Last reviewed: 25 Oct 2020
Last updated: 07 Aug 2020

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 and erythema induratum

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

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • sputum acid-fast bacilli smear
  • sputum culture
  • CBC (complete blood count)
  • nucleic acid amplification tests
More 1st investigations to order

Investigations to consider

  • gastric aspirate
  • bronchoscopy and bronchoalveolar lavage
  • tuberculin skin testing
  • interferon-gamma release assays
  • empiric treatment
  • drug susceptibility testing
  • genotyping
  • HIV test
  • CT of chest
  • Xpert MTB/RIF
More investigations to consider

Treatment algorithm

Contributors

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 reviewersVIEW 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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