Recently, a young patient presented to a northern Japanese hospital with a two week history of cough, sputum and a mild fever.
She had been seen 3 years previously with a similar episode and Mycoplasma infection had been diagnosed and subsequently treated.
She had no current risk factors for tuberculosis and denied risky sexual exposures. Her grandmother had had TB earlier in her life.
The patient was otherwise healthy and was taking no medications.
Her examination was otherwise unrevealing including chest examination.
The clinic doctor considered this to be an atypical pneumonia due to the history of the current illness and previous atypical pneumonia.
However, the chest radiograph revealed a right apical lesion which was highly suspicious of Tuberculosis.
Sputum examination with the Ziel-Nielson stain revealed two acid-fast bacilli.
Hence, these results were very suggestive of active tuberculosis primary infection.
Interestingly, she had only a mild fever and cough but none of the typical features in her history such as:
- night sweats
- weight loss
- chronic cough
- bloody sputum
Of course, it is useful to obtain a formal bacteriological diagnosis through growth on Lowenstein-Jensson media, but this should never delay treatment for TB.
Always think TB !!
Do you have any current figures for the background prevalence of TB in Japan and know why Japan has such levels of TB?? If you know, then please let us all know by leaving a message on my blog!