Pulmonary TB- a straight forward case with delayed detection

A 43 year old man came to the clinic complaining of recurrent blood-streaked sputum following bouts of coughs for three days. He looked healthy though on further questioning he admitted having a mild evening fever and that his weight had gone down recently.

When asked how long he had been coughing, he replied that it was more than three months but claimed the cough was mild and did not bother him. He had come to the clinic a couple of times for coughs and was treated with antibiotics. His coughs seemed to have settled till the recent bloody sputum that had caused great concern to him.

He is a smoker and works as a security guard. He denied any contact with a person suffering from tuberculosis.

Without wasting much time, I ordered sputum for Acid Fast Bacilli (AFB) on three  occasions and a chest X-ray which confirmed my suspicion. His sputum sample later was positive for TB bacilli. He was promptly put on a TB regime.

The cotton-wool lesions in the right middle and lower lung lobes  highly suggestive of tuberculosis prior to sputum AFB confirmation.

Really, his case could have been diagnosed earlier but somehow was not detected. Again here history taking is very important. Quite often patients are not going to volunteer information critical to diagnosis, unless probed. I always have to appear intrusive by asking questions to screen the signs and symptoms as to arrive at the right diagnosis. Early detection is vital in infectious disease control in the community.

Late diagnosis leads to greater transmission of the TB germs in the community and increase the risks of resistant TB as more patients are likely to default on the treatment causing TB control problems.

The patients' contacts are traced to ensure early treatment should any of them got infected.