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{{WikiDoc CMG}}; [[User:MoisesRomo|Moises Romo M.D.]]


{{SK}}[[TB]], [[PPD-tuberculin skin test|PPD]], [[mycobacterium tuberculosis]]
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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Tuberculosis Resident Survival Guide Microchapters}}
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Tuberculosis resident survival guide#Overview|Overview]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Tuberculosis resident survival guide#Diagnostic Criteria|Diagnostic Criteria]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Tuberculosis resident survival guide#Causes|Causes]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Tuberculosis resident survival guide#Diagnostic Approach|Diagnostic Approach]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Tuberculosis resident survival guide#Treatment|Treatment]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Tuberculosis resident survival guide#Do's|Do's]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Tuberculosis resident survival guide#Don'ts|Don'ts]]
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__NOTOC__
 
{{WikiDoc CMG}}; '''Associate Editor(s)-in-Chief:''' [[User:MoisesRomo|Moises Romo M.D.]]
 
''{{SK}} approach to tuberculosis, approach to TB, tuberculosis workup, TB workup, TB treatment''
==Overview==
==Overview==
[[Tuberculosis]] (TB) is a common and very contagious [[infectious disease]] caused by [[Mycobacterium tuberculosis|Mycobacterium tuberculosis bacteria]] (MTB). MTB can affect every [[system]] of the [[human body]], but most commonly affects the [[Tuberculosis, pulmonary|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 [[Mycobacterium tuberculosis|MTB]], being the vast majority of them [[asymptomatic]] and maintaining as [[Latent tuberculosis|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.
[[Tuberculosis]] (TB) is a common and very contagious [[infectious disease]] caused by [[Mycobacterium tuberculosis|Mycobacterium tuberculosis bacteria]] (MTB). MTB can affect every [[system]] of the [[human body]], but most commonly affects the [[Tuberculosis, pulmonary|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 [[Mycobacterium tuberculosis|MTB]], being the vast majority of them [[asymptomatic]] and maintaining as [[Latent tuberculosis|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==
==Diagnostic Criteria==
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===Test for latent tuberculosis===
===Test for latent tuberculosis===


*[[Tuberculin test|Tuberculin skin test]]. Also known as [[Mantoux test]] or [[PPD-tuberculin skin test|PPD]] consists in the visualization of the [[skin]] reaction after the injection of [[Mycobacterium tuberculosis|M. tuberculosis]] [[antigens]] 24, 48, and 72 hours after. A positive result is interpreted as the following:<ref name="pmid23130251">{{cite journal |vauthors=Nayak S, Acharjya B |title=Mantoux test and its interpretation |journal=Indian Dermatol Online J |volume=3 |issue=1 |pages=2–6 |date=January 2012 |pmid=23130251 |pmc=3481914 |doi=10.4103/2229-5178.93479 |url=}}</ref><ref name="pmid30576322">{{cite journal |vauthors=Slogotskaya L, Bogorodskaya E, Ivanova D, Sevostyanova T |title=Comparative sensitivity of the test with tuberculosis recombinant allergen, containing ESAT6-CFP10 protein, and Mantoux test with 2 TU PPD-L in newly diagnosed tuberculosis children and adolescents in Moscow |journal=PLoS ONE |volume=13 |issue=12 |pages=e0208705 |date=2018 |pmid=30576322 |pmc=6303070 |doi=10.1371/journal.pone.0208705 |url=}}</ref><ref name="pmid32310497">{{cite journal |vauthors=Pahal P, Sharma S |title= |journal= |volume= |issue= |pages= |date= |pmid=32310497 |doi= |url=}}</ref><ref name="pmid25861338">{{cite journal |vauthors=Ryu YJ |title=Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms |journal=Tuberc Respir Dis (Seoul) |volume=78 |issue=2 |pages=64–71 |date=April 2015 |pmid=25861338 |pmc=4388902 |doi=10.4046/trd.2015.78.2.64 |url=}}</ref>
*[[Tuberculin test|Tuberculin skin test]]. Also known as [[Mantoux test]] or [[PPD-tuberculin skin test|PPD]] consists in the visualization of the [[skin]] reaction after the [[injection]] of [[Mycobacterium tuberculosis|M. tuberculosis]] [[antigens]] 24, 48, and 72 hours after. A positive result is interpreted as the following:<ref name="pmid23130251">{{cite journal |vauthors=Nayak S, Acharjya B |title=Mantoux test and its interpretation |journal=Indian Dermatol Online J |volume=3 |issue=1 |pages=2–6 |date=January 2012 |pmid=23130251 |pmc=3481914 |doi=10.4103/2229-5178.93479 |url=}}</ref><ref name="pmid30576322">{{cite journal |vauthors=Slogotskaya L, Bogorodskaya E, Ivanova D, Sevostyanova T |title=Comparative sensitivity of the test with tuberculosis recombinant allergen, containing ESAT6-CFP10 protein, and Mantoux test with 2 TU PPD-L in newly diagnosed tuberculosis children and adolescents in Moscow |journal=PLoS ONE |volume=13 |issue=12 |pages=e0208705 |date=2018 |pmid=30576322 |pmc=6303070 |doi=10.1371/journal.pone.0208705 |url=}}</ref><ref name="pmid32310497">{{cite journal |vauthors=Pahal P, Sharma S |title= |journal= |volume= |issue= |pages= |date= |pmid=32310497 |doi= |url=}}</ref><ref name="pmid25861338">{{cite journal |vauthors=Ryu YJ |title=Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms |journal=Tuberc Respir Dis (Seoul) |volume=78 |issue=2 |pages=64–71 |date=April 2015 |pmid=25861338 |pmc=4388902 |doi=10.4046/trd.2015.78.2.64 |url=}}</ref>
**>5 mm: [[HIV]] infected patients, [[CXR]] that suggests [[TB]] [[infection]], individuals taking [[steroids]]
**>5 mm: [[HIV]] infected [[patients]], [[chest x ray]] that suggests [[TB]] [[infection]], individuals taking [[steroids]]
**>10 mm: [[Healthcare]] workers, [[nursing home]] dweller, [[parenteral]] [[drug]] users, patients with [[immunocompromised]] [[diseases]]
**>10 mm: [[Healthcare]] workers, [[nursing home]] dweller, [[parenteral]] [[drug]] users, [[patients]] with [[immunocompromised]] [[diseases]]
**>15 mm: All individuals not cathegorized above
**>15 mm: All individuals not cathegorized above
*[[QuantiFERON|QuantiFERON-TB]]. Detects [[cell-mediated immunity]] to [[tuberculin]].<ref name="pmid31586819">{{cite journal |vauthors=Pourakbari B, Mamishi S, Benvari S, Mahmoudi S |title=Comparison of the QuantiFERON-TB Gold Plus and QuantiFERON-TB Gold In-Tube interferon-γ release assays: A systematic review and meta-analysis |journal=Adv Med Sci |volume=64 |issue=2 |pages=437–443 |date=September 2019 |pmid=31586819 |doi=10.1016/j.advms.2019.09.001 |url=}}</ref><ref name="pmid25861338" />
*[[QuantiFERON|QuantiFERON-TB]]. Detects [[cell-mediated immunity]] to [[tuberculin]].<ref name="pmid31586819">{{cite journal |vauthors=Pourakbari B, Mamishi S, Benvari S, Mahmoudi S |title=Comparison of the QuantiFERON-TB Gold Plus and QuantiFERON-TB Gold In-Tube interferon-γ release assays: A systematic review and meta-analysis |journal=Adv Med Sci |volume=64 |issue=2 |pages=437–443 |date=September 2019 |pmid=31586819 |doi=10.1016/j.advms.2019.09.001 |url=}}</ref><ref name="pmid25861338" />
*[[QuantiFERON-TB Gold]]. Detects [[Interferon-gamma|IFN-g]] released by sensitized [[T cells]] by [[M. tuberculosis]] antigens ''[[in vitro]].<ref name="pmid31586819" /><ref name="pmid25861338" />''
*[[QuantiFERON-TB Gold]]. Detects [[Interferon-gamma|IFN-g]] released by sensitized [[T cells]] by [[M. tuberculosis]] antigens ''[[in vitro]].<ref name="pmid31586819" /><ref name="pmid25861338" />''
*T SPOT-TB. Detects [[T cells]] stimulated by [[M. tuberculosis]].<ref name="pmid31414740">{{cite journal |vauthors=Zhu M, Zhu Z, Yang J, Hu K |title=Performance Evaluation of IGRA-ELISA and T-SPOT.TB for Diagnosing Tuberculosis Infection |journal=Clin. Lab. |volume=65 |issue=8 |pages= |date=August 2019 |pmid=31414740 |doi=10.7754/Clin.Lab.2019.181109 |url=}}</ref><ref name="pmid29318113">{{cite journal |vauthors=Zhu F, Ou Q, Zheng J |title=Application Values of T-SPOT.TB in Clinical Rapid Diagnosis of Tuberculosis |journal=Iran. J. Public Health |volume=47 |issue=1 |pages=18–23 |date=January 2018 |pmid=29318113 |pmc=5756596 |doi= |url=}}</ref><ref name="pmid25861338" />
*T SPOT-TB. Detects [[T cells]] stimulated by [[M. tuberculosis]].<ref name="pmid31414740">{{cite journal |vauthors=Zhu M, Zhu Z, Yang J, Hu K |title=Performance Evaluation of IGRA-ELISA and T-SPOT.TB for Diagnosing Tuberculosis Infection |journal=Clin. Lab. |volume=65 |issue=8 |pages= |date=August 2019 |pmid=31414740 |doi=10.7754/Clin.Lab.2019.181109 |url=}}</ref><ref name="pmid29318113">{{cite journal |vauthors=Zhu F, Ou Q, Zheng J |title=Application Values of T-SPOT.TB in Clinical Rapid Diagnosis of Tuberculosis |journal=Iran. J. Public Health |volume=47 |issue=1 |pages=18–23 |date=January 2018 |pmid=29318113 |pmc=5756596 |doi= |url=}}</ref><ref name="pmid25861338" />
*AMPLICOR assay. Uses [[Polymerase chain reaction|DNA polymerase chain reaction]] (PCR) to amplify [[nucleic acid]] targets.<ref name="pmid11052908">{{cite journal |vauthors=Bonington A, Strang JI, Klapper PE, Hood SV, Parish A, Swift PJ, Damba J, Stevens H, Sawyer L, Potgieter G, Bailey A, Wilkins EG |title=TB PCR in the early diagnosis of tuberculous meningitis: evaluation of the Roche semi-automated COBAS Amplicor MTB test with reference to the manual Amplicor MTB PCR test. |journal=Tuber. Lung Dis. |volume=80 |issue=4-5 |pages=191–6 |date=2000 |pmid=11052908 |doi=10.1054/tuld.2000.0246 |url=}}</ref><ref name="pmid25861338" />
*AMPLICOR assay. Uses [[Polymerase chain reaction|DNA polymerase chain reaction]] ([[PCR]]) to amplify [[nucleic acid]] targets.<ref name="pmid11052908">{{cite journal |vauthors=Bonington A, Strang JI, Klapper PE, Hood SV, Parish A, Swift PJ, Damba J, Stevens H, Sawyer L, Potgieter G, Bailey A, Wilkins EG |title=TB PCR in the early diagnosis of tuberculous meningitis: evaluation of the Roche semi-automated COBAS Amplicor MTB test with reference to the manual Amplicor MTB PCR test. |journal=Tuber. Lung Dis. |volume=80 |issue=4-5 |pages=191–6 |date=2000 |pmid=11052908 |doi=10.1054/tuld.2000.0246 |url=}}</ref><ref name="pmid25861338" />


===Tests for active tuberculosis disease===
===Tests for active tuberculosis disease===
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**[[Mycobacterial]] culture. This test is cheap but takes weeks to have results. Culture may be done in 3 types of media: solid media (Lowenstein Jensen), agar-based media (Middlebrook 7H10 and 7H11), and liquid media (Middlebrook 7H12).<ref name="pmid22978323">{{cite journal |vauthors=Demers AM, Verver S, Boulle A, Warren R, van Helden P, Behr MA, Coetzee D |title=High yield of culture-based diagnosis in a TB-endemic setting |journal=BMC Infect. Dis. |volume=12 |issue= |pages=218 |date=September 2012 |pmid=22978323 |pmc=3482573 |doi=10.1186/1471-2334-12-218 |url=}}</ref>
**[[Mycobacterial]] culture. This test is cheap but takes weeks to have results. Culture may be done in 3 types of media: solid media (Lowenstein Jensen), agar-based media (Middlebrook 7H10 and 7H11), and liquid media (Middlebrook 7H12).<ref name="pmid22978323">{{cite journal |vauthors=Demers AM, Verver S, Boulle A, Warren R, van Helden P, Behr MA, Coetzee D |title=High yield of culture-based diagnosis in a TB-endemic setting |journal=BMC Infect. Dis. |volume=12 |issue= |pages=218 |date=September 2012 |pmid=22978323 |pmc=3482573 |doi=10.1186/1471-2334-12-218 |url=}}</ref>
**[[NAAT|Nucleic acid amplification assays]]. This test is rapid and specific to [[Mycobacterium tuberculosis|M. tuberculosi]]<nowiki/>s but costly and gives no [[Drug susceptibility testing|drug susceptibility]].<ref name="pmid22137190">{{cite journal |vauthors=Hughes R, Wonderling D, Li B, Higgins B |title=The cost effectiveness of Nucleic Acid Amplification Techniques for the diagnosis of tuberculosis |journal=Respir Med |volume=106 |issue=2 |pages=300–7 |date=February 2012 |pmid=22137190 |doi=10.1016/j.rmed.2011.10.005 |url=}}</ref>
**[[NAAT|Nucleic acid amplification assays]]. This test is rapid and specific to [[Mycobacterium tuberculosis|M. tuberculosi]]<nowiki/>s but costly and gives no [[Drug susceptibility testing|drug susceptibility]].<ref name="pmid22137190">{{cite journal |vauthors=Hughes R, Wonderling D, Li B, Higgins B |title=The cost effectiveness of Nucleic Acid Amplification Techniques for the diagnosis of tuberculosis |journal=Respir Med |volume=106 |issue=2 |pages=300–7 |date=February 2012 |pmid=22137190 |doi=10.1016/j.rmed.2011.10.005 |url=}}</ref>
*Response to [[therapy]]. Clinical response to antituberculous [[drugs]] may be an indicator of [[Tuberculosis|TB infection]], but [[lead time bias]] should assesed
*Response to [[therapy]]. Clinical response to antituberculous [[drugs]] may be an indicator of [[Tuberculosis|TB infection]], but [[lead time bias]] should assesed.


<br />
<br />
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==Causes==
==Causes==


*[[Tuberculosis]] infection is caused by [[mycobacterium tuberculosis]] which is [[Transmission|transmitted]] from person to person by [[inhalation]] of [[aerosols]] from an affected individual with active TB.<ref name="pmid29452616">{{cite journal |vauthors=Ankrah AO, Glaudemans AWJM, Maes A, Van de Wiele C, Dierckx RAJO, Vorster M, Sathekge MM |title=Tuberculosis |journal=Semin Nucl Med |volume=48 |issue=2 |pages=108–130 |date=March 2018 |pmid=29452616 |doi=10.1053/j.semnuclmed.2017.10.005 |url=}}</ref>
*[[Tuberculosis]] [[infection]] is caused by [[mycobacterium tuberculosis]] which is [[Transmission|transmitted]] from person to person by [[inhalation]] of [[aerosols]] from an affected individual with active TB.<ref name="pmid29452616">{{cite journal |vauthors=Ankrah AO, Glaudemans AWJM, Maes A, Van de Wiele C, Dierckx RAJO, Vorster M, Sathekge MM |title=Tuberculosis |journal=Semin Nucl Med |volume=48 |issue=2 |pages=108–130 |date=March 2018 |pmid=29452616 |doi=10.1053/j.semnuclmed.2017.10.005 |url=}}</ref>
*[[Tuberculosis]] may be spread through [[cough]], [[sneezing]], singing, spitting, or even talking because these particles may remain suspended in the air for several hours.
*[[Tuberculosis]] may be spread through [[cough]], [[sneezing]], singing, spitting, or even talking because these particles may remain suspended in the air for several hours.
*
*


<br />
==Diagnostic Approach==
==Diagnostic Approach==
Shown below is an algorithm summarizing the diagnosis of Tuberculosis according the the Association of Chest Physicians guidelines:<ref name="Chaudhuri2017">{{cite journal|last1=Chaudhuri|first1=ArunabhaD|title=Recent changes in technical and operational guidelines for  tuberculosis control programme in India - 2016: A paradigm shift in tuberculosis control|journal=The Journal of Association of Chest Physicians|volume=5|issue=1|year=2017|pages=1|issn=2320-8775|doi=10.4103/2320-8775.196644}}</ref>
Shown below is an [[algorithm]] summarizing the diagnosis of [[Tuberculosis]] according the the Association of Chest Physicians guidelines:<ref name="Chaudhuri2017">{{cite journal|last1=Chaudhuri|first1=ArunabhaD|title=Recent changes in technical and operational guidelines for  tuberculosis control programme in India - 2016: A paradigm shift in tuberculosis control|journal=The Journal of Association of Chest Physicians|volume=5|issue=1|year=2017|pages=1|issn=2320-8775|doi=10.4103/2320-8775.196644}}</ref>
 
<br />
<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
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{{familytree | | | | | | | | | A01 | | | A01= [[Sputum]] examination + [[Chest X-ray]] }}
{{familytree | | | | | | | | | A01 | | | A01= [[Sputum]] examination + [[Chest X-ray]] }}
{{familytree | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | }}
{{familytree | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | }}
{{familytree | | | A01 | | A02 | | A03 | | A04 |-| A05 | A01= [[Sputum]] positive for [[TB]], [[Chest X-ray]] suggestive of [[TB]] | A02= [[Sputum]] positive for [[TB]], [[Chest X-ray]] not suggestive of [[TB]] | A03= [[Sputum]] negative for [[TB]], [[Chest X-ray]] suggestive of [[TB]] | A04= [[Sputum]] negative for [[TB]], [[Chest X-ray]] not suggestive of [[TB]] | A05= High clinical suspicion for [[TB]] }}
{{familytree | | | A01 | | A02 | | A03 | | A04 |-| A05 | A01= [[Sputum]] positive for [[TB]], [[Chest X-ray]] suggestive of [[TB]] | A02= [[Sputum]] positive for [[TB]], [[chest X-ray]] not suggestive of [[TB]] | A03= [[Sputum]] negative for [[TB]], [[chest X-ray]] suggestive of [[TB]] | A04= [[Sputum]] negative for [[TB]], [[chest X-ray]] not suggestive of [[TB]] | A05= High clinical suspicion for [[TB]] }}
{{familytree | | | |!| | | |!| | | |!| | | | | | | |!|}}
{{familytree | | | |!| | | |!| | | |!| | | | | | | |!|}}
{{familytree | | | |)|-|-|-|'| | | A01 |-|-|-|-|-|-|'| | A01= [http://Cartridge-Based%20Nucleic%20Acid%20Amplification%20Test Cartridge-Based Nucleic Acid Amplification Test] }}
{{familytree | | | |)|-|-|-|'| | | A01 |-|-|-|-|-|-|'| | A01= [http://Cartridge-Based%20Nucleic%20Acid%20Amplification%20Test Cartridge-Based Nucleic Acid Amplification Test] }}
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{{familytree | | | | | | | | | A01 | | | A01= Presumptive [[TB]] }}
{{familytree | | | | | | | | | A01 | | | A01= Presumptive [[TB]] }}
{{familytree | | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | | A01 | | | A01= Place patient on RIPE ([[rifampin]], [[isoniazide]], [[Pyrazinamide|pyrazinamide]], [[ethambutol]]) }}
{{familytree | | | | | | | | | A01 | | | A01= Place [[patient]] on RIPE ([[rifampin]], [[isoniazide]], [[Pyrazinamide|pyrazinamide]], [[ethambutol]]) }}
{{familytree | | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | | A01 | | | A01= Did the specimen sent for [[culture]] at the initial evaluation return positive? }}
{{familytree | | | | | | | | | A01 | | | A01= Did the specimen sent for [[culture]] at the initial evaluation return positive? }}
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{{familytree | | | | |!| | | | | | | | | | | | | | }}
{{familytree | | | | |!| | | | | | | | | | | | | | }}
{{familytree | | | | |!| | | | | | | | | | | | | | }}
{{familytree | | | | |!| | | | | | | | | | | | | | }}
{{familytree | | | | A01 |-| A02 |-| A03 |-| A04 | | | A01= Was there [[cavitation]] on initial [[chest X-ray]]? | A02= No | A03= Is the patient [[HIV]] positive? | A04= No }}
{{familytree | | | | A01 |-| A02 |-| A03 |-| A04 | | | A01= Was there [[cavitation]] on initial [[chest X-ray]]? | A02= No | A03= Is the [[patient]] [[HIV]] positive? | A04= No }}
{{familytree | | | | |!| | | | | | | |!| | | |!| | }}
{{familytree | | | | |!| | | | | | | |!| | | |!| | }}
{{familytree | | | | A01 | | | | | | A02 | | A03 | A01= Yes| A02= Yes | A03= Give [[isoniazide]] and [[rifampin]] for 4 months }}
{{familytree | | | | A01 | | | | | | A02 | | A03 | A01= Yes| A02= Yes | A03= Give [[isoniazide]] and [[rifampin]] for 4 months }}
{{familytree | | | | |!| | | | | | | |!| | | | | | }}
{{familytree | | | | |!| | | | | | | |!| | | | | | }}
{{familytree | | | | |`|-|-| A01 |-|-|'| | A01= Give [[isoniazide]] and [[rifampin]] for 7 months }}
{{familytree | | | | |`|-|-| A01 |-|-|'| | A01= Give [[isoniazide]] and [[rifampin]] for 7 months }}
{{familytree/end}}
{{familytree/end}}<br />
 
==Do's==
==Do's==


*Suspect TB in individuals with:<ref name="Chaudhuri2017" />
*Suspect [[TB]] in individuals with:<ref name="Chaudhuri2017" />
**[[Fever]] more than 2 weeks
**[[Fever]] more than 2 weeks
**[[Weight loss]]
**[[Weight loss]]
Line 91: Line 111:
*Don't wait for culture results before initiating [[Tuberculosis|Tb]] [[treatment]] in suspicious cases.
*Don't wait for culture results before initiating [[Tuberculosis|Tb]] [[treatment]] in suspicious cases.


<br />
==References==
==References==
{{Reflist|2}}{{WikiDoc Help Menu}}
{{Reflist|2}}
 
{{WikiDoc Sources}}
 
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<br />
[[Category:Resident survival guide]]
[[Category:Up-To-Date]]

Latest revision as of 01:25, 12 December 2020

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]; Associate Editor(s)-in-Chief: Moises Romo M.D.

''Synonyms and keywords: approach to tuberculosis, approach to TB, tuberculosis workup, TB workup, TB treatment

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

  1. ↑ Nayak S, Acharjya B (January 2012). "Mantoux test and its interpretation". Indian Dermatol Online J. 3 (1): 2–6. doi:10.4103/2229-5178.93479. PMC 3481914. PMID 23130251.
  2. ↑ Slogotskaya L, Bogorodskaya E, Ivanova D, Sevostyanova T (2018). "Comparative sensitivity of the test with tuberculosis recombinant allergen, containing ESAT6-CFP10 protein, and Mantoux test with 2 TU PPD-L in newly diagnosed tuberculosis children and adolescents in Moscow". PLoS ONE. 13 (12): e0208705. doi:10.1371/journal.pone.0208705. PMC 6303070. PMID 30576322.
  3. ↑ Pahal P, Sharma S. PMID 32310497 Check |pmid= value (help). Missing or empty |title= (help)
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Ryu YJ (April 2015). "Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms". Tuberc Respir Dis (Seoul). 78 (2): 64–71. doi:10.4046/trd.2015.78.2.64. PMC 4388902. PMID 25861338.
  5. ↑ 5.0 5.1 Pourakbari B, Mamishi S, Benvari S, Mahmoudi S (September 2019). "Comparison of the QuantiFERON-TB Gold Plus and QuantiFERON-TB Gold In-Tube interferon-γ release assays: A systematic review and meta-analysis". Adv Med Sci. 64 (2): 437–443. doi:10.1016/j.advms.2019.09.001. PMID 31586819.
  6. ↑ Zhu M, Zhu Z, Yang J, Hu K (August 2019). "Performance Evaluation of IGRA-ELISA and T-SPOT.TB for Diagnosing Tuberculosis Infection". Clin. Lab. 65 (8). doi:10.7754/Clin.Lab.2019.181109. PMID 31414740.
  7. ↑ Zhu F, Ou Q, Zheng J (January 2018). "Application Values of T-SPOT.TB in Clinical Rapid Diagnosis of Tuberculosis". Iran. J. Public Health. 47 (1): 18–23. PMC 5756596. PMID 29318113.
  8. ↑ Bonington A, Strang JI, Klapper PE, Hood SV, Parish A, Swift PJ, Damba J, Stevens H, Sawyer L, Potgieter G, Bailey A, Wilkins EG (2000). "TB PCR in the early diagnosis of tuberculous meningitis: evaluation of the Roche semi-automated COBAS Amplicor MTB test with reference to the manual Amplicor MTB PCR test". Tuber. Lung Dis. 80 (4–5): 191–6. doi:10.1054/tuld.2000.0246. PMID 11052908.
  9. ↑ Ryan GJ, Shapiro HM, Lenaerts AJ (September 2014). "Improving acid-fast fluorescent staining for the detection of mycobacteria using a new nucleic acid staining approach". Tuberculosis (Edinb). 94 (5): 511–8. doi:10.1016/j.tube.2014.07.004. PMID 25130623.
  10. ↑ Bayot ML, Mirza TM, Sharma S. PMID 30725806. Missing or empty |title= (help)
  11. ↑ Demers AM, Verver S, Boulle A, Warren R, van Helden P, Behr MA, Coetzee D (September 2012). "High yield of culture-based diagnosis in a TB-endemic setting". BMC Infect. Dis. 12: 218. doi:10.1186/1471-2334-12-218. PMC 3482573. PMID 22978323.
  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)
  14. ↑ 14.0 14.1 Chaudhuri, ArunabhaD (2017). "Recent changes in technical and operational guidelines for tuberculosis control programme in India - 2016: A paradigm shift in tuberculosis control". The Journal of Association of Chest Physicians. 5 (1): 1. doi:10.4103/2320-8775.196644. ISSN 2320-8775.
  15. ↑ 15.0 15.1 "tb_therapeutic_tables [TUSOM | Pharmwiki]".


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