A 32-year-old nurse is evaluated 3 days after being exposed to a patient with active pulmonary tuberculosis. The source patient presented with cough, and a chest radiograph revealed a cavitary lung lesion. His sputum testing returned positive for acid-fast bacilli. The nurse cared for the patient for several hours without using respiratory precautions before airborne isolation precautions were implemented. She has had no symptoms and has no prior medical problems. Her only medication is an oral contraceptive. Vital signs are within normal limits, and physical examination shows no abnormalities.
Tuberculin skin test (TST) is administered and reveals a 2-mm induration at 48 hours.
Which of the following is the most appropriate next step in management of the nurse?

Question

A 32-year-old nurse is evaluated 3 days after being exposed to a patient with active pulmonary tuberculosis.  The source patient presented with cough, and a chest radiograph revealed a cavitary lung lesion.  His sputum testing returned positive for acid-fast bacilli.  The nurse cared for the patient for several hours without using respiratory precautions before airborne isolation precautions were implemented.  She has had no symptoms and has no prior medical problems.  Her only medication is an oral contraceptive.  Vital signs are within normal limits, and physical examination shows no abnormalities.
Tuberculin skin test (TST) is administered and reveals a 2-mm induration at 48 hours.
Which of the following is the most appropriate next step in management of the nurse?

Quizplus · Accepted Answer

11ec193a_985c_35a4_853d_81fa2a3994dd_MD0002_00 Patients with pulmonary tuberculosis (TB) who have acid-fast bacilli in sputum smear and/or cavitary lung lesions are highly infectious. Therefore, close contacts require investigation and monitoring for potential exposure. A tuberculin skin test (TST) should be performed within a week; TST induration ≥5 mm is considered positive in this setting. However, the window period from infection to detectable skin test reactivity is generally 2-12 weeks. As a result, the Centers for Disease Control and Prevention recommends repeat TST testing 8-12 weeks after exposure for those with negative initial TST. Patients whose repeat TST is negative are cleared. Those with positive TST require further evaluation for active TB with symptom review and chest x-ray. A similar approach would apply for interferon gamma release assays, which appear to have a window period of 4-6 weeks (Choice B). (Choice E) Patients with latent TB are often treated with 9 months of daily isoniazid. This patient should not be treated unless TST is positive and no symptoms or signs of active pulmonary TB are present. Educational objective: For close contacts of a patient with tuberculosis, a tuberculin skin test (TST) reaction of ≥5 mm induration is considered positive and warrants further evaluation (chest x-ray, symptom review). However, the TST can take up to 8-12 weeks to become positive. Therefore, individuals in close contact with an infected person who have a negative initial TST should have the test repeated 8-12 weeks after exposure. __________

A 32-Year-Old Nurse Is Evaluated 3 Days After Being Exposed