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Case report
peer-reviewed

Verification of Diagnosis in Tuberculosis: A Case Report and Discussion



Abstract

Tuberculosis (TB), caused by strains of Mycobacterium tuberculosis complex (M. tuberculosis), is a pulmonary infection that is spread by airborne droplet transmission. The development and spread of drug-resistant strains of M. tuberculosis greatly jeopardize TB control efforts. We report the case of a previously healthy 43-year-old male, visiting from China, who presented to the emergency department complaining of hemoptysis of 10 days' duration. Cultures were positive for acid fast bacteria and negative for fungi. M. tuberculosis infection was confirmed by a deoxyribonucleic acid (DNA) probe. The patient was initially started on first-line therapy of isoniazid, rifampin, pyrazinamide, and ethambutol, with pyridoxine. His country of origin, China, increased suspicion for drug-resistant tuberculosis. Two weeks later, susceptibility testing of the M. tuberculosis isolate showed resistance to isoniazid, pyrazinamide, and ethambutol. Therapy was subsequently changed to amikacin, linezolid, moxifloxacin, and rifampin. The isolate was subsequently sent to the Center for Disease Control (CDC) for evaluation. Repeat testing showed that the isolate was susceptible to rifampin, pyrazinamide, and ethambutol. The patient was then restarted on his initial anti-TB regimen and was able to return to China.

The main goals for the treatment of TB are to treat the individual patient and to minimize transmission. Clues that point to the possibility of multiple drug resistant tuberculosis (MDR-TB) include contact with a patient with MDR-TB, origin from an endemic region, or failure of therapy with documented supervision. Collaboration with experts was imperative in ensuring appropriate patient care.



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Case report
peer-reviewed

Verification of Diagnosis in Tuberculosis: A Case Report and Discussion


Author Information

Amanda M. Dave Corresponding Author

School of Medicine, Creighton University Medical Center

Abed Adelrahman

Internal Medicine, CHI Creighton University Medical Center

Vishist Mehta

Creighton University Department of Internal Medicine, Creighton Univer

Stephen Cavalieri

Pathology, Creighton

Renuga Vivekanadan

Infectious Disease, CHI Creighton University Medical Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


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Case report
peer-reviewed

Verification of Diagnosis in Tuberculosis: A Case Report and Discussion

  • Author Information
    Amanda M. Dave Corresponding Author

    School of Medicine, Creighton University Medical Center

    Abed Adelrahman

    Internal Medicine, CHI Creighton University Medical Center

    Vishist Mehta

    Creighton University Department of Internal Medicine, Creighton Univer

    Stephen Cavalieri

    Pathology, Creighton

    Renuga Vivekanadan

    Infectious Disease, CHI Creighton University Medical Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: September 03, 2017

    DOI

    10.7759/cureus.1650

    Cite this article as:

    Dave A M, Adelrahman A, Mehta V, et al. (September 03, 2017) Verification of Diagnosis in Tuberculosis: A Case Report and Discussion. Cureus 9(9): e1650. doi:10.7759/cureus.1650

    Publication history

    Received by Cureus: July 10, 2017
    Peer review began: August 23, 2017
    Peer review concluded: August 29, 2017
    Published: September 03, 2017

    Copyright

    © Copyright 2017
    Dave et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Tuberculosis (TB), caused by strains of Mycobacterium tuberculosis complex (M. tuberculosis), is a pulmonary infection that is spread by airborne droplet transmission. The development and spread of drug-resistant strains of M. tuberculosis greatly jeopardize TB control efforts. We report the case of a previously healthy 43-year-old male, visiting from China, who presented to the emergency department complaining of hemoptysis of 10 days' duration. Cultures were positive for acid fast bacteria and negative for fungi. M. tuberculosis infection was confirmed by a deoxyribonucleic acid (DNA) probe. The patient was initially started on first-line therapy of isoniazid, rifampin, pyrazinamide, and ethambutol, with pyridoxine. His country of origin, China, increased suspicion for drug-resistant tuberculosis. Two weeks later, susceptibility testing of the M. tuberculosis isolate showed resistance to isoniazid, pyrazinamide, and ethambutol. Therapy was subsequently changed to amikacin, linezolid, moxifloxacin, and rifampin. The isolate was subsequently sent to the Center for Disease Control (CDC) for evaluation. Repeat testing showed that the isolate was susceptible to rifampin, pyrazinamide, and ethambutol. The patient was then restarted on his initial anti-TB regimen and was able to return to China.

The main goals for the treatment of TB are to treat the individual patient and to minimize transmission. Clues that point to the possibility of multiple drug resistant tuberculosis (MDR-TB) include contact with a patient with MDR-TB, origin from an endemic region, or failure of therapy with documented supervision. Collaboration with experts was imperative in ensuring appropriate patient care.



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Create a free account to continue reading this article.

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Amanda M. Dave, Medical Student

School of Medicine, Creighton University Medical Center

For correspondence:
amandakrantz@creighton.edu

Abed Adelrahman

Internal Medicine, CHI Creighton University Medical Center

Vishist Mehta

Creighton University Department of Internal Medicine, Creighton Univer

Stephen Cavalieri

Pathology, Creighton

Renuga Vivekanadan

Infectious Disease, CHI Creighton University Medical Center

Amanda M. Dave, Medical Student

School of Medicine, Creighton University Medical Center

For correspondence:
amandakrantz@creighton.edu

Abed Adelrahman

Internal Medicine, CHI Creighton University Medical Center

Vishist Mehta

Creighton University Department of Internal Medicine, Creighton Univer

Stephen Cavalieri

Pathology, Creighton

Renuga Vivekanadan

Infectious Disease, CHI Creighton University Medical Center