April Week 2: Tuberculosis
You are in clinic seeing Mr. Potter with his three children, James Sirius (6 yrs), Albus Severus (5 years), and Lily Luna (3 years). He tells you that mom sent them to be evaluated because she “had concerns.” When you ask him to elaborate, he says he “has no idea” and suggests that you FaceTime with their mom, Ginny. When Ginny answers the phone, she says: “The children’s babysitter (with whom they spend every weekday afternoon) just told me that she has TB! I’m very worried that our children might have caught it from her.”
a) Mom wants to know how TB is transmitted and what symptoms she should be looking for. What do you tell her?
b) She asks you whether the children need to be tested, and if so, which tests you will choose and how they work.
c) The children are otherwise healthy and their tests come back negative. Is there anything else you need to do?
You are happily slouched down in the recesses of the couch in the Arlington call room when you hear the beep of the dreaded pager. The ER physician you speak with tells you that there is a little critter down in the ER with a cough that he would like you to evaluate. When you go down there and speak with the family, you find out that they have recently immigrated from China and the child, who is 2 years old, has had a cough and a low-grade temperature since they arrived (about 6 weeks ago). She is here today because he seems worse. Incidentally, when she took him to his pediatrician 2 days ago, they placed some sort of test on the inside of his arm.
a) The TST shows 7mm induration. Mom informs you that her son received the BCG vaccination. How will this affect the result of the tuberculin skin test?
b) The child’s physical exam is significant for an ill-appearing thin child who is coughing and has a low-grade fever. You then get a chest X-ray on this child and it is significant for hilar lymphadenopathy. How will this child need to be treated?
c) Mom is very nervous about the side effects of the medication(s) you have chosen for her child. What are the possible side-effects? What kind of follow-up will this child need, and will his PCP need to conduct screening tests?
Cases/Questions by Dr. Krupa Playforth