CHAPTER 2 Respiratory System^123
TB disease is confirmed when a person has signs and symptoms of tuberculo-
sis. The chest x-ray typically has abnormalities in the apical aspects of the lung
fields. In HIV patients other areas may also be affected.
PROGNOSIS
Some patients develop drug-resistant TB, making treatment more difficult. The
drug-resistant TB may be resistant at the time of initial infection, or may develop
as a result of medications during treatment. This occurs either because the treat-
ment was not adequate or not taken appropriately.
HALLMARK SIGNS AND SYMPTOMS
- Weight loss and anorexia
- Night sweats
- Fever, possibly low-grade, due to infection
- Productive cough with discolored, blood-tinged sputum
- Shortness of breath due to lung changes
- Malaise and fatigue due to active illness affecting lungs
INTERPRETING TEST RESULTS
- Positive Mantoux (PPD) skin test shows exposure to tuberculosis due to
development of cell-mediated immunity; typically takes between 2 and 10
weeks from time of exposure. - Chest x-ray may show areas of granuloma or cavitation.
- Sputum test identifies M. tuberculosisbacteria:
- Acid fast-staining done to initially screen for TB—bacillus will hold stain
- Culture confirms the diagnosis but is slow-growing.
TREATMENT
Patients with active TB are initially placed on respiratory isolation as inpatients to
reduce the risk of spreading the organism by droplet infection or aerosolization.
Medications are initiated to treat TB and prevent transmission to others. Treatment
may be initiated for active disease or for those without active disease who have had
recent exposure. Combination therapy is typically used to decrease the likelihood