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Case 4: Latent Tuberculosis Infection

You answered:

B You should ask him about current symptoms that would suggest active TB and obtain a chest radiograph. If his chest radiograph is negative, he does not require further treatment.

This answer is incorrect. The patient may not have current active pulmonary TB, but, based on his exposure to a person with active TB, he should be treated for latent TB infection. Although it is correct to perform a symptom review and obtain a chest radiograph for all patients who have been exposed to someone with active TB, this is not adequate for this patient. This patient has HIV infection, which increases his risk of reactivation TB, and he has had an exposure to TB. He should be treated with isoniazid (INH) once active TB is excluded.

Choose another answer:

A After excluding active TB with a symptom review and a chest radiograph, you should treat him with 9 months of isoniazid (INH).
C You should discontinue his antiretroviral therapy and start him on four-drug TB treatment.
D You should test for latent TB infection with a tuberculin skin test and for anergy with a mumps control. If, 50 hours later, he has 0 mm of induration for both of the tests, you should inform him he does not require further treatment.

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