INTRODUCTION
DR DELBANCO: Mr Z is a 52-year-old college professor with a dry, hacking cough. Born in India and raised in Bangladesh, Mr Z immigrated to the United States more than 20 years ago. He lives in Boston with his wife and daughter and has managed care insurance.
Mr Z had a negative purified protein derivative (PPD) test result 15 years ago. He recently traveled to Bangladesh for 3 weeks. Upon returning from his trip with a persistent hacking cough, he saw a primary care nurse practitioner who prescribed a steroid inhaler; the cough resolved slowly. A PPD test yielded 22 x 28 mm of induration. Results of a chest radiograph were normal. On his recent trip, he had no known contacts with tuberculosis (TB). His BCG vaccination status is unknown.
His past medical history is significant for borderline hypertension and adenomatous polyps of the colon. He . . . [Full Text of this Article]
MR Z: HIS VIEWS
DR L: HIS VIEWS
AT THE CROSSROADS: QUESTIONS FOR DR ISEMAN
Global TB: Past, Present, and Future
Factors Contributing to the Crisis
Efforts to Screen for and Prevent TB
Treatment of Latent Infection: Historical and Current Practices
The TST: Uses and Limitations
Current Guidelines for TST and Treatment of Latent Infection
Clinical Questions Relating to Mr Z
Decision Making Regarding the Care of Mr Z
QUESTIONS AND DISCUSSION
