| Other Problems to be Considered: | | | | tests) should be given a course of therapy once |
| Blast mycosis | | | | active infection and disease is ruled out. Guidelines |
| Cat scratch diseaseo It is critical that hopitalized | | | | published by the CDC in 2000 now refer to this as |
| patients with suspected or documented TB be placed | | | | treatment of latent TB. The recommended regimens |
| in appropriate isolation. This includes a private room | | | | are listed below:o INH daily for 9 monthso INH twice |
| with negative pressure and adequate air exchanges. | | | | weekly for 9 months (given as DOT)o INH daily for 6 |
| Persons entering the room must wear masks or | | | | months (should not be used in patients with fibrotic |
| respirators capable of filtering droplet nuclei.o Patients | | | | lesions on chest radiograph, patients with HIV, or |
| should remain in isolation until sputum becomes | | | | children)o INH twice weekly for 6 months (given as |
| smear-negative; however, patients ordinarily should | | | | DOT, should not be used in patients with fibrotic |
| not be kept in the hospital for the sole purpose of | | | | lesions on chest radiograph, patients with HIV, or |
| providing isolation, Special arrangements are | | | | children)o Rifampin daily for 4 monthso Rifampin plus |
| necessary for patients who live with children, | | | | pyrazinamide daily for 2 monthso Children should be |
| individuals infected with HIV, patients returning to a | | | | given INH for 9 months. In addition, children younger |
| closed-group setting (eg, nursing home, correctional | | | | than 5 years who have closed contact to an active |
| facilities, residential facility, homeless shelter). | | | | case of TB should be started on INH even of skin |
| Further Outpatient Care:o Patients diagnosed with | | | | testing is negative; preventive therapy can be |
| active TB should have sputum examined for M | | | | stopped if repeat skin testing is negative 3 months |
| tuberculosis weekly until sputum conversion is | | | | after last contact with a culture positive source |
| documented. Monitoring for toxicity includes baseline | | | | case.o |
| and periodic liver enzymes, complete blood count, and | | | | Patient exposed to MDR-TB may be given |
| serum creatinine.o In addition, patients on | | | | ethambutol plus pyrazinamide for 6 - 12 months or |
| pyrazinamide should have baseline or periodic serum | | | | pyrazinamide plus levofloxacin for 6 - 12 months; the |
| uric acid determinations, and patients on long-term | | | | index isolate should be susceptible to all drugs used.o |
| ethambutol therapy should have baseline or periodic | | | | Recommended regimens in patients with HIV |
| visual acuity and red-green color perception testing. | | | | infection include pyrazinamide plus rifampin daily for 2 |
| The latter can be performed with a standard test | | | | months, rifampin alone daily for 4 months, or 9 |
| such as Inhihara test for color blindness. | | | | months of INH (daily or twice weekly). Patients on |
| Deterrence/Prevention:o Patients with a clinically | | | | antiretroviral therapy may need rifabutin in place of |
| significant result on tuberculin skin testing (see other | | | | rifampin. |