A 19-year-old woman is admitted to the intensive care unit for massive hemoptysis. Computed tomography (CT) of the chest reveals a large, cavitated lesion in the right middle lobe. The patient has no known past medical history, lives with her family, and recently immigrated from China.
What is the MOST appropriate management strategy?A. Place the patient in a negative-pressure isolation room, and continue negative-pressure isolation until three sputum samples are negative for acid-fast bacteria and an alternative diagnosis has been established
Correct Answer: A
Mycobacterium tuberculosis infection can present as primary disease or reactivation of latent disease. Hemoptysis in a patient with epidemiologic risk factors for tuberculosis should raise the specter of active pulmonary tuberculosis, which is a public health concern. Management principles include admission to a negative-pressure isolation (airborne infection isolation) room. Positive-pressure or “reverse” isolation rooms are used to protect patients with systemic immune defects against airborne infections and are not used for management of tuberculosis. Healthcare workers caring for patients with suspected tuberculosis should wear N95 respirator masks or powered air-purifying respirators when entering the patient’s room. Empiric tuberculosis therapy would be reasonable in this patient with signs, symptoms, and epidemiologic risk factors compatible with active pulmonary tuberculosis. Discontinuation of negative-pressure isolation in patients suspected of tuberculosis requires a determination that (1) infectious tuberculosis is unlikely, and one or more of the following: (2a) an alternative diagnosis has been established, (2b) three or more consecutive sputum samples are smear-negative for acid-fast bacteria, or (2c) two or more sputum samples are negative for M. tuberculosis DNA using the Xpert MTB/RIF assay. Note that these are not the same requirements for discontinuing negative-pressure isolation in patients diagnosed with active tuberculosis.