Elisabeth Patton, DVM, PhD, Diplomate ACVIM

Size: px

Start display at page:

Download "Elisabeth Patton, DVM, PhD, Diplomate ACVIM"

Nathaniel Fields
7 years ago
Views:

PhD, Diplomate ACVIM Veterinary Program Manager Wisconsin

1 Brian Odegaard, RN BSN Public Health Madison & Dane County Diana Haley, RN BSN Sauk County Health Department Elisabeth Patton, DVM, PhD, Diplomate ACVIM Veterinary Program Manager Wisconsin Department of Agriculture, Trade and Consumer Protection Division of Animal Health

2 None!

3 1. Identify diagnostic, treatment, isolation and comorbidity challenges of patients with Mycobacterium bovis when initiating nurse case management. 2. Utilize knowledge of zoonotic TB to compose interview questions and agency communications when working with patients diagnosed with Mycobacterium tuberculosis complex. 3. Identify specific challenges for a small, local health department in the management of an active TB case.

4 April 9 th 2015, went to ER ofevers, nightsweats, hemoptysis x1 week oqft positive oabnormal CXR with cavitation osputums x2 upon hospital admission >9 AFB, PCR + for MTBC ostarted RIPE April 11 th oinsulin and Glipizide for diabetes ohiv Negative

5 52 yr old undocumented immigrant from Puebla, Mexico arriving to U.S. December 2014 o Worked as an upholsterer in Mexico o Farm Worker in WI in Dane County

6 Began working on a farm January 2015 o Working 3 rd shift 6pm-6am Fed calves colostrum and assisted with birth Primarily worked alone in a well ventilated area Lives with 5 other workers in home farmer provided including 1 son who shared bedroom Another son living nearby

7 Neighbor had TB 20 yrs ago 2 yr History of Type 2 diabetes o Taking oral diabetic pills from Mexico o Father died of diabetic complications 4 cigarettes daily; No alcohol use Needed glasses to read No PCP o Once visited free clinic in neighboring county a month ago

8 D/C d April 15 th o Prescription for RIPE and 5 mg Glipizide Glipizide covered by State TB Program Client isolated at hotel at the request of farmer from April 17 through July 7 o Hotel Cost: $ 5, o Weekly Groceries/Phone Cost: $ o Other financial concerns for patient losing home in Mexico

9 M. bovis identified April 29 th o PZA Resistant 400 mg Moxifloxacin started May 5th o DOA informed

12 AFB x3 weekly o 35 Sputum samples in the first 12 wks of Tx o Culture turnaround 2-4 wks through 6 wks Tx o Smears remained >9 AFB through 9 wks of Tx o Culture conversion occurred from specimens given after 9 weeks of treatment (June 10, 11, 12) o 3 consecutive neg. AFB smears after 12.5 wks of Tx End of initiation phase Minimal side effects of medications

13 First saw MD for Diabetes 13 days post DC from hospital o Avg. B.G. 340 o o o Metformin, Glipizide & Lantus supplied by State of WI TB Program Free supplies from MD Initial diabetes education given by PHN No diabetes education in hospital per client and was discharged without supplies or a prescription for supplies Focus was on when, how much, and how to eat Timing of blood sugar checks Taught insulin injections o Started having hypoglycemic episodes with a low of 75 o First appt. with bilingual Diabetic Specialist June 24 th

14 Period of infectiousness started Jan. 15 th T Spots on April 16 th and July 22 nd 9 close contacts tested o Roommates, coworkers, relatives 3 not tested in second round 2 had original +ppd placed after 2 nd round initiated refused LTBI treatment 0 converters that we know of

15 No longer in isolation Has a place to live with family Only on 2 TB drugs No longer on insulin for diabetes Has current BadgerCare+ insurance Can read Spanish directions

16 No English No job/needs money Needs food Needs cell phone Needs medications Directly Observed Therapy 5x per week Weekly assessments

17 Sputum testing Arrangements for medical appointments Transportation to appointments Needs diabetic equipment Outstanding medical bills

18 Needs eye glasses Needs dental exam Needs immunizations Needs extension of Medical Assistance TB only services Assessments needed for 2 additional contacts to TB case

19 Ethambutol & Moxifloxacin DC d 7/9/15 INH & Rifampin qd 7/10/15 to 8/2/15 INH & Rifampin 3X per week 8/2/15 to 4/11/16 DOT Frequency 5X per week 7/10/15 to 7/31/15 3X per week 8/3/15 to 1/29/16 1X per week 2/1/16 to 4/11/16

20 3 consecutive days every 2 weeks 7/20 8/19/15 1X every 2 weeks 9/11/15 1/20/16 Final collection 4/11/16 8/4/15 2 final negative sputum cultures (collected 6/11/15 & 6/18/15) Allowed to work with cows again per WI Dept. of Agriculture and WI TB Program

21 12/3/15 (compared with 4/10/15) great improvement 1/26/16 no appreciable change. No evidence of worsening. Continue with TB therapy until one year total time (4/11/16) 5/12/16 planned

22 Many changes with medications (Metformin ER & Glipizide) Hemoglobin A1C (6.5 on 9/28/15!) Blood sugar testing frequency Diabetic Nurse Educator Appointments

23 1 st Job grocery store 2 nd Job different grocery store 3 rd Job dairy farm where he lives 4 th Job different dairy farm nearby 5 th Job moves to dairy farm western Sauk Co. 6 th Job moves back & working at Job #4

24 Patient began TB therapy for M. bovis on 4/11/15. Patient successfully completed TB therapy on 4/11/16. Final appointment with Infectious Disease anticipated for 5/12/16.

25 Brian Odegaard RN, BSN Elisabeth Patton DVM, PhD, Diplomate ACVIM Diana Haley RN, BSN

Tuberculosis and You A Guide to Tuberculosis Treatment and Services

Tuberculosis and You A Guide to Tuberculosis Treatment and Services Tuberculosis (TB) is a serious disease that can damage the lungs or other parts of the body like the brain, kidneys or spine. There are