Pulmonary Tuberculosis: Its Symptoms and Treatment - Case Study Example

Clinical Evaluation of Case Studies Case The patient in this case was suffering from fever up to 39oC, night sweats and malaise and also had a history of progressive weakness. Besides, he lost 6 kg in weight and also had chronic productive cough as well as dyspnea. A clinical analysis suggests that the patient has “pulmonary tuberculosis”, which most commonly affects the lungs and is referred to as pulmonary TB disease. The techniques used to obtain respiratory samples such as sputum can be used in the diagnosis of the disease. “Nucleic acid assays” may also be used for diagnosis purpose. No specific clinical description of pulmonary tuberculosis is referred. The symptoms after “primary infection” may be constitutional and respiratory. Constitutional symptoms often include fever, and night sweats, asthenia, weight loss. Respiratory symptoms include cough, dyspnea and chest pain. (Clinical Practice Guideline on the Diagnosis, Treatment and Prevention of Tuberculosis 2010:1). Pulmonary tuberculosis is caused by Mycobacterium tuberculosis.Mostly tuberculosis is transmitted to individuals by respiratory droplets but some peopledevelop active tuberculosis disease after infection. The rate of progression of disease is much higher in immunocompromised individuals. According to the case study, the person is a refugee from Afghanistan. Hence the chance of causing disease is more with him. Sputum smear microscopy, culture and serological tests are the other methods used for detection of the disease. The sensitivity and specificity of culture is quite high. Cultures allow speciation, drug-susceptibility testing, and genotyping for epidemiologic purposes. Therefore, all specimens should be cultured. Culture media used include solid media (egg-based media and agar-based media) and liquid media. TK Medium uses multiple-color dye indicators to identify M. tuberculosis rapidly. The diagnosis can also be made by the direct microscopy, using carbolfuchsin stain and/or fluorochrome stain. It is a rapid method but lacks sufficient sensitivity and specificity. (Jain 1996: 1). Vaccination is a better way to prevent this disease. BCG vaccination is the most commonly used preventive measure. It is administered at a dose of 0.05 mg BCG diluted in 0.1 ml of serum. Treatment with appropriate drugs is the only effective way to cure tuberculosis. Isoniazid, rifampicin, pyrazinamide and ethambutol are mostly used. A combination of these drugs is recommended (Clinical Practice Guideline on the Diagnosis, Treatment and Prevention of Tuberculosis 2010:84). Pulmonary tuberculosis is more widely seen present in patients who are HIV positive. Case 2: According to the case study available, the patient was diagnosed with PUO and after a week he showed symptoms such as intermittent fevers, in the evening on alternate days, aches and shivers, nausea, abdominal pain, diarrhea, and a cough. The manifestation of symptoms suggests that the patient is suffering from malaria, which is caused by a single celled plasmodium parasite (Understanding Malaria: Fighting an Ancient Scourge 2007:3). Malaria can be caused by four species of plasmodium, Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale.In this case the infection can be caused by the parasite Plasmodium ovale. The symptoms of malaria are “non-specific” and commonly consist of fever, weakness, vomiting, nausea, diarrhea, headache, chills, cough, dizziness etc (Guidelines for Clinicians) 2013:1). The clinical diagnosis used in case of malaria is preparation of blood smear and its microscopic examination. Two types of smears can be prepared for observation, thick smear and thin smear. Thick smear is more sensitive but they are difficult to read while the thin smear helps in species identification and quantification. On getting a positive result in blood smear, the parasite density should be checked by observing the monolayer of RBCs under oil immersion microscope. Other clinical diagnosis includes PCR which are more sensitive and specific but it takes a long time for the result and is not applicable for “routine” diagnosis (Treatment of Malaria (Guidelines for Clinicians) 2013:2). Malaria causing parasites are usually transmitted through the bites of infected Anopheles mosquitoes. The symptoms of malaria caused by Plasmodium ovale will include irregular fever, high temperature for few days. Plasmodium ovale seems to be the causative element according to the data given in the case. The blood smear provided shows the presence of Schizonts of Plasmodium ovale. The parasite is smaller than RBC and contains 6 to 12 merozoites. The patient does not have splenomegaly which differentiates it from the malaria caused by P. vivax. Diagnosis of P. ovale is usually made by the examination of peripheral blood films stained with Giemsa stain. The parasite is ovalin nature and fimbriated infected erythrocytes. Infectioncan develop into mature schizonts and release merozoites into the blood stream (Hombhanje 1998:118). Treatment should be based on the type of malaria and the information on regional resistance, severity of illness (oral vs. intravenous), age of patient etc. “Chloroquine” (or hydroxychloroquine) can be an effective choice for P. ovale infections (Treatment of Malaria: Guidelines for Clinicians (United States) 2010). No effective vaccines are developed so far that can help prevent the disease. Case 3: According to the case description, the patient has been admitted in hospital due to seizures which occurs monthly. The patient has reported of fainting, as well as inability to talk, vision problems. Partial paralysis and formation of cyst has also been reported in this From the information given above the clinical disease of the patient can be deciphered as neurocysticercosis. Neurocysticercosis (NCC) is a helminthic infection that affects the central nervous system. Parenchymal NCC is a condition where cysticerci “develops” within the brain and is accompanied by seizures, headaches, altered mental status, focal neurological problems (Kulkantrakorn 2005). Neurocysticercosis is caused by the larval stage namely cysticerci of pork tapeworm Taenia solium. Human beings act as an intermediate host by directly ingesting T. solium eggs present in human faeces of human carriers of the parasite. These eggs develop into cysticerci which migrate to the central nervous system where they cause seizures and many other neurological symptoms. These infections are caused mainly through “faeco –oral” route and are caused due to poor hygiene and sanitation (Control of Neurocysticercosis 2002). Neurocysticercosis is first noted in the form of a cyst or as headache and this is accompanied by chronic epilepsy. The occurrence rate of seizures increases during this period as a result of “conversion” of vesicular cyst to colloidal cyst (DeGiorgio et al. 2004). The organism responsible for the infection may be parasites as most parasites have humans as a host in their life cycle. From the parasites, T. solium is the reason for the infection because they cause cysticercosis infection. The given symptoms such as seizure, partial paralysis, double vision, inability to talk, cyst formation, etc are due to cysticercosis affecting the central nervous system. Neuroimaging plays a major role in detecting neurocysticercosis and methods like plain X ray, CT scan, and MRI are used in the diagnosis. MRI is considered as the most “accurate” method to detect the infection of the parasite. Serological tests like enzyme linked immunosorbent essay (ELISA) and EITB are also used but they are not considered as efficient methods diagnosis. (Kulkantrakorn 2005: 32). The most effective methods of identification of the organism are serological methods such as ELISA and EITB. The use of these techniques would the immunodiagnostic test vesicular stage of NCC and help in better evaluation of the disease. Due to the morphological similarities in the egg of T. solium and T. saginata it is difficult to recognize morphologically. But in rare cases, the presence of double crown of hooks present in the worm scolex helps in species identification. Haematoxylin- eosin staining of histological sections of “proglottids” is also used in identification of the parasite. Presence of eosinophil in the cerebrospinal fluid helps in the diagnosis of neurocysticercosis (Garcia et al. 2003:550). For the “identification” of neurocysticercosis, the faecal samples of the patient, samples of cerebrospinal fluid and blood samples are used (Garcia et al. 2003:550).“Biopsy” of the brain and spinal cord lesions is also used in detecting the infection (Brutto et al. 2001). Computed tomography is used to locate the cyst and other methods like. Besides, CT and MRI are also used in detecting the calcification. Treatment for neurocysticercosis in earlier times was surgery of cyst excision or ventricular shunts to lower the inflammation. Praziquantel and Albendazole were initially used in neurocysticercosis, which is an effective antiparasite drug used. But studies show that the use of antiparasitic agents can increase the inflammation. According to the studies, therapeutic methods should be adapted and the growing cysticercosis should be controlled by antiparasitic drugs and by surgery. Treatment of symptoms is one useful method in the case of NCC. Seizures easily respond to first-line antiepileptic drugs (Garcia et al. 2003:552). The appropriate therapy for the patient is treatment with antiparasitic drug. Use of albendazole reduces the seizure reoccurrence (DeGiorgio et al. 2004) of seizures. The praziquantel are the most effective drug employed (DeGiorgio et al. 2004). Improving sanitation, improving sewage disposal activity and eliminating the intestinal tapeworms, controllingthe consumption of uncooked pig and improperly cleaned vegetables are some of methods to reduce NCC (Kulkantrakorn 2005). The neurocysticercosis can be more effective when it is accompanied by epilepsy. Reference List Brutto et al. (2001). ‘Proposed Diagnostic Criteria for Neurocysticercosis.’ Neurology. [Online] Available at [15 April 2014] ‘Clinical Practice Guideline on the Diagnosis, Treatment and Prevention of Tuberculosis.’ (2010). Ministry of Science and Innovation. [Online] Available at [15 April 2014] ‘Control of Neurocysticercosis.’ (2002). Secretariat: World Health Organization. [Online] Available at [15 April 2014] DeGiorgio et al. (2004). ‘Neurocysticercosis.’ NCBI. [Online] Available at [15 April 2014] Garcia et al. (2003). ‘Taenia Solium Cysticercosis.’ Thelancet.com. [Online] Available at [15 April 2014] Hombhanje, F. W. (1998). ‘Plasmodium Ovale Species in Papua New Guinea – Lest We Forget.’ Department of Basic Medical Sciences: Uni versity of Papua New Guiena. [Online] Available at [16 April 2014] Jain, N. K. (1996). ‘Laboratory Diagnosis of Pulmonary Tuberculosis: Conventional and Newer Approaches.’ Continuing Medical Education. [Online] Available at [15 April 2014] Kulkantrakorn, K. (2005). ‘Neurocysticercosis: Revisited.’ [Online] Available at [15 April 2014] ‘Treatment of Malaria: Guidelines for Clinicians (United States).’ (2010). Centers for Disease Control and Prevention. [Online] Available at [16 April 2014] ‘Treatment of Malaria (Guidelines for Clinicians).’ (2013). CDC Treatment Guidelines. [Online] Available at [16 April 2014] ‘Understanding Malaria: Fighting an Ancient Scourge.’ (2007). U. S. Department of Health and Human Services: National Institutes of Health. [Online] Available at [16 April 2014] Read More