Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- tos
- fiebre
- anorexia
- pérdida de peso
- malestar general
Other diagnostic factors
- sudores nocturnos
- dolor torácico pleurítico
- hemoptisis
- síntomas psicológicos
- auscultación pulmonar anómala
- asintomático
- disnea
- acropaquias
- eritema nodoso y eritema indurato
Risk factors
- exposición a infección
- nacimiento en un país endémico
- Infección por VIH
- medicamentos inmunosupresores
- neoplasia maligna
- silicosis
- nefropatía terminal
- fibrosis apical
- consumo de drogas ilícitas por vía intravenosa
- desnutrición
- alcoholismo
- diabetes
- instituciones de alto riesgo
- nivel socioeconómico bajo o ascendencia de raza negra, hispanos o nativo-americanos
- edad
- tabaquismo
Diagnostic tests
1st tests to order
- radiografía de tórax
- frotis de bacilos ácido-alcohol resistentes del esputo
- cultivo de esputo
- HC (hemograma completo)
- pruebas de amplificación de ácidos nucleicos (PAAN)
Tests to consider
- aspirado gástrico
- broncoscopia y lavado broncoalveolar
- pruebas en heces
- tratamiento empírico
- prueba de susceptibilidad a fármacos
- genotipado
- prueba del VIH
- ensayo de lipoarabinomanano en orina de flujo lateral (LF-LAM)
- tomografía computarizada (TC) de tórax
- pruebas cutáneas de la tuberculina
- determinación de la liberación de interferón gamma
- Pruebas cutáneas basadas en el antígeno de la tuberculosis (TBST)
Treatment algorithm
Contributors
Authors
David J. Horne, MD, MPH
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, MD
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. MN is the author of a reference cited in this topic.
Peer reviewers
Fayez Kheir, MD, MSc
Assistant Professor of Medicine
Harvard Medical School
Division of Pulmonary and Critical Care
Massachusetts General Hospital
Boston
MA
Disclosures
FK declares that he has no competing interests.
William Burman, MD
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.
Ian Campbell, MD (Lond), FRCP (Edin & Lond)
Consultant Chest Physician
Llandough Hospital
Llandough
Penarth
South Wales
Disclosures
IC declares that he has no competing interests.
References
Key articles
Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016 Oct 1;63(7):e147-95.Full text Abstract
Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):e1-33.Full text Abstract
World Health Organization. WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. Mar 2022 [internet publication].Full text
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: mycobacterium tuberculosis infection and disease. 2024 [internet publication].Full text
Nahid P, Mase SR, Migliori GB, et al. Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA clinical practice guideline. Am J Respir Crit Care Med. 2019 Nov 15;200(10):e93-142.Full text Abstract
World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].Full text
Uthman OA, Okwundu C, Gbenga K, et al. Optimal timing of antiretroviral therapy initiation for HIV-infected adults with newly diagnosed pulmonary tuberculosis: a systematic review and meta-analysis. Ann Intern Med. 2015 Jul 7;163(1):32-9. Abstract
World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-resistant tuberculosis treatment, 2022 update. Dec 2022 [internet publication].Full text
Tuberculosis Trials Consortium. Rifapentine and isoniazid once a week versus rifampicin and isoniazid twice a week for treatment of drug-susceptible pulmonary tuberculosis in HIV-negative patients: a randomised clinical trial. Lancet. 2002 Aug 17;360(9332):528-34. Abstract
American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America. Controlling tuberculosis in the United States. Am J Respir Crit Care Med. 2005 Nov 1;172(9):1169-227.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
Guidelines
- Guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV: Mycobacterium tuberculosis infection and disease
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: mycobacterium tuberculosis infection and disease
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