Perioperative Mx of Latent TB

Gabrielle Morris

60yo female, for hysteroscopy and D+C for abnormal uterine bleeding.

Background:

  • Refugee from Democratic Republic of Congo
    • Arrived 2019.
    • 10yrs prior spent in refugee camp with 6 daughters. 
    • Difficult consultation. Patient requesting only her daughter act as interpreter. Language barrier difficult, particularly on phone
  • Conversion disorder
    • Developed right sided full body pain, paraesthesia, and dysphagia (couldn’t swallow saliva) 2/7 after arrival in Australia.
    • Extensive medical review – nil organic cause found.
    • Management through HIPS.
    • Most symptoms now resolved.
  • Latent TB diagnosed on screening. No treatment.
  • Not COVID vaccinated, currently considering.

Discussion:

Implications of latent TB perioperatively?

  • Lack of literature around latent TB
  • ID advised:
    • Screen for symptoms – weight loss, night sweats, cough, haemoptysis
    • If nil symptoms present, no specific precautions needed.
  • Should ensure gynae team know that patient has latent TB, as all organs can be affected, seeding can occur, and staff exposure from surgical sites.

Video-consulting in perioperative clinic 

  • Facilitate improved communication in cases with communication barriers 
  • May also assist with patients who require visual assessment; concerns about frailty/airway, or if F2F consultation impossible or better to avoid (e.g. moving between zones with different COVID regulations)
  • Video is challenging to arrange for all patients as it impacts on efficiency and patient satisfaction as patients must “wait” in a virtual waiting room. 
  • Audiovisual technology requirements – may be challenging for older patients but family and GP surgeries could help
  • Video most beneficial as a targeted resource. May set up a specific clinic session for a group of patients to maximize clinic efficiency at other times.