Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic productive cough, progressive dyspnea, and constitutional symptoms including unintentional weight loss, night sweats, and low-grade fevers. History significant for structural lung disease or prior pulmonary insult. Symptoms are persistent despite prior courses of broad-spectrum antibiotics. No history of recent travel or known TB exposure.
Clinical Examination Findings
General: Patient appears chronically ill, cachectic. HEENT: No cervical lymphadenopathy. Respiratory: Auscultation reveals coarse crackles, bronchial breath sounds, and localized wheezing, predominantly in the upper lobes. Percussion may reveal dullness. Cardiovascular: Regular rate and rhythm, no murmurs or peripheral edema. Skin: No evidence of subcutaneous nodules or rashes.
Treatment Protocol
Initiate multi-drug regimen: Clarithromycin (or Azithromycin), Rifampin (or Rifabutin), and Ethambutol. Consider parenteral Aminoglycoside (Amikacin or Streptomycin) for initial intensive phase. Monitor for drug-induced toxicities: visual acuity/color vision (Ethambutol), LFTs (Rifamycins), and audiometry (Aminoglycosides). Surgical resection may be considered for localized cavitary disease refractory to medical therapy.