Question A: Tuberculosis is a disease that can become asymptomatic but the Mycobacteria can still be present. It has been shown that a large number of Americans actually have “inactive” TB, and when they become older this inactive disease can resume the infection. This re-emergence of infection is potentially what happened to Mr Johnson.
Question B: There is a potential problem with using the routine antibiotic therapy in this case. Mr Johnson received routine treatment before and he still harbors the organisms. Consequently, there is the possibility that Mr Johnson is harboring a resistant strain of Mycobacterium that would negate the usefulness of this approach. It would be better to try newer therapeutic protocols as a way of dealing with the re-emergence of the infection.
Question C: Testing the strain of Mycobacterium currently affecting Mr Johnson for resistance to specific antibiotics would help to determine a more correct approach to his treatment. Obtaining a sputum sample, isolating the Mycobacterium, and then testing it for resistance could easily accomplish this.
Question A: The patient is suffering from symptoms that can be attributed to a variety of central nervous system infections. He has been given medications directed toward stabilizing his mood swings but the medicines were ineffective. In this case, the history taken from the patient is very important. He mentioned that he has lived in England all of his life and received a corneal transplant 15 years ago. Living in the UK during his life may have exposed him to prion infection. In addition, there is a form of transmission of prions known as the iatrogenic form, which is associated with corneal transplants. Lastly, the symptoms he is exhibiting are seen in cases of prion disease.
Question B: Sadly there is no way to test for the possibility your patient has prion disease. The result of autopsy of the brain showing the characteristic lesions in the brain will confirm that was the case but there is currently no test for this disease.