Tuberculose pulmonar
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- tosse
- febre
- anorexia
- perda de peso
- mal-estar
Outros fatores diagnósticos
- sudorese noturna
- dor torácica pleurítica
- hemoptise
- sintomas psicológicos
- ausculta torácica anormal
- assintomático
- dispneia
- baqueteamento digital
- eritema nodoso e eritema induratum
Fatores de risco
- exposição à infecção
- nascimento em um país endêmico
- Infecção pelo vírus da imunodeficiência humana (HIV)
- medicamentos imunossupressores
- neoplasias malignas
- silicose
- doença renal em estágio terminal
- fibrose apical
- uso de substâncias por via intravenosa
- desnutrição
- alcoolismo
- diabetes
- aspectos combinados de alto risco
- baixa condição socioeconômica ou ancestralidade negra/hispânica/índios norte-americanos
- idade
- tabagismo
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- radiografia torácica
- baciloscopia do escarro para detecção de bacilos álcool-ácido resistentes
- cultura de escarro
- Hemograma completo
- testes de amplificação de ácido nucleico (NAATs)
Investigações a serem consideradas
- aspirado gástrico
- broncoscopia e lavagem broncoalveolar
- exame de fezes
- tratamento empírico
- teste de sensibilidade a medicamentos
- genotipagem
- teste de HIV
- ensaio de lipoarabinomanano de fluxo lateral na urina (LF-LAM)
- tomografia computadorizada (TC) do tórax
- teste tuberculínico cutâneo
- testes de liberação de gamainterferona
- Testes cutâneos baseados em antígenos de TB (TCTB)
Algoritmo de tratamiento
Colaboradores
Autores
David J. Horne, MD, MPH
Associate Professor
Division of Pulmonary, Critical Care, and Sleep Medicine
Department of Medicine
University of Washington
Seattle
WA
Divulgaciones
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
Divulgaciones
MN declares that he has no competing interests. MN is the author of a reference cited in this topic.
Revisores por pares
Fayez Kheir, MD, MSc
Assistant Professor of Medicine
Harvard Medical School
Division of Pulmonary and Critical Care
Massachusetts General Hospital
Boston
MA
Divulgaciones
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
Divulgaciones
WB declares that he has no competing interests.
Ian Campbell, MD (Lond), FRCP (Edin & Lond)
Consultant Chest Physician
Llandough Hospital
Llandough
Penarth
South Wales
Divulgaciones
IC declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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.Texto completo Resumen
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.Texto completo Resumen
World Health Organization. WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. Mar 2022 [internet publication].Texto completo
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].Texto completo
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.Texto completo Resumen
World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].Texto completo
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. Resumen
World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-resistant tuberculosis treatment, 2022 update. Dec 2022 [internet publication].Texto completo
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. Resumen
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.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible aquí.
Guías de práctica clínica
- 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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