21st June 2024

A patient is referred from the emergency department with a one-month history of weight loss

A patient is referred from the emergency department with a one-month history of weight loss and night sweats. Their chest radiograph shows a unilateral pleural effusion with mediastinal adenopathy. Multiple investigations, including staining, culture and NAAT testing of pleural fluid and an aspirated lymph node are negative for Mycobacterium tuberculosis. A core biopsy of a mediastinal node shows caseating granulomata. A decision is made to empirically treat the patient for a presumptive diagnosis of tuberculosis while cultures are pending, however given the patient’s country of origin, concern is raised regarding drug resistance. The patient has never before been treated for tuberculosis. Which of the following countries would confer the highest pre-existing risk of drug-resistant TB?

Select the SINGLE most appropriate answer from the list below. Select ONE option only.