Saleeb – Tuberculosis

Dr. Paul Saleeb presents a real case of a 55-year-old Indian man with a history of non-adherent TB treatment who immigrated to the U.S. and later presented with fever, night sweats, weight loss, and diabetes. The discussion covers TB diagnosis methods, including phenotypic and genotypic methods like AFB smears, cultures, and GeneXpert, which is used to detect TB and rifampin resistance. The history of TB treatments, including sanatoria and Plombage, is explored, along with the first randomized clinical trial using streptomycin. The podcast further explains first-line TB therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) and their mechanisms, as well as the monitoring process using AFB smears and cultures. The case continues with the patient developing drug-induced liver injury, the use of liver-sparing agents, challenges in treatment, and the eventual success with rifabutin. The podcast also addresses factors causing delayed sputum smear conversion, the interaction between diabetes and TB, the use of corticosteroids in TB meningitis and pericarditis, and the growing concern of drug-resistant TB, including MDR-TB and XDR-TB, and potential new treatments.