Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a subacute onset of constitutional symptoms including high-grade intermittent fevers, drenching night sweats, and significant unintentional weight loss. Respiratory complaints include a persistent non-productive cough and progressive exertional dyspnea. Review of systems is positive for fatigue, anorexia, and malaise. No history of recent travel to endemic areas or known TB exposure reported.
Clinical Examination Findings
General: Patient appears cachectic and chronically ill. Vitals: Tachycardic, tachypneic, febrile. HEENT: No cervical lymphadenopathy. Respiratory: Auscultation reveals diffuse fine crackles bilaterally; no wheezing. Cardiovascular: Tachycardic regular rhythm, no murmurs. Abdomen: Soft, non-tender, hepatosplenomegaly noted on palpation. Skin: No evidence of miliary rash or subcutaneous nodules. Neurological: Alert and oriented, no signs of meningeal irritation.
Treatment Protocol
Initiate standard anti-tubercular quadruple therapy (RIPE: Rifampin, Isoniazid, Pyrazinamide, Ethambutol) adjusted for weight and renal function. Add Pyridoxine (Vitamin B6) to prevent peripheral neuropathy. Monitor liver function tests (LFTs) and uric acid levels bi-weekly. Consider adjunctive corticosteroid therapy if there is evidence of severe systemic inflammatory response or CNS involvement. Strict respiratory isolation precautions implemented.