Tuberculosis resident survival guide

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Tuberculosis Resident Survival Guide Microchapters
Overview
Diagnostic Criteria
Causes
Diagnostic Approach
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Moises Romo M.D.

Synonyms and Keywords: Approach to tuberculosis, Approach to TB, Tuberculosis workup, TB workup

Overview

Tuberculosis (TB) is a common and very contagious infectious disease caused by Mycobacterium tuberculosis bacteria (MTB). MTB can affect every system of the human body, but most commonly affects the respiratory system since this organism grow vigorously in high oxygen environments. It is calculated that more than a third of the world's population has been exposed to MTB, being the vast majority of them asymptomatic and maintaining as latent. Symptoms of respiratory active tuberculosis includes hemoptysis, shortness of breath, fever, chills, night sweats, and weight loss. Usually latent tuberculosis is treated with a regimen of 6-9 months of rifampin or isoniazid, while active TB is managed with a phase of four antituberculous agents (rifampin, isoniazid, ethambutol, pyrazinamide) for 2 months to later be continued only by isoniazid and rifampin 4 more months.

Diagnostic Criteria

Test for latent tuberculosis

Tests for active tuberculosis disease


Causes


Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of Tuberculosis according the the Association of Chest Physicians guidelines:[14]

 
 
 
 
 
 
 
 
Presumptive TB
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sputum examination + Chest X-ray
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sputum positive for TB, Chest X-ray suggestive of TB
 
Sputum positive for TB, chest X-ray not suggestive of TB
 
Sputum negative for TB, chest X-ray suggestive of TB
 
Sputum negative for TB, chest X-ray not suggestive of TB
 
High clinical suspicion for TB
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cartridge-Based Nucleic Acid Amplification Test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mycobacterium tuberculosis detected
 
Mycobacterium tuberculosis not detected or Cartridge-Based Nucleic Acid Amplification Test result not available
 
 
 
 
Considere alternate diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rifampicin sensitive
 
Rifampicin indeterminate
 
Rifampicin resistant
 
Clinically diagnosed TB
 
Alternate diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Microbiologically confirmed TB
 
 
 
 
 
Repeat Cartridge-Based Nucleic Acid Amplification Test on 2nd sample
 
Refer to management of Rifampicin resistance
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Indeterminate of 2nd sample, collect fresh sample of liquid culture/ Line Probe Assay
 


Treatment

Shown below is an algorithm summarizing the treatment of Tuberculosis according the the Centers of Disease Control and Prevention guidelines (CDC):[15]


 
 
 
 
 
 
 
 
Presumptive TB
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Place patient on RIPE (rifampin, isoniazide, pyrazinamide, ethambutol)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Did the specimen sent for culture at the initial evaluation return positive?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Give isoniazide and rifampin for 4 months
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Was there cavitation on initial chest X-ray?
 
No
 
Is the patient HIV positive?
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
Yes
 
Give isoniazide and rifampin for 4 months
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Give isoniazide and rifampin for 7 months
 
 
 
 
 
 
 
 
 
 
 


Do's


Don'ts

  • Don't wait for culture results before initiating Tb treatment in suspicious cases.


References

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  12. Hughes R, Wonderling D, Li B, Higgins B (February 2012). "The cost effectiveness of Nucleic Acid Amplification Techniques for the diagnosis of tuberculosis". Respir Med. 106 (2): 300–7. doi:10.1016/j.rmed.2011.10.005. PMID 22137190.
  13. Ankrah AO, Glaudemans A, Maes A, Van de Wiele C, Dierckx R, Vorster M, Sathekge MM (March 2018). "Tuberculosis". Semin Nucl Med. 48 (2): 108–130. doi:10.1053/j.semnuclmed.2017.10.005. PMID 29452616. Vancouver style error: initials (help)
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