Last reviewed: 4 Jul 2024
Last updated: 05 Oct 2023
Summary
Definition
History and exam
Key diagnostic factors
- enlarged lymph node
- pleuritic chest pain
- skeletal pain
- urinary symptoms
- abdominal swelling
- abdominal pain
- headache
Full details
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
Full details
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
Full details
Diagnostic tests
1st tests to order
- 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)
Full details
Tests 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
- 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)
Full details
Treatment algorithm
INITIAL
latent TB infection: nonpregnant
latent TB infection: pregnant
ACUTE
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
ONGOING
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
More GuidelinesPatient information
Tuberculosis
BCG vaccination
More Patient informationVideos
Diagnostic lumbar puncture in adults: animated demonstration
Abdominal paracentesis animated demonstration
More videos- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer