| Other Problems to be Considered: | | | | |
| | | | Deterrence/Prevention: |
| Blast mycosis | | | | |
| | | | - Patients with a clinically significant |
| Cat scratch disease | | | | result on tuberculin skin testing (see other |
| | | | tests) should be given a course of therapy |
| - It is critical that hopitalized patients | | | | once active infection and disease is ruled |
| with suspected or documented TB be placed in | | | | out. Guidelines published by the CDC in 2000 |
| appropriate isolation. This includes a | | | | now refer to this as treatment of latent TB. |
| private room with negative pressure and | | | | The recommended regimens are listed below:o |
| adequate air exchanges. Persons entering the | | | | INH daily for 9 monthso INH twice weekly for |
| room must wear masks or respirators capable | | | | 9 months (given as DOT)o INH daily for 6 |
| of filtering droplet nuclei. | | | | months (should not be used in patients with |
| | | | fibrotic lesions on chest radiograph, |
| - Patients should remain in isolation until | | | | patients with HIV, or children)o INH twice |
| sputum becomes smear-negative; however, | | | | weekly for 6 months (given as DOT, should not |
| patients ordinarily should not be kept in the | | | | be used in patients with fibrotic lesions on |
| hospital for the sole purpose of providing | | | | chest radiograph, patients with HIV, or |
| isolation, Special arrangements are necessary | | | | children)o Rifampin daily for 4 monthso |
| for patients who live with children, | | | | Rifampin plus pyrazinamide daily for 2 months |
| individuals infected with HIV, patients | | | | |
| returning to a closed-group setting (eg, | | | | - Children should be given INH for 9 months. |
| nursing home, correctional facilities, | | | | In addition, children younger than 5 years |
| residential facility, homeless shelter). | | | | who have closed contact to an active case of |
| | | | TB should be started on INH even of skin |
| Further Outpatient Care: | | | | testing is negative; preventive therapy can |
| | | | be stopped if repeat skin testing is negative |
| - Patients diagnosed with active TB should | | | | 3 months after last contact with a culture |
| have sputum examined for M tuberculosis | | | | positive source case. |
| weekly until sputum conversion is documented. | | | | |
| Monitoring for toxicity includes baseline and | | | | - Patient exposed to MDR-TB may be given |
| periodic liver enzymes, complete blood count, | | | | ethambutol plus pyrazinamide for 6 - 12 |
| and serum creatinine. | | | | months or pyrazinamide plus levofloxacin for |
| | | | 6 - 12 months; the index isolate should be |
| - In addition, patients on pyrazinamide | | | | susceptible to all drugs used. |
| should have baseline or periodic serum uric | | | | |
| acid determinations, and patients on | | | | - Recommended regimens in patients with HIV |
| long-term ethambutol therapy should have | | | | infection include pyrazinamide plus rifampin |
| baseline or periodic visual acuity and | | | | daily for 2 months, rifampin alone daily for |
| red-green color perception testing. The | | | | 4 months, or 9 months of INH (daily or twice |
| latter can be performed with a standard test | | | | weekly). Patients on antiretroviral therapy |
| such as Inhihara test for color blindness. | | | | may need rifabutin in place of rifampin. |