Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- linfonodo aumentado
- dor torácica pleurítica
- dor esquelética
- sintomas urinários
- inchaço abdominal
- dor abdominal
- cefaleia
Other diagnostic factors
- tosse
- estado mental alterado
- sintomas neurológicos
- hepatomegalia
- exames torácicos anormais
- febre
- perda de peso de mais que 10% do peso corporal
- anorexia
- mal-estar
- sudorese noturna
- dispneia
- assintomático
- eritema nodoso e eritema induratum
Risk factors
- exposição à tuberculose (TB)
- nascidos na Ásia, América Latina ou África
- Infecção pelo vírus da imunodeficiência humana (HIV)
- medicamentos imunossupressores
- neoplasia hematológica ou de cabeça/pescoço
- doença renal em estágio terminal
- fibrose apical
- uso de substâncias por via intravenosa
- sexo feminino
- indivíduos de origem asiática, negros e índios norte-americanos
- desnutrição
- alcoolismo
- diabetes
- cirrose
- aspectos combinados de alto risco
- condição socioeconômica baixa
- muito jovem
Diagnostic investigations
1st investigations to order
- radiografia torácica
- baciloscopia do escarro
- cultura de escarro
- Hemograma completo
- aspiração com agulha fina do linfonodo
- análise do líquido pleural
- análise do líquido ascítico
- radiografias dos ossos
- análise do líquido cefalorraquidiano
- urinálise
- teste de amplificação de ácido nucleico (NAAT)
Investigations to consider
- biópsia de linfonodos
- biópsia pleural
- biópsia sinovial
- biópsia hepática
- biópsia da medula óssea
- hemocultura
- biópsia peritoneal
- aspirado gástrico
- broncoscopia
- toracoscopia
- teste de sensibilidade a medicamentos
- genotipagem
- teste de HIV
- ensaio de lipoarabinomanano de fluxo lateral na urina (LF-LAM)
- tratamento empírico
- tomografia computadorizada (TC) do tórax ou abdome
- ultrassonografia abdominal
- colonoscopia
- análise do líquido pericárdico
- biópsia pericárdica
- teste tuberculínico cutâneo
- testes de liberação de gamainterferona
- Testes cutâneos baseados em antígenos de TB (TCTB)
Treatment algorithm
infecção latente por TB: não gestante
infecção latente por TB: gestante
TB ativa: não gestante, HIV-negativo
TB ativa: não gestante, HIV-positivo
TB ativa: gestante
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
- Linfadenite micobacteriana não tuberculosa
- Sarcoidose
More DifferentialsGuidelines
- Guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV: Mycobacterium tuberculosis infection and disease
- Guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV: Mycobacterium tuberculosis infection and disease
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Tuberculose
Vacinação com BCG
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