I Caught One!

Started by zenman
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zenman

zenman

Senior Member
7+ Year Member
15+ Year Member
My bearer (custodian) for my office brought by a female bearer last week and wanted me to check her records from a physician's visit. I took her next door so our HR lady could translate for me and she explained the lady's symptoms and I took a look at her records. Everything was negative and although it wasn't documented, we understood from her that the doctor had done a PPD on her and it was also negative.

The words "TB" were screaming at me in spite of the medical report. Since this lady had already spent half her monthly salary seeing one of the more reputable doctor groups here, I was able to get admin (in the interests of public health) to get her in to see a British doc who I know and we would cover the costs. They repeated all the labs as well as a sputum which all came back negative. PPD was positive this time. The British doc told me today that she is thinking disseminated TB and is getting her partner to check the lady out. They will also get her into a funded program to take care of her meds.

Sure damn glad I listened to those voices in my head, lol! She's the first case of disseminated TB I've seen and while mildly interesting, I'm glad to refer 😀
 
Actually, last night I thought about contacting the physician, once he has a definite diagnosis, and seeing if I can work on her first if she agrees. Maybe we can write it up.😀

What tests will they do next to locate which organs might be affected, total body scan?
 
Incidentally, a positive PPD doesn't confirm the diagnosis. They still need to culture mycobacterium from somewhere (tissue, bone marrow, etc.) to nail it down.

Hopefully, she also had an HIV test.

TB should always be in the differential diagnosis, particularly in third-world countries.

zenman said:
What tests will they do next to locate which organs might be affected, total body scan?
Click to expand...

A chest x-ray is a good starting point. If that's unrevealing, probably a chest and abdominal CT next. They'd be looking for granulomas to biopsy and culture. If there's nothing evident in tissue, maybe a bone marrow aspiration.

If she has CNS symptoms, they'd probably also want to scan her head and do an LP.
 
Last edited by a moderator:
Tired said:
Tell her to get a job.
Click to expand...

She has a full-time job but her less than $100 USD a month salary won't go far. Price of food staples doubled here recently...least we don't have the obesity problem...
 
Blue Dog said:
Incidentally, a positive PPD doesn't confirm the diagnosis. They still need to culture mycobacterium from somewhere (tissue, bone marrow, etc.) to nail it down.

Hopefully, she also had an HIV test.

TB should always be in the differential diagnosis, particularly in third-world countries.

A chest x-ray is a good starting point. If that's unrevealing, probably a chest and abdominal CT next. They'd be looking for granulomas to biopsy and culture. If there's nothing evident in tissue, maybe a bone marrow aspiration.

If she has CNS symptoms, they'd probably also want to scan her head and do an LP.
Click to expand...

CXR and sputum were neg. I'll see the doc tomorrow and see what's going on now.
 
zenman said:
My bearer (custodian) for my office brought by a female bearer last week and wanted me to check her records from a physician's visit. I took her next door so our HR lady could translate for me and she explained the lady's symptoms and I took a look at her records. Everything was negative and although it wasn't documented, we understood from her that the doctor had done a PPD on her and it was also negative.

The words "TB" were screaming at me in spite of the medical report. Since this lady had already spent half her monthly salary seeing one of the more reputable doctor groups here, I was able to get admin (in the interests of public health) to get her in to see a British doc who I know and we would cover the costs. They repeated all the labs as well as a sputum which all came back negative. PPD was positive this time. The British doc told me today that she is thinking disseminated TB and is getting her partner to check the lady out. They will also get her into a funded program to take care of her meds.

Sure damn glad I listened to those voices in my head, lol! She's the first case of disseminated TB I've seen and while mildly interesting, I'm glad to refer 😀
Click to expand...

which country is she from? How old is said patient? Think of BCG vaccine with a positive PPD in someone from a third world country.
 
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