A case report in the current issue of WMJ (vol. 112, no. 3) highlights the importance of early identification of tuberculosis (TB), which recently was in the news following an outbreak in Sheboygan County. Physicians and other health care professionals also should be mindful of the various manifestations of the disease such as empyema necessitans, according to the report.
TB is a rare cause for skin abscesses, but one of the major etiologic agents in empyema necessitans, according to the authors of “Empyema Necessitans Caused by Mycobacterium tuberculosis in an Immunocompetent Patient.” Treatment for tuberculosis empyema necessitans is usually all of the same medications as for any form of primary tuberculosis, and prompt identification of TB means faster treatment and fewer public health exposures.
According to the Wisconsin Department of Health Services (DHS), the Sheboygan area recently experienced “an unusually high number of TB cases at one time, including a confirmed multi-drug resistant TB case.” DHS reported eight cases of active tuberculosis within an extended family in Sheboygan as of June 3, when it requested additional state funds to contain the outbreak.
In light of the recent outbreak, physicians are reminded to:
- Understand the epidemiology of TB in Wisconsin. Virtually all active TB is in people who are foreign-born or who can name someone they knew with active TB. Most TB in Wisconsin is due to reactivation of a TB infection. Afflicted patients may have been exposed decades ago in areas of indigenous TB or may have been recently exposed to an actively infected contact. This is important when using increasing common immunosuppressants, such as prednisone or injectable immunomodulating agents, in populations that may have had occult exposure to TB.
- Report all suspect cases of TB to the local health department. Numerous resources – free testing, payment for medical assessment, free treatment – are available for people reported as potential TB patients. In addition, local health departments can help work through options for testing, find out if community members are at risk and assist patients and their families in understanding TB infection and disease.
- Report all TB to the local health department. Some physicians believe that extrapulmonary TB is not reportable. All TB – suspect or confirmed, pulmonary or extrapulmonary – is reportable within 24 hours of suspected diagnosis to the local health department where the patient lives.
- Ask for education, assistance and support. With fewer than 70 cases of TB per year in Wisconsin, most clinicians will never see a case of active disease. It is a challenge for clinicians to prudently add TB to the differential, especially with low prevalence rates. The State TB Program and local public health departments are good resources because all reported tuberculosis is managed collaboratively by clinicians and public health.
Back to July 18, 2013 Medigram