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