Maryland CC Project Saleeb – Tuberculosis
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Jun 8, 2020 
Dr. Paul Saleeb, Assistant Professor of Medicine in Infectious Diseases, dives deep into tuberculosis, particularly its pulmonary manifestations. He shares a compelling case study of a 55-year-old man with a complex TB history. Saleeb discusses advanced diagnostic methods like GeneXpert PCR and explores the intricacies of treatment regimens, including the effects of diabetes on TB outcomes. He also highlights emerging therapies for drug-resistant TB, showcasing how new treatments are improving patient results in challenging cases.
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Patient With Recurrent TB And New Diabetes
- A 55-year-old man from India with prior incomplete TB treatment presented with fever, night sweats, weight loss and new uncontrolled diabetes.
- He had extensive bilateral cavitary pulmonary disease on chest x-ray and immigrated to the U.S. in 2003 with intermittent travel back to India.
Phenotypic Versus Genotypic TB Tests
- Diagnostic methods split into phenotypic (smear/culture) and genotypic (PCR) approaches for TB detection and resistance testing.
- GeneXpert gives rapid MTB detection and rifampin-resistance results in about two hours on sputum samples.
Repeat GeneXpert If Smear Negative
- Use multiple GeneXpert tests if initial sputum is smear-negative to raise sensitivity from ~70% toward 90%.
- Rely on its high specificity because non-tuberculous mycobacteria do not trigger a positive GeneXpert.