Here’s an update on drug-resistant TB
November 1, 1999 3 minutes read
Here’s an update on drug-resistant TB
More cases of pulmonary tuberculosis are drug-resistant than ever before, reports Paula Heitkemper, RN, BSN, CIC, infection control practitioner at the University Hospital in Cincinnati.
Find out whether your state or county has a problem with multidrug-resistant tuberculosis (MDRTB), she recommends. This is important to know, because the New York City-based American Thoracic Society and the Atlanta-based Centers for Disease Control and Prevention recommend initial treatment with four drugs in areas where drug resistance is 4% or greater, she says.
MDRTB is usually acquired, rather than primary, says Heitkemper. "This means that the patient with tuberculosis develops resistance over time due to nonadherence, inadequate therapy, or inappropriate drug therapy."
Katherine L. Heilpern, MD, FACEP, interim residency director and assistant professor in the department of emergency medicine at Emory University School of Medicine in Atlanta, says, "We have gotten very aggressive in tracking down patients who have multidrug-resistant TB into programs and utilizing public health nurses to make sure these patients are not out there wandering the streets. However, this is going to be a problem that continues to concern us, especially with the homeless and disenfranchised population."
ED nurses should have a high index of suspicion for tuberculosis in homeless patients, especially men, advises Heitkemper. "In many large cities, the homeless stay overnight at shelters, sleeping in large rooms with very poor air circulation. The more fresh air that enters the room [thus dilating the Mycobacterium tuberculosis bacteria], the more it costs the homeless shelter for energy costs. Thus, homeless shelters are notorious for poor air circulation and the spread of tuberculosis from one person to another."
Alcoholics, the elderly, and the malnourished are especially prone to tuberculosis, due to poor resistance to disease of any kind, notes Heitkemper. "Homeless patients who were seen in the ED, diagnosed with tuberculoses, admitted, treated, and discharged, frequently leave against medical advice [AMA] from the long-term care facility they were transported to; only to return to the ED weeks or months later with unresolved tuberculosis."
A positive skin test (PPD) only indicates that the patient has been infected with tuberculosis, cautions Heitkemper. "A positive PPD skin test does not necessarily mean that the patient has the disease unless they have symptoms of disease such as night sweats, weight loss, fever, productive cough, and positive chest X-ray consistent with cavitary lesions, especially in upper lobes."
A person is usually no longer infectious after two weeks of effective drug therapy if the patient shows signs of clinical improvement, chest infiltrates and fever have resolved, appetite has improved, coughing has diminished, and sputum cultures and smears are negative, says Heitkemper.
When a patient with a positive PPD skin test is taking only isoniazid (INH), they aren’t necessarily infectious to others, notes Heitkemper. "The INH is given prophylactically to keep the patient from developing disease. If the patient had disease, he/she would be taking three to four drugs as therapy."
For more information about infectious diseases, contact:
• Katherine Heilpern, MD, FACEP, Department of Emergency Medicine, Emory University School of Medicine, 69 Butler St. S.E., Atlanta, GA 30303. Telephone: (404) 616-4411. Fax: (404) 659-6012. E-mail: [email protected].
• Paula Heitkemper, RN, BSN, CIC, Infection Control Practitioner, University Hospital, 234 Goodman St., Cincinnati, OH 45219-0784. Telephone: (513) 584-7687. Fax: (513) 584-5737. E-mail: [email protected].
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content