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


{{SK}}
{{SK}}[[TB]], [[PPD-tuberculin skin test|PPD]], [[mycobacterium tuberculosis]]
==Overview==
==Overview==
Tuberculosis (abbreviated as TB for 'Tubercle bacillus' or Tuberculosis is a common [[infectious disease]] caused by ''[[Mycobacterium tuberculosis]]''. Tuberculosis most commonly involves the lungs as the organism thrives in high oxygen environments, but it can also cause disease in the [[central nervous system]], the [[lymphatic system]], the [[circulatory system]], the [[genitourinary system]], [[bone]]s, [[joint]]s and even the [[skin]].<ref name="Harrison">{{cite book | author = Raviglione MC, O'Brien RJ | chapter = Tuberculosis | title = Harrison's Principles of Internal Medicine | editor = Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, eds. | edition = 16th ed. | publisher = McGraw-Hill Professional | year = 2004 | pages = 953–66 | doi =10.1036/0071402357 | isbn = 0071402357 }}</ref> Over one-third of the world's population has been exposed to ''M. tuberculosis'', and new infections occur at a rate of one per second.<ref name="WHO2004data">[[World Health Organization]] (WHO). [http://www.who.int/mediacentre/factsheets/fs104/en/index.html Tuberculosis Fact sheet N°104 - Global and regional incidence.] March 2006, Retrieved on 6 October 2006.</ref> Not all individuals exposed to the bacterium develop clinically overt tuberculosis infection; in fact, [[asymptomatic]], latent TB infection discovered by screening is more common. Approximately, one in ten latent infections progresses to active (symptomatic) TB disease, which, if left untreated, carries mortality rates of up to 50%. Symptoms include shortness of breath, hemoptysis, fever, chills, night sweats, and weight loss. Several treatment regimens are available for the latent and active forms of TB. Classically, a prolonged course of 6-9 months of a single agent (rifampin or isoniazid) is administered to patients with latent TB, while a more aggressive course that consists of 4 major antituberculous agents (rifampin, isoniazid, ethambutol, pyrazinamide) is reserved for patients with active disease.
[[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.  
==Causes==
 
== Diagnostic Criteria ==
 
=== 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:
** >5 mm: [[HIV]] infected patients, [[CXR]] that suggests [[TB]] [[infection]], individuals taking [[steroids]]
** >10 mm: [[Healthcare]] workers, [[nursing home]] dweller, [[parenteral]] [[drug]] users, patients with [[immunocompromised]] [[diseases]]
** >15 mm: All individuals not cathegorized above
* [[QuantiFERON|QuantiFERON-TB]]. Detects [[cell-mediated immunity]] to [[tuberculin]]
* [[QuantiFERON-TB Gold]]. Detects [[Interferon-gamma|IFN-g]] released by sensitized [[T cells]] by [[M. tuberculosis]] antigens ''[[in vitro]]''
* T SPOT-TB. Detects [[T cells]] stimulated by [[M. tuberculosis]]
* AMPLICOR assay. Uses [[Polymerase chain reaction|DNA polymerase chain reaction]] (PCR) to amplify [[nucleic acid]] targets.
 
=== Tests for active tuberculosis disease ===
 
* [[Microbiological]] detection:
** [[AFB stain|Acid fast bacilli]] [[stain]]. This tests is relatively fast and cheap but presents with a high number of [[false positive]]<nowiki/>s, since may detect [[Mycobacterium bovis]] or NBT
** [[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).
** [[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]]
* Response to [[therapy]]. Clinical response to antituberculous [[drugs]] may be an indicator of [[Tuberculosis|TB infection]], but [[lead time bias]] should assesed
 
<br />
 
== Causes ==
 
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
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*[[Common cause 5]]
*[[Common cause 5]]


==Diagnosis==
==Complete Diagnostic Approach==
Shown below is an algorithm summarizing the diagnosis of Tuberculosis according the the Association of chest physicians guidelines.{{familytree/start |summary=PE diagnosis Algorithm.}}
Shown below is an algorithm summarizing the diagnosis of Tuberculosis according the the Association of chest physicians guidelines.{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | A01 | | | A01= Presumptive [[TB]] }}
{{familytree | | | | | | | | | A01 | | | A01= Presumptive [[TB]] }}

Revision as of 13:46, 3 September 2020

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

Synonyms and keywords:TB, PPD, mycobacterium tuberculosis

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

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of Tuberculosis according the the Association of chest physicians guidelines.

 
 
 
 
 
 
 
 
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
 


Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

Template:WikiDoc Sources

  Treatment

Shown below is an algorithm summarizing the treatment of disease name according the the [...] guidelines.

  Do's The content in this section is in bullet points. Don'ts The content in this section is in bullet points. References  

Template:WikiDoc Sources

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