determine which medicine is working best. Some of the most commonly used drugs include Isoniazid, Rifampin, Pyrazinamide and Ethambutol. Other drugs that may be used include Amikacin, Ethionnamide, Moxifloxacin, para-aminosalicylic acid and Streptomycin (NIH, 2010, p.1). Drug treatment can last as long as 6 months in order to completely kill the infection. In addition, the patient may also need to be quarantined in a hospital for 2 to 4 weeks to avoid spreading the infection.

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