Last reviewed: 27 Jun 2021
Last updated: 29 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough
  • fever
  • anorexia
  • weight loss
  • malaise

Other diagnostic factors

  • night sweats
  • pleuritic chest pain
  • haemoptysis
  • psychological symptoms
  • abnormal chest auscultation
  • asymptomatic
  • dyspnoea
  • clubbing
  • erythema nodosum and erythema induratum

Risk factors

  • 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

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • sputum acid-fast bacilli smear
  • sputum culture
  • FBC (full blood count)
  • nucleic acid amplification tests (NAAT)

Investigations to consider

  • gastric aspirate
  • bronchoscopy and bronchoalveolar lavage
  • tuberculin skin testing
  • interferon-gamma release assays
  • empirical treatment
  • drug susceptibility testing
  • genotyping
  • HIV test
  • lateral flow urine lipoarabinomannan (LF-LAM) assay
  • CT of chest

Treatment algorithm

Contributors

Authors

David J. Horne, MD, MPH
David J. Horne

Associate Professor

Division of Pulmonary, Critical Care, and Sleep Medicine

Department of Medicine

University of Washington

Seattle

WA

Disclosures

DJH declares that he has no competing interests.

Masahiro Narita, MD
Masahiro Narita

Professor of Medicine

Division of Pulmonary, Critical Care, and Sleep Medicine

Department of Medicine

University of Washington

Seattle

WA

Disclosures

MN declares that he has no competing interests.

Peer reviewers

William Burman, MD

Professor

Division of Infectious Diseases

University of Colorado at Denver and Health Sciences Center

Denver

CO

Disclosures

WB declares that he has no competing interests.

Ian Campbell, MD (Lond), FRCP (Edin & Lond)

Consultant Chest Physician

Llandough Hospital

Llandough

Penarth

South Wales

Disclosures

IC declares that he has no competing interests.

Use of this content is subject to our disclaimer