Reactivation tuberculosis happens when a latent Mycobacterium tuberculosis infection, held in check for years, becomes active, usually in the upper lobes of the lungs. HIV, diabetes, older age, steroids and other drugs that weaken immunity raise the risk.
Key symptoms
- Cough for more than 2 to 3 weeks
- Coughing up blood
- Fever and night sweats
- Weight loss and fatigue
What you find on exam
- Temperature and weight compared with earlier visits
- Crackles in the upper lungs; the exam is often normal
- Lymph nodes in the neck
- Oxygen saturation
Tests
- Chest X-ray: upper lobe infiltrates and cavities
- Three sputum samples for acid-fast smear and culture
- Rapid molecular test (NAAT) on sputum
- HIV test and baseline liver tests
Treatment basics
- Airborne isolation in a negative-pressure room; staff wear N95 respirators
- Four drugs for 2 months: isoniazid, rifampin, pyrazinamide and ethambutol
- Then isoniazid and rifampin for 4 more months
- Directly observed therapy, with pyridoxine alongside isoniazid
- Report to public health and test close contacts
Red flags
- Large amount of blood coughed up
- Low oxygen or respiratory distress
- Jaundice or vision changes during treatment
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Sources: NCCPA PANCE Content Blueprint; CDC, Guideline for Isolation Precautions (2007) and PPE sequence; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.