#explanation8
ANSWER:
Mycobacterium tuberculosis
EXPLANATION:
The BCG vaccine is unreliable in protecting against pulmonary tuberculosis Although the BCG is routinely given to people at high risk of exposure through occupation, it's strengths lie in preventing
extrapulmonary manifestations of tuberculosis, rather than the more common, pulmonary form. This patient has spent a prolonged period of time working in refugee camps, which tend to be overcrowded, creating an environment in which TB can spread rapidly amongst inhabitants.Pneumonia caused Staphylococcus aureus often is preceded by a viral illness such as influenza.Mycoplasma pneumoniae frequently causes mild cases of pneumonia, otherwise referred to 'Walking pneumonia'. Systemic symptoms are less common, and it usually presents with a non-productive cough. Klebsiella pneumoniae often causes cavitating lung lesions and is most commonly associated with pneumonia in patients with a history of alcohol excess.Legionella pneumophila is often accompanied by more generalised symptoms, such as diarrhoea and myalgia. It is also associated with hyponatraemia, however the mechanism through which this occurs is unclear.
BCG VACCINE
The Bacille Calmette-Guérin (BCG) vaccine offers limited protection against tuberculosis (TB). In the UK it is given to high-risk infants. Until 2005 it was also routinely given to children at the age of 13 years.
The Greenbook currently advises that the vaccine is administered to the following groups (below is summary, please see the link for more details):
• all infants (aged 0 to 12 months) living in areas of the UK where the annual incidence of TB is 40/100,000 or greater
• all infants (aged 0 to 12 months) with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. The same applies to older children but if they are 6 years old or older they require a tuberculin skin test first
• previously unvaccinated tuberculin-negative contacts of
cases of respiratory TB
• previously unvaccinated, tuberculin-negative new
entrants under 16 years of age who were born in or who
have lived for a prolonged period (at least three months)
in a country with an annual TB incidence of 40/100,000 or
greater
• healthcare workers
• prison staff
• staff of care home for the elderly
• those who work with homeless people
The vaccine contains live attenuated Mycobacterium bovis. It also offers limited protection against leprosy.
Administration
• any person being considered for the BCG vaccine must first be given a tuberculin skin test. The only exceptions are children < 6 years old who have had no contact with tuberculosis
•given intradermally, normally to the lateral aspect of the left upper arm
• BCG can be given at the same time as other live vaccines,
but if not administered simultaneously there should be a
4 week interval
Contraindications
• previous BCG vaccination
• a past history of tuberculosis
• HIV
• pregnancy
• positive tuberculin test (Heaf or Mantoux)
The BCG vaccine is not given to anyone over the age of 35, as
there is no evidence that it works for people of this age group.
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2November 21, 2023 996 1
