Last reviewed: June 2018
Last updated: March  2018

Summary

Definition

History and exam

Key diagnostic factors

  • cough
  • fever
  • anorexia
  • weight loss
  • malaise

Other diagnostic factors

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

Risk factors

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

Diagnostic investigations

1st investigations to order

  • CXR
  • sputum acid-fast bacilli (AFB) smear
  • sputum culture
  • CBC
  • nucleic acid amplification tests (NAAT)
Full details

Investigations to consider

  • gastric aspirate
  • bronchoscopy and bronchoalveolar lavage (BAL)
  • tuberculin skin testing (TST)
  • interferon-gamma release assays (IGRAs)
  • empiric treatment
  • susceptibility testing
  • genotyping
  • HIV test
  • CT of chest
  • Xpert MTB/RIF
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

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

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 VIEW ALL

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.

Consultant Chest Physician

Llandough Hospital

Llandough

Penarth

South Wales

Disclosures

IC declares that he has no competing interests.

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