Diagnosis and management

Sputum tests, cultures and chest radiographs, as well as a tuberculin skin test, are standard diagnostic tools. In cases of suspected tuberculous meningitis, a spinal puncture is necessary to determine whether the patient has lymphocytosis and a moderate increase in protein. The diagnosis is confirmed when tubercle bacilli can be identified or cultured from the fluid; however, since irreversible brain damage may result from waiting for cultural confirmation, it is often necessary to begin therapy on the basis of a presumptive clinical diagnosis. The brain scan may show hydrocephalus, focal infarcts, and exudate in basal brain cisterns. (19)

It is important in psychiatric settings that suspected tuberculosis patients receive a proper diagnostic evaluation, not only for the sake of their own health but also for that of other patients who may be exposed to the infection in the unit. It may be necessary to transfer psychiatric inpatients with tuberculosis to a ward where isolation can be assured. The Centres for Disease Control recommend routine tuberculosis screening for patients in HIV risk groups, and for residents of mental health facilities. (20,)

The most commonly used drugs for the treatment of tuberculosis are isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin. Compliance is vital to achieve effective treatment.

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