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