X-ray showing acute miliary TB reveals many fine micronodules
An Asian woman who immigrated to this country was diagnosed with miliary pulmonary TB per lung biopsy that showed a caseating granuloma. Both her purified protein derivative test and sputum culture for acid-fast bacilli are negative. While awaiting culture reports of the lung biopsy, she has been receiving four anti-TB medications. She has no respiratory symptoms. How long must she be on respiratory isolation?
—Win N. Yo, MD, New York City
This is a difficult question to answer without knowing the patient's HIV status. As long as she is HIV-negative, most experts would agree that in a setting of smear-negativity, two weeks of effective antituberculous therapy should suffice to eliminate the need for respiratory isolation. Traditional quadruple therapy may not be adequate, however, if she is infected with a multidrug-resistant strain, so resistance patterns from her place of origin should be evaluated. Note that she does not need to be hospitalized during this time and she may be safer and a lower risk to the general public if she is confined to her place of residence.
—Cedric W. Spak, MD, MPH (121-9)