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File: 123096_sep96_decls23_0037.txt
Subject: DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANCE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003203
Folder Title: DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Document Number: 1
Folder Seq #: 88
VI. Treatment:
E. Invasive procedures: A. Standard treatment is a 9 month course of INH, 300 Mg
1. Gastric aspirate for smear and culture may be QD, plus rifampin, 600 mg (10 mg/kg) QD.
useful if no sputum can be produced.
2. Bronchoscopy, with washings for cultures, may be
diagnostic when TB is a consideration but or- B. Given the high level of resistance to INH anticipated
ganisms cannot be recovered by less invasive in organisms acquired in the Middle East, treatment of
means. TB cases in that setting should include rifampin plus
3. The choice of other specific invasive procedures, at least one other drug in addition to INH. Optimal
including thoracentesis, lumbar puncture, or bio- choices for the third drug include pyrazinamide, 25-35
psies, is guided by clinical evidence of extrapul- mg/kg (maximum 2.5 gm) QD, or ethambutol, 15-25 mg/kg
monary TB. QD. A four drug regimen containing INH, rifampin,
ethambutol, and pyrazinamide may be optimal in this
F. skin testing: in previous non-reactors, PPD may setting pending mycobacterial sensitivity results.
convert to positive by 4 weeks. PPD may be negative in
isease, or C. Monitor therapy monthly.
in patients with immunosuppression from other disease.
Up to 25% of patients with pulmonary TB may have D. Alternative agents include:
negative skin tests; 5% of patients may have selective 1. Streptomycin, 750 to 1000 mg IM QD for 2 to 3
energy (negative PPD and positive energy panel). In an months, then 750-1000 mg IM 2 to 3 times per week;
area of high prevalence, IPPD skin tests of >10 mm resistance to streptomycin is common in the Middle
induration are consider positive. East.
2. Capreomycin, I gm IM QD; greater ototoxicity than
G. Diagnostic confirmation: successful culture of MYCO- streptomycin.
bacteria from clinical specimens. 3. Ethionamide, 10-15 mg/kg PO QD; bacteriostatic@
has GI, hepatic, and neurotoxicity.
IV. Duration: 4. Cycloserine, 750-1000 mg PO QD, divided in 3 or 4
doses); bacteriostatic; has significant potential
A. Treated: variable, depending on extent of disease. central nervous system toxicity. Pyridoxine, 100
Treatment regimens range from 9-18 months in length, PO QD, should be considered to prevent CNS toxi-
curs much sooner. city.
5. Amikacin, 15 mg/kg IM QD.
B. Untreated: indefinite: 50% die; 25% develop chronic
TB, which can remain active for years; and 25% spon- E. Treatment failures or relapses: therapy should be
taneously heal. guided by mycobacterial sensitivity results, with the
basic principle of always using at least two new drugs
to which the organism is sensitive. Refer patients
V. complications: with resistant disease for specialist management. If a
A. Pulmonary: hemoptysis; massive hemorrhage; and major patient is failing on therapy, always add two new drugs
parenchymal lung damage with permanent impairment of until sensitivities are known.
respiratory function. VII. Disposition: varies with severity of clinical disease.
B. Extrapulmonary: ranges from minor damage to destruc-
tion of the involved organ. A. Asymptomatic, or mildly ill patients whose symptoms
resolve quickly, may be returned to duty on medication,
C. Recurrence, possibly with resistant organisms, ray with follow-up, once non-infectious (usually by two
ecurrence in weeks of treatment).
adequately treated patients is very uncommon, but may
occur. B. More seriously ill, or persistently ill, patients will
require evacuation.
65
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Document 52 f:/Week-36/BX003203/DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS/diagnosis and treatment of diseases of importanc:12179609281524
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Folder Seq # = 88
Subject = DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANC
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 17-DEC-1996