Abstract

CASTANHEIRA, Liliana; OLIVENCA, Raquel  and  LIMA, Maria Fernanda. Tuberculosis in primary care: a clinical case. Rev Port Med Geral Fam [online]. 2019, vol.35, n.2, pp.136-140. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v35i2.11819.

Introduction: Tuberculosis is still an important health problem all over the world that affects thousands of people every year and it remains the second larger cause of death by the infectious disease worldwide. This clinical case reminds us that pulmonary tuberculosis can be a hypothesis in the diagnosis of patients with persistent respiratory symptoms. Case description: Man, 31 years old, healthy, comes to our family medicine consult with a four-day case of fever, myalgia, chills, and persistent cough with purulent sputum, fatigue, and discomfort in the middle region of the left hemithorax but without dyspnea. He was first medicated with paracetamol and we ordered a chest x-ray. The x-ray showed an image of pulmonary parenchymal densification of the upper left lobe with air bronchogram signal and therefore the patient was treated with amoxicillin plus clavulanic acid. After six days of antibiotic, he presented a new onset of night sweat, keeping the remaining symptoms and with no changes in a most recent chest x-ray. We contacted the local Pulmonology Diagnostic Center, where the pulmonologist suggested a direct cultural and bacteriological examination of mycobacteria and a new x-ray. After fulfilling the prescribed antibiotic therapy, for lack of improvement of the clinic, we began a new treatment with levofloxacin. After five days we had the result of the direct bacteriological examination, the first two samples were negative and the third one identified Enterobacter cloacae. We chose to keep the antibiotic. After completing the therapy with levofloxacin, for lack of improvement, it was decided to request a new sputum collection for direct bacteriological examination and culture test. After 35 days of the first visit, new results of the second bacteriological examination were ready, in which the first sample was positive for acid-alcohol resistant bacillus, therefore the patient was forwarded to the Pulmonology Diagnostic Center, which conducted additional tests and started the tuberculostatic treatment.

Keywords : Pulmonary tuberculosis; Family doctor; Diagnosis.

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