Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- enlarged lymph node
- pleuritic chest pain
- skeletal pain
- urinary symptoms
- abdominal swelling
- abdominal pain
- headache
Otros factores de diagnóstico
- 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
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- 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)
Pruebas diagnósticas que deben considerarse
- 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)
Algoritmo de tratamiento
latent TB infection: nonpregnant
latent TB infection: pregnant
active TB: nonpregnant, HIV-negative
active TB: nonpregnant, HIV-positive
active TB: pregnant
Colaboradores
Autores
David J. Horne, MD, MPH
Associate Professor
Division of Pulmonary, Critical Care, and Sleep 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
University of Washington
Co-Founder
Firland Northwest TB Center
Seattle
WA
Divulgaciones
MN declares that he has no competing interests.
Revisores por pares
Carlos Acuña-Villaorduña, MD
Infectious Diseases Physician
Boston University Medical Center
Boston
MA
Divulgaciones
CA-V declares that he has no competing interests.
James Shepherd, MD, PhD
Infectious Disease Consultant
Yale University School of Medicine
New Haven
CT
Divulgaciones
JS 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
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. Sep 2022 [internet publication].Texto completo
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
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].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: tuberculosis preventive treatment. Module 1: prevention. 2020 [internet publication].Texto completo
World Health Organization. WHO consolidated guidelines on tuberculosis, module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Dec 2022 [internet publication]Texto completo Resumen
British HIV Association. BHIVA guidelines for the management of tuberculosis in adults living with HIV 2018 (2023 interim update). 2023 [internet publication].Texto completo
World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Lymphoma
- Nontuberculous mycobacteria lymphadenitis
- Sarcoidosis
Más DiferencialesGuías de práctica clínica
- WHO consolidated guidelines on tuberculosis. Module 3: diagnosis - rapid diagnostics for tuberculosis detection, 3rd ed
- WHO consolidated guidelines on tuberculosis: module 6: tuberculosis and comorbidities
Más Guías de práctica clínicaFolletos para el paciente
Tuberculosis
BCG vaccination
Más Folletos para el pacienteVideos
Diagnostic lumbar puncture in adults: animated demonstration
Abdominal paracentesis animated demonstration
Más vídeos
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad