Patient Encounter 1

HPI: AF is a 56-year-old man who presents to the medical clinic complaining of a 1-month history of a persistent cough that has become productive over the past 2 weeks. He also complains of malaise, fever, night sweats, and a 6-kg (13-lb) weight loss over the past 2 months.

PMH: Type II diabetes mellitus (NIDDM)—well controlled; hypertension (HTN) x 5 years—well controlled

FH: Mother and father died in an MVA 10 years ago; one brother, age 54, is HIV positive and lives with the patient; one sister, age 50, is alive and has had breast cancer

SH: Single, one daughter. He works as an undercover agent and just returned from an operation in Cambodia. He denies smoking or IV drug use. He had a 20-year history of alcohol abuse but has been sober for 10 years.

Meds: Lisinopril 20 mg daily; amlodipine 5 mg daily; metformin 500 mg twice daily. Patient reports that he tries to be compliant with his therapies and takes them regularly except when he is unable to get his refills; over the past 2 months, he has gone 3 to 4 days without medication.

Allergies: NKDA

What information is suggestive of TB?

What factors place this patient at increased risk for acquiring TB? Risk Factors for Disease

Once infected with M. tuberculosis, a person's lifetime risk of active TB is about 10%,

with about half this risk evident during the first 2 years after infection. , , Young children, the elderly, and immunocompromised patients have greater risks. HIV-infected patients with M. tuberculosis infection are roughly 100 times more likely to develop active TB than normal hosts owing to the lack of normal cellular immunity.3,9

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