Resident in LTC with positive AFB'S

TELEpathicRN · Jul 2, 2004

Here is a question to all of you infectious dz nurses:

Should a resident with positive AFB smears who is on TB prophylaxis (hx of HIV and TB. No fever or coughing) be on any type of isolation precautions in a LTC facility? Thanks in advance for your help.

MRhodes · Jul 3, 2004

You need to go by cultures, but since it takes 6 to 8 weeks to get the cx back you must go by improving symptoms, improving CXR and on therapy for over 2 weeks. The only thing about HIV infected persons is thier immune system is caflooy. So they may not show the same symptoms. If you can get a quick TB test on the cx you can tell more about it (a gen probe or mtd). If this is neg the pt is not infectious.

MRhodes · Jul 3, 2004

You need to go by cultures, but since it takes 6 to 8 weeks to get the cx back you must go by improving symptoms, improving CXR and on therapy for over 2 weeks. The only thing about HIV infected persons is thier immune system is caflooy. So they may not show the same symptoms. If you can get a quick TB test on the cx you can tell more about it (a gen probe or mtd). If this is neg the pt is not infectious.

TELEpathicRN · Jul 8, 2004

Thanks for your reply. The health dept is involved, so there is not an option to get a speady culture result. They say it will be 8 weeks. The first one they did was positive! This is the second culture. They say the AFB'S being positive could represent chronic TB and that he had "dead" tissue in his sputum. I am just keeping my fingers crossed that he is not infectious like they say.

caroladybelle, BSN, RN · Jul 8, 2004

It depends on the meds that the patient is on/has been on.

My understanding is that even with positive cultures, after 2 weeks of "active disease"medication regimen, that they are no longer considered infectious. The "active disease" regimen generally includes 3-4 drugs, and "inactive" disease is frequently just 1-2 drugs in lower doses.

Also, check that the AFBs are specific for Mycobacterium Tuberculim (TB) and not Mycobacterium Avium /Complex. Both are acid fast and both are endemic in HIV+ people, as well as use similar prophylaxis, but TB is generally considered more infectious and problematic. MAC for some reason does not require as many precautions.

MRhodes · Jul 8, 2004

as long as the afb in the sputum are "dead", respiratory precautions should not be necessary. however an n95 should be used for wound care, especially irrigation.

melba