Productive Cough, Hemoptysis and Evening Rise of Temperature

A 34 years old male consults you because of cough, sputum production and mild hemoptysis. He has had evening rise of temperature for the past one month and claims to have lost 12 kg over 3 months period. On examination, he appeared to be chronically ill and cachexic. Carvenous breath sounds are heard over the right apex.

Chest X-Ray shows fluffy infiltrates and some amount of contraction of the right upper lobe. There is cavity in the superior segment of the right upper lobe. A working diagnosis of tuberculosis is made.

QUESTIONS:

1. Which spontaneously expectorated sputum would be adequate for the mycobacteriology lab? - A.M. sputum or 24 hours pooled specimen?

Fluorescent staining is positive for organism. ZN stain shows Acid Fast bacilli.

2. Is ZN stain specific for tuberculosis?

3. If the smear is positive, is there a need to send for culture?

He is a school teacher for standard 1, and the physician decided to admit him for hospital care. An intermediate strength of PPD was applied. There is 12mm induration in 48 hours.

4. How do you intepret the result? Does he has TB infection or disease?

We always ask about "Evening Rise in Temperature", as we know that it somehow point towards Tuberculosis infection.

5. What is the basis and reasons behind "EVENING RISE OF TEMPERATURE in TB"?

Source: www.meddean.luc.edu