Protean manifestations of tuberculosis in Kentucky: a case report and discussion

The incidence of tuberculosis has decreased significantly in Kentucky, particularly in the second half of the last century, from significantly above to below the national average. However, its incidence is still high in certain high-risk segments of our population, where it may present in either typical or unusual fashions. Proper identification of risk factors, high index of suspicion, and modern advances in diagnostic testing aid in the diagnosis of patients with protean manifestation of disease. Recently improved technology and management strategies have been adopted to improve the outcome of management including advances in diagnostic modalities and improved drug administration to patients. It is these scientific advances which caused a steeper decline in the case rates of tuberculosis in the state of Kentucky. Improvement in public health measures including direct observation of therapy with adequate treatment and prevention of drug resistant organisms will be essential to maintain low rates of Mycobacterium tuberculosis in Kentucky.