A 27-year-old woman comes to the office for an annual physical examination. She currently works as a medical interpreter in a regional hospital. The patient feels well and has no medical problems. Her only medication is a daily oral contraceptive pill. She does not use tobacco, alcohol, or illicit drugs. The patient is up to date with recommended vaccinations and has had no known contact with a person infected with tuberculosis. Vital signs are within normal limits. Mucous membranes are moist and without lesions. Lung fields are clear to auscultation and heart sounds are normal. The abdomen is soft and nontender with no organomegaly. No skin rash is present. A tuberculin skin test is performed and produces a 12-mm induration at 48 hours. Chest radiography is normal, and urine pregnancy testing is negative. The patient receives counseling and initiation on anti-tuberculosis therapy. Which of the following is the most appropriate employment-related recommendation for this patient?

Question

A 27-year-old woman comes to the office for an annual physical examination.  She currently works as a medical interpreter in a regional hospital.  The patient feels well and has no medical problems.  Her only medication is a daily oral contraceptive pill.  She does not use tobacco, alcohol, or illicit drugs.  The patient is up to date with recommended vaccinations and has had no known contact with a person infected with tuberculosis.  Vital signs are within normal limits.  Mucous membranes are moist and without lesions.  Lung fields are clear to auscultation and heart sounds are normal.  The abdomen is soft and nontender with no organomegaly.  No skin rash is present.  A tuberculin skin test is performed and produces a 12-mm induration at 48 hours.  Chest radiography is normal, and urine pregnancy testing is negative.  The patient receives counseling and initiation on anti-tuberculosis therapy.  Which of the following is the most appropriate employment-related recommendation for this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfc6_ccf8_8f63_abf7dc348006_MD0005_00 All health care personnel (HCP) should receive regular (eg, annual) screening for tuberculosis (TB) with a tuberculin skin test (TST) or interferon-gamma release assay. HCP who have a TST with >10-mm induration at 48 hours are likely to be infected with Mycobacterium tuberculosis and should undergo a chest x-ray. Those with no chest x-ray abnormalities and no symptoms (eg, weight loss, night sweats, chronic cough) are considered to have latent tuberculosis infection (LTBI). LTBI is noninfectious. LTBI screening should only be offered if treatment would be considered because, for most patients, the lifetime risk of advancing to active TB is small (5%-10%). Treatment (eg, 6-9 months of isoniazid) should be offered to affected individuals who are at higher risk of developing active TB (eg, immunosuppressed individuals) or those who reside (eg, inmates) or work (eg, HCP) in high-risk congregate settings. Because LTBI is noninfectious, affected individuals, including HCP, may continue to work (even if they decline or do not complete treatment); they do not require precautions (eg, N95 mask) or an absence for a full course of treatment . (Choice B) Patients treated for active TB are considered noninfectious when 3 consecutive acid-fast bacilli sputum smears are negative (8-24-hour intervals and >1 early morning samples). This patient does not require acid-fast bacilli smears as she has LTBI (no symptoms or chest x-ray abnormality). (Choice E) Patients exposed to TB several years prior may have false-negative initial tuberculin skin testing. As such, most organizations recommend 2-step pre-employment testing for LTBI; individuals with negative initial skin tests should have repeat testing in 1-3 weeks. This patient with a positive tuberculin skin test does not require repeat skin testing. Educational objective: Health care personnel (HCP) should be screened for tuberculosis on a regular basis. Infection is likely if skin testing shows >10-mm induration at 48 hours. Those with no symptoms and a normal chest x-ray are considered to have latent tuberculosis infection (LTBI). LTBI is noninfectious, and individuals may continue their normal daily lives without restrictions. However, because HCP work in congregant settings, treatment (eg, isoniazid) should be offered. References: Treatment of latent tuberculosis infection. (http://www.ncbi.nlm.nih.gov/pubmed/24056289) Drugs for tuberculosis. (http://www.ncbi.nlm.nih.gov/pubmed/22450707)

A 27-Year-Old Woman Comes to the Office for an Annual