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A.G. Holley Hospital
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Histories
Case 5
33 YO man presented to local hospital with weight loss,
cough and positive sputumafb smears; positive nucleic acid probe for Mtb., C/w active
pulmonary tuberculosis. After 4 days on INH/RIF/EMB/PZA, "Dad" signs out of
hospital AMA (during weekend, and before follow up treatment ahospital contacts Public
Health Unit first thing Monday.Contact investigation reveals his 29 year old pregnant
wife has a 12mm PPD induration
Kids (11 and 14yo) both have Dad is suspected of cocaine hobby; wife does not think he
cares, comes and goes, stays home for periods of time while she’s at work. Wife is
concerned, dad knows Hearing held, Judge ruled in favor of court-ordered DOT
Non-adherence is the leading cause of treatment failure and drug resistance. DOT
ensures adherence. Recalcitrant patients require legal intervention. Private Sector-Public
Health unit liasons improve/enhance reporting, discharge planning, contact
investigationsthree weeks later, Dad fails to report for his DOT he has TB, afraid to
confront DOT worker can’t locate him; What Now?
Non-reactive Tuberculin tests, everyone is asymptomatic with normal chest x rays.
Rrangements could be made.) Dad has no phone listed.lives in 2 bedroom apartment, with
wife, two children, ages 11 and 14.
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