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Extrapulmonary tuberculosis

Última revisão: 11 Aug 2025
Última atualização: 01 Nov 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

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

Outros fatores diagnósticos

  • 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 and erythema induratum
Detalhes completos

Fatores de risco

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

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • chest x-ray
  • sputum smear
  • sputum culture
  • CBC (complete blood count)
  • lymph node fine-needle aspiration
  • pleural fluid analysis
  • ascitic fluid analysis
  • bone films
  • cerebrospinal fluid analysis
  • urinalysis
  • nucleic acid amplification test (NAAT)
Detalhes completos

Investigações a serem consideradas

  • lymph node biopsy
  • pleural biopsy
  • synovial biopsy
  • liver biopsy
  • bone marrow biopsy
  • blood culture
  • peritoneal biopsy
  • gastric aspirate
  • bronchoscopy
  • thoracoscopy
  • drug susceptibility testing
  • genotyping
  • HIV test
  • lateral flow urine lipoarabinomannan (LF-LAM) assay
  • empiric treatment
  • CT scan chest or abdomen
  • abdominal ultrasound
  • colonoscopy
  • pericardial fluid analysis
  • pericardial biopsy
  • tuberculin skin testing
  • interferon-gamma release assays
  • TB antigen-based skin tests (TBST)
Detalhes completos

Algoritmo de tratamento

Inicial

latent TB infection: nonpregnant

latent TB infection: pregnant

AGUDA

active TB: nonpregnant, HIV-negative

active TB: nonpregnant, HIV-positive

active TB: pregnant

Colaboradores

Autores

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

Associate Professor

Division of Pulmonary, Critical Care, and Sleep Medicine

University of Washington

Seattle

WA

Declarações

DJH declares that he has no competing interests.

Masahiro Narita, MD
Masahiro Narita

Professor of Medicine

Division of Pulmonary, Critical Care, and Sleep Medicine

University of Washington

Co-Founder

Firland Northwest TB Center

Seattle

WA

Declarações

MN declares that he has no competing interests.

Revisores

Carlos Acuña-Villaorduña, MD

Infectious Diseases Physician

Boston University Medical Center

Boston

MA

Declarações

CA-V declares that he has no competing interests.

James Shepherd, MD, PhD

Infectious Disease Consultant

Yale University School of Medicine

New Haven

CT

Declarações

JS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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. Sep 2022 [internet publication].Texto completo

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

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. Mycobacterium tuberculosis infection and disease. May 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: tuberculosis preventive treatment. Module 1: prevention. 2020 [internet publication].Texto completo

World Health Organization. WHO consolidated guidelines on tuberculosis, module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Dec 2022 [internet publication]Texto completo  Resumo

British HIV Association. BHIVA guidelines for the management of tuberculosis in adults living with HIV 2018 (2023 interim update). 2023 [internet publication].Texto completo

World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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    • WHO consolidated guidelines on tuberculosis. Module 3: diagnosis - rapid diagnostics for tuberculosis detection, 3rd ed
    • WHO consolidated guidelines on tuberculosis: module 6: tuberculosis and comorbidities
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