Summary
Definition
History and exam
Other diagnostic factors
- night sweats
- pleuritic chest pain
- haemoptysis
- psychological symptoms
- abnormal chest auscultation
- asymptomatic
- dyspnoea
- clubbing
- erythema nodosum and erythema induratum
Risk factors
- exposure to infection
- birth in an endemic country
- HIV infection
- immunosuppressive medicines
- malignancy
- silicosis
- end-stage renal disease
- apical fibrosis
- intravenous drug use
- malnutrition
- alcoholism
- diabetes
- high-risk congregate settings
- low socio-economic status or black/Hispanic/Native American ancestry
- age
- tobacco smoking
Diagnostic investigations
1st investigations to order
- chest x-ray
- sputum acid-fast bacilli smear
- sputum culture
- FBC (full blood count)
- nucleic acid amplification tests (NAAT)
Investigations to consider
- gastric aspirate
- bronchoscopy and bronchoalveolar lavage
- stool testing
- empirical treatment
- drug susceptibility testing
- genotyping
- HIV test
- lateral flow urine lipoarabinomannan (LF-LAM) assay
- CT of chest
- tuberculin skin testing
- interferon-gamma release assays
- TB antigen-based skin tests (TBSTs)
Treatment algorithm
Contributors
Authors
David J. Horne, MD, MPH

Associate Professor
Division of Pulmonary, Critical Care, and Sleep Medicine
Department of 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
Department of Medicine
University of Washington
Seattle
WA
Disclosures
MN declares that he has no competing interests. MN is the author of a reference cited in this topic.
Peer reviewers
Fayez Kheir, MD, MSc
Assistant Professor of Medicine
Harvard Medical School
Division of Pulmonary and Critical Care
Massachusetts General Hospital
Boston
MA
Disclosures
FK declares that he has no competing interests.
William Burman, MD
Professor
Division of Infectious Diseases
University of Colorado at Denver and Health Sciences Center
Denver
CO
Disclosures
WB declares that he has no competing interests.
Ian Campbell, MD (Lond), FRCP (Edin & Lond)
Consultant Chest Physician
Llandough Hospital
Llandough
Penarth
South Wales
Disclosures
IC declares that he has no competing interests.
Guidelines
- Guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV: Mycobacterium tuberculosis infection and disease
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: mycobacterium tuberculosis infection and disease
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