Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Trypanosomiasis, American (Chagas’ Disease) Tuberculosis 1459

Routine

■Prolonged follow-up for development of or persistence of myocardial

or bowel pathology.

complications and prognosis

■Treatment of acute phase prevents chronic parasitization in about

50% of cases. Immunosuppressed states can lead to renewal of acute

disease with trypanosomes in blood, fever, and sometimes cerebral

masses. Treatment can still be effective. Cardiac transplant done for

advanced myocardial disease.

TUBERCULOSIS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Etiologic agentMycobacterium tuberculosis, an aerobic, acid-fast

bacillus

■Humans only known reservoir; infection results from inhalation of

aerosolized droplets containing viable organisms

■Risk factors for infection include close contact with infected indi-

viduals, immunosuppression (15 mg prednisone daily for at least a

month, HIV, organ transplantation), residence in or recent (within 5

years) immigration from high prevalence areas (Asia, Africa, Central

America, Mexico), intravenous drug use, homelessness, incarcera-

tion in prison, residents and employees of nursing homes (including

health care workers with exposure to TB) and the presence of certain

underlying diseases (diabetes, chronic renal insufficiency, hemato-

logic and solid malignancies, malnutrition, gastrectomy, ileojejunal

bypass, silicosis)

Signs & Symptoms

■Pulmonary – cough (initially dry, then becoming productive of puru-

lent sputum that may be blood tinged) and constitutional symptoms

(fever, chills, night sweats, anorexia, weight loss, fatigue) hallmarks

of disease; rales or consolidation on exam

■Extra-pulmonary – any organ can be involved; most common

include: meningitis (presentation over several weeks with fever,

headache, nausea, vomiting, seizures, confusion and cranial nerve

palsies); skeletal – spine infection or Pott’s disease (localized pain)