Summary
Definition
History and exam
Key diagnostic factors
- enlarged lymph node
- pleuritic chest pain
- skeletal pain
- urinary symptoms
- abdominal swelling
- abdominal pain
- headache
Other diagnostic factors
- 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
Risk factors
- exposure to TB
- born in Asia, Latin America, or Africa
- HIV infection
- immunosuppressive medications
- hematologic or head/neck malignancy
- end stage renal disease (ESRD)
- apical fibrosis
- intravenous drug use
- female gender
- Asian, black, and Native American ethnicity
- malnutrition
- alcoholism
- diabetes
- cirrhosis
- high-risk congregate settings
- low socioeconomic status
- very young age
Diagnostic investigations
1st investigations to order
- chest x-ray
- sputum smear
- sputum culture
- tuberculin skin testing (TST)
- CBC
- lymph node FNA
- pleural fluid analysis
- ascitic fluid analysis
- bone films
- CSF analysis
- urinalysis
- nucleic acid amplification test (NAAT)
Investigations to consider
- lymph node biopsy
- pleural biopsy
- synovial biopsy
- liver biopsy
- bone marrow biopsy
- blood culture
- peritoneal biopsy
- gastric aspirate
- bronchoscopy
- thoracoscopy
- susceptibility testing
- interferon-gamma release assays (IGRAs)
- genotyping
- HIV test
- empiric treatment
- CT scan chest or abdomen
- colonoscopy
- pericardial fluid analysis
- pericardial biopsy
Treatment algorithm
Contributors
Authors VIEW ALL
Associate Professor
Division of Pulmonary, Critical Care, and Sleep Medicine
University of Washington
Director
Firland Northwest TB Center
Seattle
WA
Disclosures
DJH has received a research grant from Qiagen, the manufacturer of QuantiFERON tests, to study a fourth-generation interferon-gamma release assay.
Professor of Medicine
Division of Pulmonary, Critical Care, and Sleep Medicine
University of Washington
Co-Founder
Firland Northwest TB Center
Seattle
WA
Disclosures
MN declares that he has no competing interests.
Peer reviewers VIEW ALL
Infectious Disease Specialist
Alabama Infectious Diseases Center
Huntsville
AL
Disclosures
AH declares that he has no competing interests.
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