HS 2222 - Infectious Disease Learning Journal Week 3
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University of the People *
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Health Science
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May 21, 2024
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University of the People
HS 2212 - 01: Infectious Disease
Instructor Kaushal Sharma
Written Assignment – Unit 3
September 24, 2023
Introduction:
In this case study, we will explore the diagnosis and treatment of latent tuberculosis infection
(LTBI) through the fictional story of Sarah Doe. Sarah is a 35-year-old female teacher with a
family history of diabetes who has recently been exposed to a colleague with active
tuberculosis (TB). We will follow her journey as she navigates the healthcare system to
receive a diagnosis and understand the impact of her comorbidity on treatment
recommendations.
Patient Profile:
Sarah Doe, a 35-year-old female teacher, enjoys spending time with her family, hiking, and
reading. She has a family history of diabetes but no known allergies or previous TB infection.
Her recent exposure to a colleague with active TB has prompted her to seek medical
attention.
Diagnosis and Treatment of Latent TB:
Sarah's journey into the diagnosis and treatment of latent TB begins with a tuberculin skin
test (TST), which confirms her exposure to TB bacteria. Subsequently, an interferon-gamma
release assay (IGRA) provides further evidence of latent TB infection (CDC, 2021).
Diagnosis:
Tuberculin Skin Test (TST): Sarah undergoes a tuberculin skin test (TST), which involves the
injection of a small amount of purified protein derivative (PPD) just under the skin. After 48–
72 hours, the healthcare provider evaluates the reaction at the injection site. In Sarah's case,
her TST results are positive, indicating exposure to TB bacteria.
Interferon-Gamma Release Assay (IGRA): To confirm the diagnosis, an interferon-gamma
release assay (IGRA) is conducted. Sarah's IGRA results are also positive, providing further
evidence of latent TB infection.
The TST and IGRA results are positive, indicating that Sarah has a latent TB infection (CDC,
2021). This diagnosis is a critical turning point in her healthcare journey.
Treatment:
Without treatment, Sarah's lifetime risk for TB reactivation is estimated to be around 10%.
However, her family history of diabetes increases this risk further. Given her comorbidity,
her healthcare provider recommends a more aggressive treatment approach to reduce her risk
of TB reactivation (CDC, 2021).
Impact of Diabetes:
Diabetes is a known risk factor for the progression of latent TB infection to active TB
disease. Sarah's family history of diabetes raises concerns about her higher risk. Her
healthcare provider estimates her lifetime risk to be closer to 15% due to this comorbidity.
Treatment Recommendations:
Sarah's diagnosis of latent TB infection is a critical juncture in her healthcare journey.
Without treatment, her lifetime risk for TB reactivation is estimated to be around 10%.
However, due to her reported family history of diabetes, her risk is increased. It's important to
address the impact of this additional risk factor.
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To mitigate her increased risk, Sarah is prescribed a daily regimen of isoniazid (INH) and
rifampin (RIF) for three months under direct observation, known as directly observed therapy
(DOT). This dual-drug therapy is more effective for individuals with risk factors like diabetes
(CDC, 2021).
Given Sarah's increased risk due to diabetes, her healthcare provider recommends a more
aggressive approach to treatment. While standard treatment for latent TB infection typically
involves a daily isoniazid (INH) regimen for 6–9 months, her provider suggests an alternative
regimen. Sarah is prescribed a daily dose of INH and rifampin (RIF) for three months under
direct observation, known as directly observed therapy (DOT). This dual-drug therapy is
more effective in reducing the risk of TB reactivation for individuals with risk factors like
diabetes.
Physical and psychological impacts:
Sarah's diagnosis of latent TB infection and the subsequent treatment regimen have both
physical and psychological impacts on her. Physically, she may experience side effects from
the medications, such as nausea or fatigue. The need for regular clinic visits for DOT may
disrupt her daily routine.
Psychologically, Sarah may feel anxious or worried about the possibility of TB reactivation,
especially given her diabetes history. The uncertainty and the responsibility of treatment may
add stress to her life. It is crucial for her healthcare provider to provide education, support,
and reassurance throughout her treatment journey to address these concerns.
Conclusion:
Sarah's case highlights the complexities of diagnosing and treating latent TB infection,
especially when comorbidities like diabetes are involved. It underscores the importance of
personalized treatment approaches and comprehensive patient support to address both the
physical and psychological aspects of LTBI management. Healthcare providers must consider
risk factors and educate and reassure patients like Sarah as they navigate their TB treatment
journey (CDC, 2021).
Word Count:724
Centers for Disease Control and Prevention. (2021).