Today I confirmed that a patient my team admitted yesterday had consumption (aka TB or tuberculosis). This 20-ish year old man of Vietnamese origin had been sick for over two months with fevers, feeling unwell, coughing up brown sputum. Over the last two days, he started coughing up blood (haemoptysis) and came to the emergency department yesterday with an X-ray which his local doctor had presumably ordered. He had lowered air entry into his right upper zone and had a right upper lobe pneumonia on chest X-ray. For some god-forsaken reason, he was not immediately put into an isolation room with negative-pressure and started on anti-tuberculous medication.
Instead, he got placed in the general ward, where he ended up in a single room with the door closed. I saw him yesterday morning with my registrar and one of my consultants in the emergency department and we started antibiotics to cover community acquired pneumonias (i.e. we put him on penicillin and roxithromycin). The same evening, I got called to see him because of increased haemoptysis. I reviewed him and found that he had a temperature of 38.7C but was haemodynamically stable with good peripheral perfusion and a SaO2 of 96% on room air. I inserted another 18 gauge IV cannula, took blood cultures and more sputum samples and did a group and hold for his blood in case he lost more and did require a transfusion. I found out that, while he had been in Australia for more than 10 years, he had been born in Vietnam and did indeed know of a possible personal contact - his friend's wife was recently diagnosed with TB. In my mind the most likely diagnosis was definitely tuberculosis.
Handing off his case to the evening staff, I went home.
In the morning, I came to work to find that he had just coughed up a "large amount" of blood - approximately 200-300ml and his oxygen saturation had dropped to 70% on room air and 85% on 4L/min oxygen via nasal prongs.
He was given IV fluids and the respiratory team were called in. A mobile CXR was done. The ICU team were called in to assess him so that he could be placed in the ICU if he deteriorated further. A CT angiogram of his lungs was arranged. I bugged the people in microbiology to do urgent stains for Acid-Fast Bacili on his sputum samples.
Radiology showed a cavitating upper lobe lesion in his right lung but no involvement of bronchial blood vessels. Microbiology paged me to say that one of his sputum samples was positive for AFBs.
Well, this poor man is now in the ICU receiving anti-tuberculous treatment - probably some combination of rifampicin, isoniazid, ethambutol and pyrizinamide. The respiratory team will take over care of him soon.
What bothers me is the possible infection risk. He was not placed in a negative pressure room. Even though the door was closed and everyone who wanted to enter the room was instructed to wear a mask and don gloves and a gown, it's conceivable that, as he was coughing the stuff all around all day and all night, someone could have been infected by now ...
Which reminds me - I should go have a Mantu test and a chest X-ray in a few months time ...