TB or Not TB!

Whether ‘tis nobler in the mind to suffer the slings and arrows of a Quantiferon-Gold
Or to take arms against an induced sputum PCR
And by admitting, rule out
To die, to sleep
-D. Alex Perry, MD

That is the question in our noon report today.

Dr. Perry led us through a case where we were reminded to avoid premature closure. Similarly, there is a prospective multi-center French study which developed a predictive model based on risk factors including immigrant status, BCG immunization, HIV infection, homlessness, clinical symptoms and chest x-ray findings. Tattevin, P. et al “The validity of medical history, classic symptoms, and chest radiographs in predicting pulmonary tuberculosis.” Chest.1999 115:1248-55

Additionally, we discussed the differential for night sweats which helped broaden the differential. Night Sweats

  • Malignancy
    • Lymphoma
    • Solid Tumors (germ cell, meduallary thryoid carcinoma, prostate cancer, renal cell carcinoma)
  • Infections
    • Myobacterial (TB and atypical mycobacteria)
    • Bacterial (abscess, brucellosis, endocarditis, osteomyelitis)
    • Fungal
    • Viral (HIV, HCV)
  • Medications (several, a brief list is included)
    • Antidepressants (Buproprion, SSRIs, SNRIs, TCAs)
    • NSAIDs
    • Aromatase Inhibitors
    • Cholinergic Agonists
  • Substance Withdrawl (alcohol, cocaine, opioids)
  • Endocrine Disorders
    • Carcinoid
    • Hyperthryoidism
    • Pheochromocytoma
  • Menopause
  • Miscellaneous (includes panic disorder and temporal arteritis to name a few)