Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic productive cough, progressive dyspnea, and constitutional symptoms including low-grade fever, night sweats, and unintentional weight loss. History significant for underlying structural lung disease (e.g., COPD, bronchiectasis, or prior TB). Symptoms are indolent in progression, mimicking pulmonary tuberculosis. No recent travel to endemic areas or known contact with active TB cases.
Clinical Examination Findings
General: Patient appears chronically ill, cachectic. Respiratory: Auscultation reveals coarse crackles, localized wheezing, or diminished breath sounds, typically in the upper lobes. Cardiovascular: Regular rate and rhythm, no murmurs or peripheral edema. Lymphatic: Palpable cervical or supraclavicular lymphadenopathy may be present. Skin: No evidence of cutaneous nodules or abscesses.
Treatment Protocol
Initiate standard triple-drug regimen: Rifampin (600 mg daily), Ethambutol (15 mg/kg daily), and Isoniazid (300 mg daily). Continue therapy for at least 12 months after achieving negative sputum cultures. Monitor for drug-induced hepatotoxicity, ocular toxicity (ethambutol-related), and peripheral neuropathy. Monthly sputum cultures required to assess microbiological response.