When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Pulmonary tuberculosis

Last reviewed: 27 Jun 2024
Last updated: 17 Oct 2023

Summary

Definition

History and exam

Key diagnostic factors

  • cough
  • fever
  • anorexia
  • weight loss
  • malaise
Full details

Other diagnostic factors

  • night sweats
  • pleuritic chest pain
  • hemoptysis
  • psychological symptoms
  • abnormal chest auscultation
  • asymptomatic
  • dyspnea
  • clubbing
  • erythema nodosum and erythema induratum
Full details

Risk factors

  • exposure to infection
  • birth in an endemic country
  • HIV infection
  • immunosuppressive medications
  • malignancy
  • silicosis
  • end-stage renal disease
  • apical fibrosis
  • intravenous drug use
  • malnutrition
  • alcoholism
  • diabetes
  • high-risk congregate settings
  • low socioeconomic status or black/Hispanic/Native-American ancestry
  • age
  • tobacco smoking
Full details

Diagnostic tests

1st tests to order

  • chest x-ray
  • sputum acid-fast bacilli smear
  • sputum culture
  • CBC (complete blood count)
  • nucleic acid amplification tests (NAAT)
Full details

Tests to consider

  • gastric aspirate
  • bronchoscopy and bronchoalveolar lavage
  • stool testing
  • empiric 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)
Full details

Treatment algorithm

INITIAL

latent TB infection: nonpregnant

latent TB infection: pregnant

ACUTE

active TB HIV-negative nonpregnant: no hepatic dysfunction

active TB HIV-positive nonpregnant: no hepatic dysfunction

active TB pregnant

active TB non-pregnant: pre-existing or drug-induced hepatic dysfunction

ONGOING

recurrent TB

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. MN is the author of a reference cited in this topic.

Peer reviewers

Fayez Kheir, MD, MSc

Assistant Professor of Medicine

Harvard Medical School

Division of Pulmonary and Critical Care

Massachusetts General Hospital

Boston

MA

Disclosures

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

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.

  • Pulmonary tuberculosis images
  • Differentials

    • Coronavirus disease 2019 (COVID-19)
    • Community-acquired pneumonia
    • Lung cancer
    More Differentials
  • Guidelines

    • WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis
    • WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-resistant tuberculosis treatment, 2022 update
    More Guidelines
  • Patient information

    Tuberculosis

    BCG vaccination

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer