Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- agrandamiento de ganglios linfáticos
- dolor torácico pleurítico
- dolor esquelético
- síntomas urinarios
- hinchazón abdominal
- dolor abdominal
- cefalea
Other diagnostic factors
- tos
- alteración del estado mental
- síntomas neurológicos
- hepatomegalia
- exploración física de tórax anómala
- fiebre
- pérdida de peso mayor al 10% del peso corporal
- anorexia
- malestar general
- sudores nocturnos
- disnea
- asintomático
- eritema nodoso y eritema indurato
Risk factors
- exposición a la tuberculosis (TB)
- personas nacidas en Asia, América Latina o África
- Infección por VIH
- medicamentos inmunosupresores
- neoplasia maligna hematológica o de cabeza/cuello
- nefropatía terminal
- fibrosis apical
- consumo de drogas ilícitas por vía intravenosa
- sexo femenino
- etnias asiáticas, de raza negra y de indígenas norteamericanos
- desnutrición
- alcoholismo
- diabetes
- cirrosis
- instituciones de alto riesgo
- bajo nivel socioeconómico
- edad muy temprana
Diagnostic investigations
1st investigations to order
- radiografía de tórax
- frotis de esputo
- cultivo de esputo
- HC (hemograma completo)
- aspiración con aguja fina de los ganglios linfáticos
- análisis del líquido pleural
- análisis del líquido ascítico
- radiografías óseas
- análisis de líquido cefalorraquídeo
- análisis de orina
- prueba de amplificación de ácidos nucleicos (PAAN)
Investigations to consider
- biopsia del ganglio linfático
- biopsia pleural
- biopsia sinovial
- biopsia hepática
- biopsia de médula ósea
- hemocultivo
- biopsia peritoneal
- aspirado gástrico
- broncoscopia
- toracoscopia
- prueba de susceptibilidad a fármacos
- genotipado
- prueba del VIH
- ensayo de lipoarabinomanano en orina de flujo lateral (LF-LAM)
- tratamiento empírico
- tomografía computarizada (TC) de tórax o abdomen
- ultrasonido de abdomen
- colonoscopia
- análisis del líquido pericárdico
- biopsia pericárdica
- pruebas cutáneas de la tuberculina
- determinación de la liberación de interferón gamma
- Pruebas cutáneas basadas en el antígeno de la tuberculosis (TBST)
Treatment algorithm
infección de TB latente: no embarazada
infección latente de TB: embarazada
TB activa: no embarazada, VIH negativo
TB activa: no embarazada, VIH positivo
TB activa: embarazada
Contributors
Authors
David J. Horne, MD, MPH
Associate Professor
Division of Pulmonary, Critical Care, and Sleep 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
University of Washington
Co-Founder
Firland Northwest TB Center
Seattle
WA
Disclosures
MN declares that he has no competing interests.
Peer reviewers
Carlos Acuña-Villaorduña, MD
Infectious Diseases Physician
Boston University Medical Center
Boston
MA
Disclosures
CA-V declares that he has no competing interests.
James Shepherd, V
Infectious Disease Consultant
Yale University School of Medicine
New Haven
CT
Disclosures
JS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
World Health Organization. WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. Sep 2022 [internet publication].Full text
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
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
World Health Organization. WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment. Module 1: prevention. 2020 [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
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. Mycobacterium tuberculosis infection and disease. May 2024 [internet publication].Full text
World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].Full text
World Health Organization. WHO consolidated guidelines on tuberculosis, module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Dec 2022 [internet publication].Full text Abstract
British HIV Association. British HIV Association guidelines for the management of tuberculosis in adults living with HIV 2018 (2023 interim update). 2023 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Linfoma
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