Ms. X, a 32-year-old Hispanic woman, has had a history of intermittent pleuritic chest pain and joint pain for the past several years. Recently, she went to her physician because she noticed that an erythematous, butterfly-shaped rash had appeared on her face. Further lab tests indicated protein in her urine. Her blood test indicated the presence of numerous antinuclear antibodies, especially anti-DNA, and mature neutrophils containing nuclear material. A diagnosis of systemic lupus erythematosus (SLE) was made. (Refer to Chapter 7, Immunity)
- Discuss possible reasons why SLE was not diagnosed earlier.
- Discuss how the presence of antibodies can cause such widespread damage in organ systems.
- Discuss treatments for SLE and a prognosis for the patient in this case.
Mr. F, age 46 years, has had a persistent unproductive cough for several months that did not respond to cough medications. Recently, he has developed a productive cough accompanied by fatigue, anorexia, and night sweats.
Examination indicated abnormal chest sounds and weight loss. A chest radiograph showed a small cavity and infiltrate, the tuberculin test was positive, and the sputum sample contained a small amount of blood and numerous acid-fast bacilli, confirming the diagnosis of active tuberculosis. (Refer to Chapter 13, Respiratory Disorders)
- Discuss the pathologic changes occurring during the development of active tuberculosis.
- Discuss the transmission of TB and the conditions predisposing to the development of TB.
- Discuss the treatment of tuberculosis and the precautions involved for health care personnel coming into contact with the patient.
- Suggest how family members or co-workers can protect themselves.
Expert Solution Preview
Introduction:
As a medical professor, it is essential to discuss case studies that help students understand the clinical aspects of a particular disease. This article focuses on two case scenarios: systemic lupus erythematosus (SLE) and active tuberculosis. In the following sections, we will discuss the possible reasons why SLE was not diagnosed earlier, how the presence of antibodies can cause widespread damage in organ systems, treatments for SLE, and the prognosis for the patient. Additionally, we will discuss the pathologic changes occurring during the development of active tuberculosis, transmission of TB, conditions predisposing to the development of TB, treatment, precautions for health care personnel, and suggestions on how family members or co-workers can protect themselves.
1) Discuss possible reasons why SLE was not diagnosed earlier.
SLE is a complex autoimmune condition that can affect almost any organ system. Unfortunately, SLE is challenging to diagnose as the symptoms are often non-specific and can mimic other diseases. Additionally, the onset of SLE can be gradual, making it challenging to detect until it reaches an advanced stage. Furthermore, there is no single test to diagnose SLE as it involves numerous laboratory assessments, including the presence of antinuclear antibodies (ANA). It is also possible that healthcare professionals might not be familiar with the symptoms of SLE, leading to a delayed diagnosis.
2) Discuss how the presence of antibodies can cause such widespread damage in organ systems.
Autoantibodies are a hallmark of SLE and are associated with damage to various organ systems. The antibodies target the body’s own cells, leading to inflammation and tissue damage. They can cause a wide range of clinical manifestations, including skin rashes, joint pain, and kidney disease. The antibodies also play a role in the development of severe complications, such as blood clots, heart disease, and autoimmune hepatitis.
3) Discuss treatments for SLE and a prognosis for the patient in this case.
The management of SLE is complex and depends on the severity of the disease and the symptoms experienced by the patient. Treatment aims to control symptoms, slow down the disease progression, and prevent complications. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarials, and immunosuppressive drugs. It is also essential to provide supportive care, such as lifestyle modifications and counselling. The prognosis for SLE varies depending on the severity of the disease, the organs involved, and how early the diagnosis was made. With early diagnosis and appropriate treatment, patients can lead a relatively normal life.
4) Discuss the pathologic changes occurring during the development of active tuberculosis.
Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis. The bacterium primarily affects the lungs but can spread to other parts of the body. Pathologic changes during the development of active tuberculosis include the formation of granulomas, which are aggregates of infected macrophages, lymphocytes, and fibroblasts. The granulomas can interfere with the air passages, leading to coughing, chest pain, and shortness of breath. Tuberculosis can also cause tissue destruction, leading to cavities in the lungs.
5) Discuss the transmission of TB and the conditions predisposing to the development of TB.
TB is primarily transmitted through the air when an infected person talks, coughs, or sneezes. People who are in close contact with an infected person are at a higher risk of contracting the disease. Conditions that predispose to the development of TB include HIV infection, malnutrition, diabetes, use of immunosuppressive drugs, and smoking.
6) Discuss the treatment of tuberculosis and the precautions involved for health care personnel coming into contact with the patient.
The treatment of TB involves a combination of antibiotics, also known as directly observed therapy (DOT). The therapy usually lasts six to nine months, and it is essential to complete the entire course of antibiotics to prevent the development of drug-resistant TB. For healthcare personnel, standard precautions must be followed, including the use of masks, gloves, and gowns when providing care to the patient. Airborne precautions, such as negative-pressure rooms, must be used in healthcare settings to prevent the spread of infection.
7) Suggest how family members or co-workers can protect themselves.
Family members and co-workers can protect themselves from TB by practicing good hygiene and following infection control measures. This includes avoiding close contact with the infected person, covering the mouth and nose when around them, wearing masks, and practicing hand hygiene regularly. It is also important to avoid sharing personal items, such as utensils and towels, with the infected person. If someone develops TB symptoms, they should seek medical attention immediately.
