Last reviewed: November 2017
Last updated: December  2017

Summary

Definition

History and exam

Key diagnostic factors

  • enlarged lymph node
  • pleuritic chest pain
  • skeletal pain
  • headache
  • urinary symptoms
  • abdominal swelling
  • abdominal pain

Other diagnostic factors

  • cough
  • altered mental status
  • neurologic symptoms
  • hepatomegaly
  • abnormal chest examination
  • fever
  • weight loss of more than 10% body weight
  • anorexia
  • malaise
  • night sweats
  • dyspnea
  • asymptomatic
  • erythema nodosum

Risk factors

  • exposure to TB
  • born in Asia, Latin America, or Africa
  • HIV infection
  • immunosuppressive medications
  • hematologic or head/neck malignancy
  • end stage renal disease (ESRD)
  • apical fibrosis
  • intravenous drug use
  • female gender
  • Asian, black, and Native American ethnicity
  • malnutrition
  • alcoholism
  • diabetes
  • cirrhosis
  • high-risk congregate settings
  • low socioeconomic status
  • very young age

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • sputum smear
  • sputum culture
  • tuberculin skin testing (TST)
  • CBC
  • lymph node FNA
  • pleural fluid analysis
  • ascitic fluid analysis
  • bone films
  • CSF analysis
  • urinalysis
  • nucleic acid amplification test (NAAT)
Full details

Investigations to consider

  • lymph node biopsy
  • pleural biopsy
  • synovial biopsy
  • liver biopsy
  • bone marrow biopsy
  • blood culture
  • peritoneal biopsy
  • gastric aspirate
  • bronchoscopy
  • thoracoscopy
  • susceptibility testing
  • interferon-gamma release assays (IGRAs)
  • genotyping
  • HIV test
  • empiric treatment
  • CT scan chest or abdomen
  • colonoscopy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

David J. Horne

Assistant Professor

Division of Pulmonary and Critical Care Medicine

University of Washington

Director

Firland Northwest TB Center

Seattle

WA

Disclosures

DJH has received a research grant from Qiagen, the manufacturer of QuantiFERON tests, to study a fourth-generation interferon-gamma release assay.

Masahiro Narita

Professor of Medicine

Division of Pulmonary and Critical Care Medicine

University of Washington

Co-Founder

Firland Northwest TB Center

Seattle

WA

Disclosures

MN declares that he has no competing interests.

Peer reviewers VIEW ALL

Infectious Disease Specialist

Alabama Infectious Diseases Center

Huntsville

AL

Disclosures

AH declares that he has no competing interests.

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