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 and erythema induratum
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
- 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
Diagnostic investigations
1st investigations to order
- chest x-ray
- sputum smear
- sputum culture
- tuberculin skin testing
- 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)
Investigations to consider
- lymph node biopsy
- pleural biopsy
- synovial biopsy
- liver biopsy
- bone marrow biopsy
- blood culture
- peritoneal biopsy
- gastric aspirate
- bronchoscopy
- thoracoscopy
- drug susceptibility testing
- interferon-gamma release assays
- 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
- TB antigen-based skin tests (TBST)
Treatment algorithm
latent TB infection: nonpregnant
latent TB infection: pregnant
no comorbidity nonpregnant, presumed or confirmed active TB: intensive phase
with comorbidity nonpregnant, presumed or confirmed active TB: intensive phase
pregnant, presumed or confirmed active TB: intensive phase
no comorbidity nonpregnant: continuation phase
with comorbidity nonpregnant: continuation phase
pregnant: continuation phase
Contributors
Authors
David J. Horne, MD, MPH

Associate Professor
Division of Pulmonary, Critical Care, and Sleep Medicine
University of Washington
Director
Firland Northwest TB Center
Seattle
WA
Disclosures
DJH declares that he has no competing interests.
Masahiro Narita, MD

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
Ali Hassoun, MD, FACP, FIDSA, AAHIVS
Infectious Disease Specialist
Alabama Infectious Diseases Center
Huntsville
AL
Disclosures
AH declares that he has no competing interests.
Differentials
- Lymphoma
- Nontuberculous mycobacteria lymphadenitis
- Sarcoidosis
More DifferentialsGuidelines
- WHO consolidated guidelines on tuberculosis. Module 4: treatment - tuberculosis care and support
- WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update
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