Which of the following patients needs to be staed on multidrug therapy for TB?
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.
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.
A 17 year old with a lymph node biopsy growing Mycobacterium tuberculosis
A 51 year old nurse who was inadveently exposed to a patient with active pulmonary tuberculosis in an emergency room for 30 minutes
A 34 year old man with cough and expectoration for 4 weeks, not responding to oral amoxycilin and symptomatic management.