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A.G. Holley Hospital
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Histories
Case 6
The patient is a previously healthy 1 yo child who was exposed to a person with
tb.
The person did not live in the same house, however he did visit frequently. The source
case had 2-3+ during the initial screening, most of the family members were ppd positive.
The 1 yo pt was ppd neg but was placed on inh until at least the second ppd screening 3 mo
later. Because of the high risk to children at this age the recommendation was for
dopt.
Smear positive and because of non-compliance, was the outreach worker who was going to
give the inh to the child, knew the child’s mother. She said that she trusted the
mother and no dopt was done. Pick-up of meds by the mother was inconsistentSix months
later, the child was taken to the emergency room with an obtunded mental state and a left
hemi-paresis. Evaluation by ct scan showed an inflamed meninges and cerebritis
Lumbar puncture showed a predominant lymphocytic cell count.
Close contacts of patients with active tb must be evaluated for the presence of tb
infection or disease and started on appropriate therapy. Those that are immunosuppressed
or are under the age of 1yo are at the highest risk of developing active disease.
Compliance can not be predicted
Those that are at increased risk of developing disease should be on dopt therapy to
assure compliance.
Sent to ag holley
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