Thank you for viewing this presentation. We would like to remind you that this material is the property of the author. It is provided to you by the ERS for your personal use only, as submitted by the author. 2012 by the author
Exercise: 20 CXRs Estimate the probability of TB Graham Bothamley Homerton University Hospital NHS Foundation Trust, London; UK Christoph Lange Clinical Infectious Diseases, Research Center Borstel University of Lübeck; Germany
8.091 M 75yrs ex-painter and decorator Afro-Caribbean Jamaica UK 1950 Fever Night sweats Dementia Alcohol Diabetes smoker lives alone wbc 8.0/nL CRP 35 mg/L
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
8.138
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
8.138 F 41yr housewife White-UK No contacts cough 3m sputum 3m weight loss 5 kg Alcoholic Smoker BCG+
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Respiratory isolation 2.Send sputum for TB smear examination 3.Treat with antibiotics e.g. moxifloxacin 4.1 and 2 above 5.1, 2 and 3 above
8.078 M 47 yr unemployed White-UK No contacts Travel to W. Indies cough 3 months sputum 3 months fever 3 months sweats 3 months weight loss 12 kg Alcoholic Diabetes Hepatitis C Smoker BCG-
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Respiratory isolation 2.Send sputum for TB smear examination 3.Treat with antibiotics e.g. moxifloxacin 4.1 and 2 above 5.1, 2 and 3 above
5
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3
8.087 M 42yr
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Treat with antibiotics 2.Send sputum for TB smear examination 3.Respiratory isolation 4.1 and 2 above 5.2 and 3 above
47 M Temp: C SaO2: 89% wbc: 10.0 Neutrophils: 9.5 CRP: 120 mg/L
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Respiratory isolation 2.Send sputum for TB smear examination 3.Treat with antibiotics e.g. moxifloxacin 4.1 and 2 above 5.1, 2 and 3 above
M 32yrs IT White Cough 4 weeks Sputum 4 w Weight loss 1 kg Night sweats Smokes cannabis BCG
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Respiratory isolation 2.Send sputum for TB smear examination 3.Treat with antibiotics 4.1 and 2 above 5.1, 2 and 3 above
F 70 yrs Ex school assistant White UK No TB contact Cough Sputum Weight loss 1 kg Smoker 20/day >50 yrs No BCG 9
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
M Temp: C SaO2: 93% wbc: 8.0 Neutrophils: 7.5 CRP: 35 mg/L
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Respiratory isolation 2.Send sputum for TB smear examination 3.Treat with antibiotics e.g. moxifloxacin 4.1 and 2 above 5.1, 2 and 3 above
M Temp: 37 C SaO2: 93% wbc: 8.0 Neutrophils: 7.5 CRP: <5 mg/L
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Respiratory isolation 2.Send sputum for TB smear examination 3.Treat with antibiotics 4.1 and 2 above 5.1, 2 and 3 above
M 47 yr unemployed White-UK No contacts Travel to W. Indies cough 3 months sputum 3 months fever 3 months sweats 3 months weight loss 12 kg Alcoholic Diabetes Hepatitis C Smoker BCG-
Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3
F 32yr shop assistant Afro-Caribbean No TB contacts Travel to Jamaica cough 3m no sputum haemoptysis x 1 anti-depressants BCG+
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
M 32yrs IT Russian UK 9 yrs Friend had TB Cough 4 weeks Sputum 4 w Weight loss 1 kg Night sweats Smokes cannabis BCG+
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Respiratory isolation 2.Send sputum for TB smear examination 3.Treat with antibiotics 4.1 and 2 above 5.1, 2 and 3 above
M 42yr unemployed Born in Gambia In UK 14 years Smoker BCG+ Temp 37.8 C SaO2 92% wbc 8.0 Neutrophils 7.0 CRP 25 mg/L
Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Treat with antibiotics 2.Send sputum for TB smear examination 3.Respiratory isolation 4.1 and 2 above 5.2 and 3 above
Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3
F 70 yrs White UK No TB contact Fever Night sweats Weight loss 1 kg Smoker 20/day >50 yrs
Estimate the likelihood of active tuberculosis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
F 16yrs student Belgium UK 3 yrs Grandmother may have had TB Cough 2m No sputum Fever Night sweats Temp 37.8 C SaO2 93% wbc 8.0 Neutrophils 7.5 CRP 35 mg/L 9.072
Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Treat with antibiotics 2.Send sputum for TB smear examination 3.Respiratory isolation 4.1 and 2 above 5.2 and 3 above
9.011 M 48 “housekeeper”
Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Treat with antibiotics 2.Send sputum for TB smear examination 3.Respiratory isolation 4.1 and 2 above 5.2 and 3 above
F 16yrs student Belgium UK 3 yrs Grandmother may have had TB Cough 2m No sputum Fever Night sweats Temp 37.8 C SaO2 89% wbc 10.0 Neutrophils 9.0 CRP 35 mg/L
Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Treat with antibiotics 2.Send sputum for TB smear examination 3.Respiratory isolation 4.1 and 2 above 5.2 and 3 above
M 36 yr Cough 5m BCG+ SaO 2 91% Fbc -microcytic anaemia CRP 8 mg/L
Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3
M 48yr “housekeeper” Nepal In UK 4 months neck lymph node smoker BCG+
Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
Further investigations 1.FNA for cytology 2.CT scan 3.IGRA and/or tuberculin skin test 4.Lymph node biopsy 5.1, 2 and 3
F 16yrs student Belgium UK 3 yrs Grandmother may have had TB Cough 2m No sputum Fever Night sweats Temp 37 C SaO2 93% wbc 8.0 Neutrophils 7.5 CRP <5 mg/L
Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
The following actions should be taken: 1.Treat with antibiotics 2.Send sputum for TB smear examination 3.Respiratory isolation 4.1 and 2 above 5.2 and 3 above
Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3
M 36 yr business Poland UK 9 yrs Travel to Poland No TB contact Flu-like illness Cough 5m Weight loss 10 kg 2 bottles spirits/wk BCG+ SaO 2 91% Fbc -microcytic anaemia CRP 8 mg/L
Estimate the likelihood of active tuberculo sis 1.0 – 10% 2.11 – 39% 3.40 – 60% 4.61 – 89% % Please vote
Further investigations 1.Bronchoscopy 2.CT scan 3.IGRA and/or tuberculin skin test 4.1 and 2 5.1, 2 and 3