US Seeks Fliers Possibly Exposed to Rare TB - page 3

in case you haven't seen this news story yet, here is an excerpt with the link. now that we know that this superbug is here in the us, we need to be especially rigorous with our infection control... Read More

  1. by   caroladybelle
    As a note:

    I am PPD positive since childhood. I had gotten CXRs for work for years and ws clear.

    A few years ago, I had a routine CXR that showed a ground glass infiltrate. I was starting a new assignment and they insisted that I get additional films (decub films). The films showed one clear ground glass infiltrate in the base of one lung. The facility determined that it was not TB and I could work. I started the assignment.

    My HCP though wanted to know what the lesion was. It was decided to do a CT and then on my break between assignments, he would work up what it was. I made the crucial mistake of having the CT done at the facility that I was on assignment with. And they made the mistake of sending the results to the wrong MD.

    I got a call within hours that they were cancelling my assignment after the test was sent to OH instead of my MD. I was sent to a pulmonary attending who showed the CT - multiple granulomas in the lungs, liver, spleen. I underwent a bronch which tested negative for everything but I was still required to take INH. I did manage to complete the assignment after ten days off. They ran the washings for everything, including fungal, AFB, etc.

    We found out later that the granulomas were probably from an illness from either a trip to Africa or from a wild animal bite sustained about a year prior. We still do not know what it was.
  2. by   NHavenRN
    Quote from critterlover
    i'm not a tb expert, but i'll give it a go.

    my understanding is that the dx came from an xray that was done due to broken ribs.

    [color=#483d8b]there are certain infiltrates on cxrs that are suspicious for tb. when someone has one of these infiltrates on cxr, then they are usually required to see a pulmonologist or an id specialist. at that point, sputum samples are usually collected for afb smear. (from an er standpoint, if we find one of these infiltrates on xray, the patient gets isolated and worked up for tb. isolation lasts until they get three separate, negative afb smears from three consecutive days. obviously, they are admitted for this workup).

    [color=#483d8b]i believe that smear showed that he did have tb. at that point, they either did a sensitivity or did some sort of genotype testing to determine that it is the drug resistant variety.

    [color=#483d8b]i could be very wrong about the specifics in this case; however, this is how i generally see the dx come about. i do remember reading (probably here) that they didn't know it was drug-resistant tb until after he was already in europe.

    [color=#483d8b]i would guess that his father-in-law was allowed in the meetings because he is a researcher specializing in drug-resistant tb. now that i find significant, and i wonder if the rest of the family has been checked out........
    but didn't the news reports initially say that his sputum smears were actually negative, hence why he - and all the cdc officials - keep saying that he's not particularly infectious? (in a relative sense, of course.) although the articles i found didn't specify that they made their diagnosis from bronchial sampling, i can't imagine any other way they could id drug resistance without a positive afb (short of a lung biopsy).

    i agree in general though - there are a ton of sketchy holes in this story. there are definitely large pieces of the story we're not being told; and having seen how tb and potential tb patients are managed on my floor (the i.d. unit of my hospital) my feeling is that the mistakes made here are more likely on the part of buearocracy letting things fall through the cracks than overtly terrible behavior on the part of this patient. just my $0.02 - admittedly based on hugely pre-filtered info from the mainstream media.