A.K, a 32-year-old female street vendor, presents to the local health clinic with a chronic cough lasting over three weeks, unintentional weight loss, night sweats, and intermittent fever.

AK's symptoms began approximately six weeks ago with a mild cough, which she initially dismissed as a common cold. However, the cough progressively worsened, becoming more persistent and productive, with occasional blood-tinged sputum. She has experienced a noticeable loss of appetite and has lost about 6 kg over the past month. She also reports feeling fatigued and having frequent night sweats that drench her clothes and bedding.

A.K lives in a crowded urban slum with her husband and three children. The living conditions are poor, with inadequate ventilation and sanitation. She spends most of her day in close contact with people while selling goods at the market. There is a known high prevalence of tuberculosis (TB) in her community. She has no history of previous TB infection or treatment.

- General: Thin and pale appearance, mild respiratory distress
- Vitals: BP 110/70 mmHg, HR 100 bpm, RR 22 breaths/min, SpO2 94% on room air, temperature 38.2°C
- Respiratory: Bilateral coarse crackles in the upper lobes, dullness to percussion
over the right upper lobe, mild wheezing
- Lymphatic: Palpable axillary and cervical lymphadenopathy

- Sputum Analysis: Positive for acid-fast bacilli (AFB)

- Chest X-ray: Cavitary lesions and infiltrates in the upper lobes of both lungs
- Tuberculin Skin Test (TST): Positive with induration of 15 mm
- HIV Test: Negative

Pulmonary Tuberculosis (PTB)

1. Anti-TB Medications:
- Initiation of a standard 6-month course of anti-tuberculosis therapy (ATT) with the first two months of intensive phase including isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by a continuation phase of isoniazid and rifampicin.
2. Nutritional Support: Education about balanced diet that could be got from locally produced food. Provision of nutritional supplements to address weight loss and malnutrition.
3. Infection Control: Education on cough hygiene, use of masks, and importance of ventilation to reduce transmission risk.
4. Follow-Up: Regular follow-up visits to monitor treatment adherence, side effects, and response to therapy. Sputum samples will be checked at 2, 4, and 6 months to ensure conversion to AFB-negative status.

- Contact Tracing: Screening and testing of household members and close contacts for TB.
- Community Education: Raising awareness about TB symptoms, transmission, and the importance of early.