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Unit 5 Isoniazid Prevention Therapy: B Family Case

Unit 5 Isoniazid Prevention Therapy: B Family Case . Botswana National Tuberculosis Programme Manual Training for Medical Officers. B Family Case . Mrs. B is 28 years old and is concerned about a cough her husband has had for 2-3 weeks

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Unit 5 Isoniazid Prevention Therapy: B Family Case

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  1. Unit 5 Isoniazid Prevention Therapy: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers

  2. B Family Case • Mrs. B is 28 years old and is concerned about a cough her husband has had for 2-3 weeks • She also suspects that he may be engaging in behaviours that would put him at risk for HIV • Mrs. B decides to go to the clinic to get tested for HIV Unit 5: Case Study

  3. B Family Case: Question 1 What TB screening questions do you ask Mrs. B? Unit 5: Case Study

  4. Cough for 2-3 weeks Weight loss Night sweats Fever Malaise Shortness of breath Chest pain Haemoptysis B Family Case: Answer 1 You ask the patient if she has experienced the following symptoms: Unit 5: Case Study

  5. Mrs. B denies any TB symptoms and her exam does not show any signs that would be suspicious of TB She reports that she lives with her: 3 children (all under 7 years old) 32 year-old husband 22 year-old sister 56 year-old mother She reports that her husband has had a cough for 2-3 weeks and she is concerned that he might have TB She is also concerned that he may be engaging in behaviours that would put him at risk for HIV B Family Case: Question 2 Based on what she reports, what do you do next for Mrs. B? Unit 5: Case Study

  6. B Family Case: Answer 2 Test Mrs. B for HIV Unit 5: Case Study

  7. B Family Case: Question 3 Mrs. B tests positive for HIV and her husband is diagnosed with smear-positive pulmonary TB What is your management plan for Mrs. B? Unit 5: Case Study

  8. B Family Case: Answer 3 • Counselling • Do fine needle aspiration from lymph node • Draw blood for CD4 • Initiate contact tracing • Send a health worker to her home to screen her 3 children, mother and sister for symptoms of TB Unit 5: Case Study

  9. B Family Case: Question 4 FNA showed only reactive changes in the lymph node (no sign of TB), so you can assume that she has PGL What do you do now? Unit 5: Case Study

  10. B Family Case: Answer 4 • Start her on IPT (Isoniazid Preventive Therapy) • 300mg daily (+ pyridoxine, 25mg daily) x 6 months • Patient education regarding the benefits of IPT • Start her on ARVs, depending on her CD4 count Unit 5: Case Study

  11. B Family Case: Question 5 How do you do contact tracing? • Who is responsible? • What do you evaluate the contacts for? • Where do you record the information? Unit 5: Case Study

  12. B Family Case: Answer 5 (1) • A health worker goes to the patient’s home to interview all family members for signs and symptoms of TB (contact tracing) • A clinic-based nurse is responsible for contact tracing • Contact examination form should be used Unit 5: Case Study

  13. Evaluate the contacts for: Cough for 2-3 weeks Weight loss Night sweats Fever Malaise Shortness of breath Chest pain Haemoptysis If any family member is symptomatic, ask that family member to come to the clinic B Family Case: Answer 5 (2) Unit 5: Case Study

  14. B Family Case: Answer 5 (3) • Record the information in a TB contact examination form • The form, with case notes for the patient, is maintained at the clinic • A nurse or doctor uses this information to initiate INH prophylaxis in children or IPT in adults • Annex 11, form 7 in the BNTP manual Unit 5: Case Study

  15. Unit 5: Case Study Unit 5 Cases: Diagnosing TB

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