Which of the following patients needs to be staed on multidrug therapy for TB?

A. A 43 year old with a history of tuberculosis treated with three drugs for 6 months, who has calcified granulomas on his chest X-ray.

B. A 17 year old with a lymph node biopsy growing Mycobacterium tuberculosis

C. A 51 year old nurse who was inadveently exposed to a patient with active pulmonary tuberculosis in an emergency room for 30 minutes

D. A 34 year old man with cough and expectoration for 4 weeks, not responding to oral amoxycilin and symptomatic management.

Correct Answer: A 17 year old with a lymph node biopsy growing Mycobacterium tuberculosis

Description: A 17 year old with a lymph node biopsy growing Mycobacterium tuberculosis * Active tuberculosis at any site (the presence of culturable organisms or evidence of progressive disease) mandates multidrug therapy. * For patients with latent tuberculosis infection, treatment with a single drug will suffice to kill the small number of organisms. * The calcified granulomas in patient (a) are a sign of old disease; he does not need new treatment unless he becomes symptomatic. * The patients (c) and (d) have had low-risk exposures and would not be treated unless there was evidence of a change in skin tests.

Category: Surgery

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