CASE STUDY ABOUT

ANTIBIOTICS:
Tuberculosis
Group:
Cesar Emmanuel Abigania
Angelica Fernandez
Ilonah May Uddifa
Zephaniah Embile
PATIENT HISTORY:

Patient named Robertson is a 30-year-old male who was admitted to the

hospital from home after 1 week of cough, profuse nocturnal sweating, loss
of appetite and hyposomnia. He was seen by an emergency room
physician who noted signs of depression. The patient has a history of
intravenous drug abuse and hepatitis B.
DIAGNOSTIC PROCEDURES:

PHYSICAL EXAM
General
Young male, looks older then stated age
Regular rate and rhythm, no murmurs, rubs, or gallops
Card
Abd Slightly distended
Resp
Unilateral (left side) crepitation

MICRO LAB RESULTS:

Blood Culture No growth at 5 days

Sputum Smear 4+ squamous epithelial cells,

Gram Stain 1+ segmented neutrophils, no organisms

AFS (acid fast stain) No organisms

Sputum Culture No growth at 48 hrs

MGIT (mycobacteria growth indicator tube) Negative

RADIOLOGY
Chest X-ray showed infiltrate in the middle of left lung with diameter of 1.7 cm with signs of cavitation.
DIAGNOSIS:
Infiltrative TB of left lung with cavitation without MTB shedding.

TREATMENT:
Robertson was originally administered isoniazid, rifampin, pyrazinamide, and ethambutol for 7 days
per week for 8 weeks, followed by isoniazid and rifampin 7 days per week for 24 weeks. After two
months he returned to the hospital, concerned that he had been “coughing up blood” over the
previous 3 days. In addition to hemoptysis, he revealed that, since his previous visit, he had
continued to feel malaise, was continuing to lose weight, and had been experiencing night
sweats.
The emergency room physician immediately transferred the patient for isolation in a local hospital.
A repeat chest radiograph revealed progressive bilateral fibronodular disease with a “miliary”
pattern. The patient was given a 20-month regimen of levofloxacin, kanamycin, cycloserine,
pyrazinamide and prothionamide. Following completion of therapy, closure of the destruction
cavity was found with local pneumofibrosis.
OVERVIEW:
With 1.3 million deaths annually, tuberculosis remains one of the leading causes of
mortality worldwide. The emergence of multidrug- and extensive drug resistance
(MDR-TB and XDR-TB, respectively) is a major public health problem that threatens
progress made in TB care and control. Drug resistance arises due to improper use
of antibiotics in drug-susceptible TB patients, which includes administration of
inappropriate treatment regimens and failure to ensure that patients complete
the whole treatment course.
Essentially, drug resistance arises in geographic locales with weak TB control
programs. A patient who develops active disease with a MDR-TB strain can
transmit this form of TB to other individuals.
TB DIAGNOSTICS
Rapid diagnosis and proper disease control are crucial for preventing organism
shedding and infection of new individuals, for curbing additional drug-resistant TB (as
occurred in this clinical case) and for saving the lives of MDR-TB patients who have a
short life expectancy if not treated properly. Therefore, use of the most rapid methods
available for culture and identification of mycobacterium tuberculosis complex (MTBC)
is advocated.
Traditional solid media alone can require 4-8 weeks for detection of growth. Thus,
culture methods that utilize both a liquid and a solid medium are now recommended
and should allow detection within as little as 10-14 days, and up to as much as 21 days
from receipt of specimen. Although liquid systems are more sensitive and may increase
the case yield by as much as 10%, they are also more prone to contamination.
Fortunately, major advances in rapid diagnostics have revolutionized TB diagnosis in
the past few years. In the particular worst-case scenario described here, no
confirmation of TB was achieved through the customary sputum smear. The classic
solid medium and newer liquid culture assays (typically incubated for 14 days) were
negative at 48 hours—at which time the patient was treated on the suspicion of TB.
Presented with an especially difficult conundrum, the physician and patient could
have benefitted from the availability of newer rapid TB diagnostics, some of which are
independent of sputum smear and culture results.
TREATMENT OF MDR-TB

In general, treatment of MDR-TB is extended to 20 months and an individualized treatment

regimen often is required. The principles of management include use of aggressive regimens with
at least five drugs that are likely to be effective. Fluoroquinolones play a key role in resistant TB,
and the later generation fluoroquinolones (e.g. levofloxacin or moxifloxacin) are considered to
be the most effective ones. Use of an injectable agent, such as capreomycin or an
aminoglycoside (e.g.kanamycin), have been shown to predict culture conversion and survival.13
However, resistance to aminoglycosides is becoming increasingly common. The regimens may be
reinforced by pyrazinamide and ethambutol, as these contribute by increasing the regimen’s
activity or by preventing resistance to more active agents.
REFERENCE
Roman Kozlov, M. (2019). Abott. Retrieved from Test Target Treat:
https://www.testtargettreat.com/en/home/educational-resources/case-
studies/tuberculosis-case-study.html