Pulmonary Tuberculosis

40 years old malay male was admitted 4 days ago with the chief complaints of cough for the past 3 months. Patient was apparently well 3 months ago. The cough is on and off, productive with whitish sputum and non foul smelling.There is no hemoptysis, fever, shortness of breath, evening rise of temperature, chest pain, PND, and palpitations. He does however claim to have lost of appetite and lost of weight of about 15kgs over the past 3 months. There is history of coming in contact with tuberculosis because his uncle was diagnosed of TB and is on treatment.

On examination, general examination is fair, vital signs are stable. Respiratory examination revealed only occasional expiratory ronchi. No other findings.
Sputum has been sent for Acid Fast Bacilli and returned as positive.

Diagnosis is Pulmonary Tuberculosis.

Pulmonary tuberculosis is quite rampant in this state. I’ve learned the management and complications of pulmonary tuberculosis from this particular case. Lets further discuss the management and complications of pulmonary tuberculosis.

Were you surprised that there were no specific clinical features? The only features are loss of appetite and weight...

What was differential diagnosis before you saw the sputum AFB reports?

No sir..I was not surprised. My differential diagnosis at that point of time besides Tuberculosis was Carcinoma Lung. This is because carcinoma lung can as well present with loss of appetite and weight, and cough, but there was no hemoptysis or any further findings on clinical examination really suggestive of carcinoma.

Nice case write-up, buven. Based on your description, can you identify the category (of TB) to which this patient belongs? A brief outline of different categories would be helpful too.

WHO recommended short course antituberculous regime
Category 1- New smear positive pulmonary TB;New smear negative pulmonary TB with extensive lung involvement;New severe extrapulmonary TB.

Category 2- Smear positive pulmonary TB : replase;treatment failure;defaulters

Category 3- New smear negative pulmonary TB with limited lung involvement;Less severe extrapulmonary TB

Catogory 4- chronic cases ie. bacteriologically positive after supervised re-treatment.

For the treatment duration and drugs use, i invite further discussion.