Pulmonary tuberculosis
Summary
Definição
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
- cough
- fever
- anorexia
- weight loss
- malaise
Outros fatores diagnósticos
- night sweats
- pleuritic chest pain
- haemoptysis
- psychological symptoms
- abnormal chest auscultation
- asymptomatic
- dyspnoea
- clubbing
- erythema nodosum and erythema induratum
Fatores de risco
- exposure to infection
- birth in an endemic country
- HIV infection
- immunosuppressive medicines
- malignancy
- silicosis
- end-stage renal disease
- apical fibrosis
- intravenous drug use
- malnutrition
- alcoholism
- diabetes
- high-risk congregate settings
- low socio-economic status or black/Hispanic/Native American ancestry
- age
- tobacco smoking
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- chest x-ray
- sputum acid-fast bacilli smear
- sputum culture
- FBC (full blood count)
- nucleic acid amplification tests (NAAT)
Investigações a serem consideradas
- gastric aspirate
- bronchoscopy and bronchoalveolar lavage
- stool testing
- empirical treatment
- drug susceptibility testing
- genotyping
- HIV test
- lateral flow urine lipoarabinomannan (LF-LAM) assay
- CT of chest
- tuberculin skin testing
- interferon-gamma release assays
- TB antigen-based skin tests (TBSTs)
Algoritmo de tratamento
latent TB infection: non-pregnant
latent TB infection: pregnant
active TB HIV-negative non-pregnant: no hepatic dysfunction
active TB HIV-positive non-pregnant: no hepatic dysfunction
active TB pregnant
active TB non-pregnant: pre-existing or drug-induced hepatic dysfunction
recurrent TB
Colaboradores
Autores
David J. Horne, MD, MPH
Associate Professor
Division of Pulmonary, Critical Care, and Sleep Medicine
Department of Medicine
University of Washington
Seattle
WA
Declarações
DJH declares that he has no competing interests.
Masahiro Narita, MD
Professor of Medicine
Division of Pulmonary, Critical Care, and Sleep Medicine
Department of Medicine
University of Washington
Seattle
WA
Declarações
MN declares that he has no competing interests. MN is the author of a reference cited in this topic.
Revisores
Fayez Kheir, MD, MSc
Assistant Professor of Medicine
Harvard Medical School
Division of Pulmonary and Critical Care
Massachusetts General Hospital
Boston
MA
Declarações
FK declares that he has no competing interests.
William Burman, MD
Professor
Division of Infectious Diseases
University of Colorado at Denver and Health Sciences Center
Denver
CO
Declarações
WB declares that he has no competing interests.
Ian Campbell, MD (Lond), FRCP (Edin & Lond)
Consultant Chest Physician
Llandough Hospital
Llandough
Penarth
South Wales
Declarações
IC declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016 Oct 1;63(7):e147-95.Texto completo Resumo
Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):e1-33.Texto completo Resumo
World Health Organization. WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. Mar 2022 [internet publication].Texto completo
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: mycobacterium tuberculosis infection and disease. 2024 [internet publication].Texto completo
Nahid P, Mase SR, Migliori GB, et al. Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA clinical practice guideline. Am J Respir Crit Care Med. 2019 Nov 15;200(10):e93-142.Texto completo Resumo
World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].Texto completo
Uthman OA, Okwundu C, Gbenga K, et al. Optimal timing of antiretroviral therapy initiation for HIV-infected adults with newly diagnosed pulmonary tuberculosis: a systematic review and meta-analysis. Ann Intern Med. 2015 Jul 7;163(1):32-9. Resumo
World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-resistant tuberculosis treatment, 2022 update. Dec 2022 [internet publication].Texto completo
Tuberculosis Trials Consortium. Rifapentine and isoniazid once a week versus rifampicin and isoniazid twice a week for treatment of drug-susceptible pulmonary tuberculosis in HIV-negative patients: a randomised clinical trial. Lancet. 2002 Aug 17;360(9332):528-34. Resumo
American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America. Controlling tuberculosis in the United States. Am J Respir Crit Care Med. 2005 Nov 1;172(9):1169-227.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Coronavirus disease 2019 (COVID-19)
- Community-acquired pneumonia
- Lung cancer
Mais Diagnósticos diferenciaisDiretrizes
- Guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV: Mycobacterium tuberculosis infection and disease
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: mycobacterium tuberculosis infection and disease
Mais DiretrizesFolhetos informativos para os pacientes
Tuberculosis
BCG vaccination
Mais Folhetos informativos para os pacientes
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