A 25-year-old man comes to the employee health center for a physical examination prior to starting work as a patient care technician in a community hospital. The patient's family immigrated to the United States from Eastern Europe when he was a toddler. He received a medical evaluation prior to immigrating, but the records are not available. The patient has had no fevers, chills, night sweats, weight loss, cough, or fatigue. He has no chronic medical problems and takes no medications. He consumes alcohol occasionally but does not use tobacco or illicit drugs. The patient went on a 2-month backpacking trip through Central and South America a year ago. His immunization records are up to date. He has a small scar in the right deltoid area and notes that he received a bacillus Calmette-Guérin vaccination as an infant. The patient has no other abnormalities on physical examination. The patient's interferon-gamma release assay (IGRA) is positive. He is asymptomatic and feels well. Chest x-ray reveals no abnormalities. Which of the following is the next most appropriate step in management of this patient?

Question

A 25-year-old man comes to the employee health center for a physical examination prior to starting work as a patient care technician in a community hospital.  The patient's family immigrated to the United States from Eastern Europe when he was a toddler.  He received a medical evaluation prior to immigrating, but the records are not available.  The patient has had no fevers, chills, night sweats, weight loss, cough, or fatigue.  He has no chronic medical problems and takes no medications.  He consumes alcohol occasionally but does not use tobacco or illicit drugs.  The patient went on a 2-month backpacking trip through Central and South America a year ago.  His immunization records are up to date.  He has a small scar in the right deltoid area and notes that he received a bacillus Calmette-Guérin vaccination as an infant.  The patient has no other abnormalities on physical examination. The patient's interferon-gamma release assay (IGRA) is positive.  He is asymptomatic and feels well.  Chest x-ray reveals no abnormalities.  Which of the following is the next most appropriate step in management of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfc9_650e_8f63_afc5104364eb_MD0005_00 Health care providers with positive tuberculosis (TB) screening require further evaluation with chest x-ray and symptom review to determine if they have latent or active disease. Findings concerning for active TB include the following: Nonspecific symptoms - unexplained weight loss, anorexia, night sweats, fever, fatigue Pulmonary symptoms - coughing >3 weeks, hemoptysis, chest pain Chest x-ray findings - cavitation or infiltrate Patients with no symptoms or x-ray abnormalities have latent tuberculosis infection (LTBI). Although LTBI is considered noninfectious, individuals with LTBI are at risk for conversion to active disease. If conversion occurs, TB can spread from one individual to another. Health care providers with LTBI are generally given treatment with isoniazid daily for 9 months. (Choices A and E) Patients with a positive interferon-gamma release assay (IGRA) or tuberculin skin test (TST) do not require additional confirmation of TB exposure with repeat TST or IGRA. (Choices B and D) Individuals with active TB require microbial diagnosis with serial sputum samples for acid-fast bacilli and mycobacterial culture. Once a microbial diagnosis is obtained, treatment with 4-drug therapy is typically initiated. This patient with no symptoms and a normal chest x-ray has LTBI, not active TB. Treatment with isoniazid daily should be initiated without additional testing. Educational objective: Health care providers with positive tuberculosis screening should receive chest x-ray and symptom review to determine if they have latent or active disease. Those with no symptoms or chest x-ray abnormalities (eg, infiltrate, cavitation) are considered to have latent tuberculosis infection and should be offered treatment with isoniazid daily for 9 months.

A 25-Year-Old Man Comes to the Employee Health Center for a Physical