Laboratory Values US Units

Na 139 mEq/L K 3.9 m Eq/L CI98mEq/L C02 38 mEq/L BUN 20 rng/dL SCr 1.3 rng/dL Gluc 123 mg/dl AST 36 lU/L ALT 28 IU/L Tbili 1 mg/dL PT 10 second

Normal

135-145 mEq/L

95-105 mEq/L

22-30 mEq/L

5-25 mg/dL

Less than 140 mg/dL

5-40 international urits/L

5-35 international units/L

10-12 second

RBC 4,6 x lOYmm3 WBC 4.5 x 107mm3 PMN 62% Lymph 34% Mono 5%

Other: HIV negative

Normal

4,6-6 x 107mnnJ

4-10 x 10Yrnm3

Laboratory Values (SI Units)

Na 139 mmol/L

K 3.9 mmol/L CI 93 mmol/L CO. 38 mmol/L BUN 7.1 mmol/L SCr 115 pmol/L, Gluc 6,8 mmol/L AST Q.60 nKat/L ALT 0,47 pKat/L Tbili 17 |jmol/L PT 10 second

Normal

135-145 mmol/L

3.5-5 mmol/L 95-105 mmol/L 22-30 mmol/L 1.3-8,9 mmol/L 71-115 pmol/L Less than 7.8 mrnof/L 0,08-0.67 pKat/L 0,08-0.58 pKat/L 1.7-20.5 jjmol/L 10-12 second

Hgb 135 g/Lor 0,84 mmol/L

Hct 0,4 vol fraction RBC 4,6 x 1Q1J/L WBC 4.5 X 10VL PMN 62% Lymph 34% Mono 6%

Other: HtV negative

Norma!

135 - 175 g/L Or 084-1.08 mmol/L 0,4-0,54 vol fraction 4,6-6,0 x 10i:/L 4,0-10 x 107L 50-65% 25-35% 2-6%

CXR: Profound bilateral upper lobe infiltrates with cavitation on left; small left pneumothorax

Clinical Course: The patient was admitted and placed on respiratory isolation. Three separate sputum AFB stain specimens were reported to contain 3+ AFB. A PPD tuberculin skin test was placed. Sputum samples were sent for AFB, fungi, and bacterial cultures and sensitivities. After 48 hours, the PPD skin test was read as a 12-mm area of induration.

Assessment: Active pulmonary TB; pneumothorax; HTN; type II diabetes mellitus

Which signs, symptoms, and other findings are consistent with active TB infection?

Advances in TB diagnosis include methods for rapid identification of patients with suspected TB. Improved smear microscopy, automated liquid cultures, nucleic acid amplification tests, antibody detection tests, antigen detection tests are under devel-

opment.

Interferon-gamma release assay (IGRA) is a new method for the diagnosis of LTBIs. The main advantage of this assay with respect to tuberculin skin test is the lack of cross-reaction with BCG and most nontuberculous mycobacteria. It also eliminates the need for the patient to return for test reading in 48 to 72 hours. The IGRAs cannot distinguish between latent and active TB and data are lacking in children and HIV-infected individuals.31-33

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