Tuberculosis
Pulmonary TB
Symptoms
Productive cough of 2 weeks or more; any duration if HIV +
o +/- Haemoptysis
Fever > 2 weeks
Night sweats
Unexplained weight loss (> 1.5kg in a month)
Can also present with:
o Chest pain Pleurisy, muscle strain
o SOB Extensive disease
o Localised wheeze TB bronchitis
Signs
General
o Fever
o Tachycardia
Respiratory
o Crackles
o Localised wheeze
o +/- Dullness on percussion if there is effusion
Extra-pulmonary TB
TB lymphadenitis
Pleural effusion/Empyema
TB of bones and joints
Pericardial effusion
TB meningitis
Disseminated/Miliary TB (miliary appearance of most organs)
TB ascites
1
Disseminated TB
Widespread blood borne dissemination of TB bacilli. This is either the consequence of a
recent primary infection or the erosion of a tuberculous lesion into a blood vessel.
Dissemination of tubercle bacilli causes multiple millet-seed tuberculous nodules in various
organs—spleen, liver, lymph nodes, kidneys, brain or joints
Clinical features
Severity of constitutional symptoms
Involvement of other organs
o Pleural effusion
o HSM
o Meningism
Diagnosis
CXR Miliary nodules
FBC
o Pancytopenia or anaemia
LFT abnormal
Bacteriological confirmation
TB lymphadenopathy
Peripheral TB lymphadenopathy most commonly occurs in the neck and armpits
As nodes increase in size and become fluctuant, they may suppurate and drain via a
chronic fistula, resulting ultimately in scarring.
TB infected lymph nodes decrease extremely slowly in size (over weeks or months)
on treatment
TB and HIV
2
Diagnosis
I. Molecular
a. GXP
i. Rapid diagnosis, allows rapid screen to exclude Rifampicin resistance
b. Line Probe assay
i. Confirm drug resistance and detect resistance to both Rifampicin and
Isoniazid
II. Culture (still gold standard)
a. Indications (why when GXP is available)
i. HIV+ patients with negative GXP
ii. Susceptibility testing
iii. MDR TB suspected
III. Smear microscopy
a. Observe acid fast bacilli
i. Ziel-Neelson stain
ii. Fluorescent auramine o stain
b. Good specificity for TB but has very low sensitivity in detecting TB in patients
with non cavitary pulmonary disease or low bacillary load in sputum (e.g. HIV
positive patients)
TB Treatment
In some instances of severe or complicated disease (meningitis, TB bones/joints,
miliary TB) treatment may need to be extended to nine months. The intensive
3
phase remains two months and the continuation phase is prolonged to seven
months
Adjunctive treatment
Pyridoxine (Vit B6) 25mg daily
o Prevent peripheral neuropathy most commonly caused by isoniazid
Steroids
o Highly recommended in extra-pulmonary TB
MDR-TB Treatment
Resistance to rifampicin and isoniazid. XDR TB is diagnosed when there is resistance to
rifampicin and isoniazid plus resistance to fluoroquinolones and an injectable medicine e.g.
kanamycin.
I. Intensive phase 6 months
a. Kanamycin
b. Moxifloxacin
c. Ethionamide
d. Terizidone
e. Pyrazinamide
II. Continuation phase 18 months
a. Moxifloxacin
b. Ethionamide
c. Terizidone
d. Pyrazinamide
