Pulmonary Tuberculosis

A 30-year-old man, who was homeless, was admitted to the hospital with a several-month history of dyspnea and fever. He complained of producing excessive sputum and having frequent bouts of hemoptysis. Bilateral crackles were heard during examination of the lungs. The patient was in acute respiratory distress and was intubated to provide ventilatory support.

The chest film, which was submitted by Drs Sonia Arunabh and Navin Verma of Flushing, NY, revealed a cavity in the right upper lobe along with bilateral alveolar infiltrates. A bronchoalveolar lavage yielded acid-fast bacilli, which confirmed the diagnosis of pulmonary tuberculosis. A four-drug regimen comprising isoniazid, rifampin, pyrazinamide, and ethambutol was prescribed. The patient was extubated from the ventilator and continued on medication under an outpatient observed therapy program.

Drs Arunabh and Verma add that tuberculosis may present as a pulmonary and/or extrapulmonary disease and is caused by Mycobacterium tuberculosis, or Koch's bacillus. Pulmonary tuberculosis is transmitted via inhalation of droplet nuclei produced by an infected person. A recent development that complicates treatment is the emergence of organisms that are resistant to the traditional therapies. This complication is a concern particularly in persons infected with HIV and in those who have a history of tuberculosis treatment.