Question
Read the clinical history and answer the following questions: A 20 year old young male was admitted with history of fever with evening rise of temperature and cough since two months. Recently he developed haemoptysis. X-ray showed features of right lobe consolidation
- (a) Mention the probable diagnosis and name the causative agent. 2 mark(s)
- (b) Describe briefly the methods of laboratory diagnosis. 4 mark(s)
- (c) What are the complications of the disease 1 mark(s)
- (d) How the disease is treated 1 mark(s)
- (e) What is the prophylaxis. 2 mark(s)
Answer
a) Probable diagnosis and causative agent Pulmonary tuberculosis — chronic fever with evening rise of temperature, cough of two months’ duration, haemoptysis, and right upper/mid-zone consolidation on X-ray are the classic presentation. Causative agent: Mycobacterium tuberculosis (acid-fast bacillus).
b) Laboratory diagnosis
- Sputum smear microscopy — Ziehl-Neelsen (ZN) staining for acid-fast bacilli on at least two sputum samples (spot and early-morning); fluorescence microscopy (auramine-rhodamine) is more sensitive for screening.
- Culture — Lowenstein-Jensen (LJ) egg-based medium, gold standard but slow (2–8 weeks); liquid culture systems (BACTEC MGIT) give faster results (1–2 weeks) and allow drug-susceptibility testing.
- Molecular methods — CBNAAT/GeneXpert MTB-RIF, a rapid PCR-based test that also detects rifampicin resistance.
- Radiology — chest X-ray showing consolidation, cavitation, or fibrosis.
- Tuberculin skin test (Mantoux) — supportive, indicates exposure/infection rather than active disease.
- Histopathology (if tissue available) — caseating granuloma with epithelioid cells, Langhans giant cells.
c) Complications Haemoptysis (as in this case), pleural effusion/empyema, pneumothorax, bronchiectasis, cor pulmonale, dissemination (miliary TB), and secondary bacterial infection.
d) Treatment Directly Observed Treatment, Short-course (DOTS) under the National TB Elimination Programme — intensive phase with four first-line drugs (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) for 2 months, followed by continuation phase with Isoniazid and Rifampicin for 4 months (longer for drug-resistant or complicated disease).
e) Prophylaxis BCG vaccination at birth (prevents severe childhood forms — miliary TB, TB meningitis); early case detection and treatment to break transmission; contact tracing and chemoprophylaxis (isoniazid) for high-risk contacts/children; improved nutrition and reduced overcrowding; respiratory hygiene/cough etiquette in patients with active disease.