Pulmonary TB suspects

In the majority of cases, PTB suspects attend as outpatients for the diagnosis of TB. In some cases it is necessary to admit PTB suspects to hospital. If possible admit them to a separate ward from other patients. There are often no facilities to separate PTB suspects from other patients. At least try to keep PTB suspects in a part of the ward away from other patients. Staff should also encourage PTB suspects to spend daylight hours outside the ward if the weather is good. Sputum for smear examination should be collected as rapidly as possible. The laboratory should process and examine sputum smears rapidly and efficiently. Hospitals should ensure a minimum of delay in delivering smear examination results back to the wards.Adults accompanying small children with possible TB may also themselves have TB and be the source of the child's disease.

14.2.5 ] Patients with sputum smear-positive pulmonary TB

Ideally, sputum smear-positive PTB patients should start anti-TB treatment as soon as the smear results are known. In many NTPs, sputum smear-positive PTB patients spend at least part, and often all, of the intensive phase of anti-TB treatment in hospital. Isolation of these patients in TB wards helps reduce the risk of TB exposure to other patients. Do not admit a patient to the TB ward until you have made the diagnosis of TB.TB suspects with HIV infection and high susceptibility to TB should avoid exposure to TB.They may turn out not to have TB.

14.2.6 ] Patients with multidrug-resistant TB (MDR-TB)

In many cases it is impossible to predict or to detect MDR-TB, and in many countries this information never becomes available. However patients with known MDR-TB require special management at a referral centre.These patients may have prolonged periods of infectiousness. It is therefore necessary to minimize the possibility of contact with other patients who do not have TB or do not have MDR-TB.They should be in a separate area or facility, preferably in well-ventilated individual patient rooms. If this is not feasible, then it is necessary to establish a ward or an area of a ward for MDR-TB.

PRACTICAL POINT

Patients with MDR-TB must be separated from patients who have HIV infection. In many countries, outbreaks of MDR-TB have spread very rapidly on wards for AIDS patients.

I4.3 ROLE OF BCG IN PREVENTING TB IN HIV-INFECTED INDIVIDUALS

I4.3.I ] Background

BCG (Bacille Calmette-Guerin) is a live attenuated vaccine derived originally from M. bovis. The route of injection is intradermal.The usual dose is 0.05 ml in neonates and infants under the age of 3 months, and 0.1 ml in older children. In countries with high TB prevalence, WHO recommends a policy of routine BCG immunization for all neonates.

The benefit of BCG is in protecting young children against disseminated and severe TB, e.g. TB meningitis and miliary TB. BCG has little or no effect in reducing the number of adult cases of PTB.

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