Unit 5 Isoniazid Prevention Unit 5 Isoniazid Prevention Therapy: B Family Case Therapy: B Family Case

Botswana National Tuberculosis Programme Manual Training for Medical Officers

Slide 2Unit 5: Case Study

B Family Case B Family Case

• Mrs. B is 28 years old and is concerned about a cough her husband has had for 2-3 weeks

• She also suspects that he may be engaging in behaviours that would put him at risk for HIV

• Mrs. B decides to go to the clinic to get tested for HIV

Slide 3Unit 5: Case Study

B Family B Family Case: Question 1Case: Question 1

What TB screening

questions do you ask Mrs. B?

Slide 4Unit 5: Case Study

B Family B Family Case: Case: Answer 1Answer 1

• Cough for 2-3 weeks

• Weight loss

• Night sweats

• Fever

• Malaise

• Shortness of breath

• Chest pain

• Haemoptysis

You ask the patient if she has experienced the following symptoms:

Slide 5Unit 5: Case Study

B Family B Family Case: Case: Question 2Question 2

• Mrs. B denies any TB symptoms and her exam does not show any signs that would be suspicious of TB

• She reports that she lives with her:• 3 children (all under 7

years old)

• 32 year-old husband

• 22 year-old sister

• 56 year-old mother

• She reports that her husband has had a cough for 2-3 weeks and she is concerned that he might have TB

• She is also concerned that he may be engaging in behaviours that would put him at risk for HIV

Based on what she reports, what do you do next for Mrs. B?

Slide 6Unit 5: Case Study

B Family B Family Case: Answer 2Case: Answer 2

Test Mrs. B for HIV

Slide 7Unit 5: Case Study

B Family B Family Case: Case: Question 3Question 3

Mrs. B tests positive for HIV and her husband is diagnosed with smear-positive pulmonary TB

What is your management

plan for Mrs. B?

Slide 8Unit 5: Case Study

B Family B Family Case: Answer 3Case: Answer 3

• Counselling

• Do fine needle aspiration from lymph node

• Draw blood for CD4

• Initiate contact tracing• Send a health worker to her home to screen her 3

children, mother and sister for symptoms of TB

Slide 9Unit 5: Case Study

B Family B Family Case: Question 4Case: Question 4

FNA showed only reactive changes in the lymph node (no sign of TB),

so you can assume that she has PGL

What do you do now?

Slide 10Unit 5: Case Study

B Family B Family Case: Answer 4Case: Answer 4

• Start her on IPT (Isoniazid Preventive Therapy)• 300mg daily (+ pyridoxine, 25mg daily) x 6 months

• Patient education regarding the benefits of IPT

• Start her on ARVs, depending on her CD4 count

Slide 11Unit 5: Case Study

B Family B Family Case: Case: Question 5Question 5

How do you do contact tracing?• Who is responsible?

• What do you evaluate the contacts for?

• Where do you record the information?

Slide 12Unit 5: Case Study

B Family B Family Case: Answer 5 (1)Case: Answer 5 (1)

• A health worker goes to the patient’s home to interview all family members for signs and symptoms of TB (contact tracing)

• A clinic-based nurse is responsible for contact tracing • Contact examination form should be used

Slide 13Unit 5: Case Study

B Family B Family Case: Answer 5 (2)Case: Answer 5 (2)

• Evaluate the contacts for:• Cough for 2-3 weeks• Weight loss• Night sweats• Fever• Malaise• Shortness of breath• Chest pain

• Haemoptysis • If any family member

is symptomatic, ask that family member to come to the clinic

Slide 14Unit 5: Case Study

B Family B Family Case: Answer 5 (3)Case: Answer 5 (3)

• Record the information in a TB contact examination form• The form, with case notes for the patient, is

maintained at the clinic• A nurse or doctor uses this information to initiate

INH prophylaxis in children or IPT in adults• Annex 11, form 7 in the BNTP manual

Slide 15Unit 5: Case StudyUnit 5 Cases: Diagnosing TB