Pulmonary tuberculosis

Last reviewed: 3 Nov 2022
Last updated: 30 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough
  • fever
  • anorexia
  • weight loss
  • malaise
More key diagnostic factors

Other diagnostic factors

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

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
More risk factors

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)
More 1st investigations to order

Investigations to consider

  • gastric aspirate
  • bronchoscopy and bronchoalveolar lavage
  • stool testing
  • 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
  • TB antigen-based skin tests (TBSTs)
More investigations to consider

Treatment algorithm

INITIAL

latent TB infection: non-pregnant

latent TB infection: pregnant

ACUTE

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

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.

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.

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