Introduction

This presentation is focused on the diagnosis and treatment of latent tuberculosis infection. The case study will be fictional, but the information presented will be based on real-life scenarios to illustrate the specific diagnosis and treatment process.

Case study

The patient in this case study is a 40-year-old male David who works as a teacher with no significant medical history and does not smoke or drink alcohol. However, he presents to the hospital with a persistent cough, fatigue, and night sweats. A chest X-ray shows no evidence of active TB disease, but a positive Mantoux tuberculin skin test indicates a diagnosis of latent TB infection.

Diagnosis and Treatment

The diagnosis of latent TB infection is made through a positive Mantoux tuberculin skin test. If either test is positive, additional tests, such as a sputum culture, may be done to rule out active TB disease. David was started on a course of treatment with Isoniazid (INH)* and Rifapentine (RPT)† for three months once weekly, which is the standard treatment for latent TB infection (Noreen, Jan, Latif, Tiba, Zafar, Yook, Khan, & Mohammed, 2022). During this time, he will have regular follow-up visits with his healthcare provider to monitor for any side effects and ensure adherence to the medication regimen. Treatment for latent TB infection is essential to prevent the development of active TB disease.

Patient’s experience

David was initially scared and worried when she received his positive TB skin test result. He had never heard of latent TB infection and was concerned about what it meant for his health and job. He also felt stigmatized and worried about being perceived as a risk to others. The physical and psychological impact of the diagnosis can be overwhelming, and patients require support and understanding from healthcare professionals.

Lifetime Risk for Reactivation

According to current research data, David’s lifetime risk for TB reactivation is estimated to be about 5%-10% without treatment. However, with proper treatment for latent TB infection, the risk of developing active TB disease can be reduced by up to 90%. If David had another risk factor for developing active TB infection, such as diabetes or HIV, his risk of reactivation would be significantly higher. For example, According to Soh, Chee, Wang, Yuan, and Koh (2019), research suggests that individuals with diabetes have a two to three times higher risk of developing active TB disease compared to those without diabetes. Similarly, individuals with HIV have a much higher risk of TB reactivation, especially if they have low CD4+ T cell counts. Individuals with HIV have weakened immune systems making it harder for the body to fight TB microorganisms.

Conclusion

Latent tuberculosis infection is a significant global health issue that requires early detection and treatment to prevent the development of active TB disease. Through our fictional case study, we have explored the diagnosis and treatment of latent TB infection and discussed the physical and psychological impacts on the patient. We have also highlighted the importance of considering additional risk factors for the most appropriate treatment plan. It is essential to raise awareness of this infection and provide support and education to patients and healthcare professionals.

Reference

Soh, A. Z., Chee, C. B. E., Wang, Y. T., Yuan, J. M., & Koh, W. P. (2019). Diabetes and body mass index in relation to risk of active tuberculosis: a prospective population-based cohort. The International Journal of Tuberculosis and Lung Disease, 23(12), 1277-1282.

Noreen, N., Rakesh, J., Sadia, L., Tiba, R., Hafsa, Z., Yook, J. H., … & Mohammed, L. (2022). Use of isoniazid monotherapy in comparison to rifamycin-based regimen for the treatment of patients with latent tuberculosis: A systematic review. Cureus, 14(5).