Download Tuberculosis

Tuberculosis
Recommend
 Consider TB whenever someone has a new or changed cough that has persisted for three or more
weeks. Infectious TB is easily diagnosed by collecting at least three, preferably five, consecutive
morning sputum specimens for acid fast bacilli (AFB)
 Consider TB in people of any age with unexplained weight loss and with fever of unknown cause.
Tuberculosis is often overlooked in the elderly by attributing minor symptoms to old age or bronchitis
Background
 Tuberculosis (TB) is transmitted by infectious droplets produced by people with active pulmonary TB
when they cough or perform other forceful expiratory manoeuvres (singing, yelling, sneezing etc.)
 Most people with active TB have the pulmonary form. 15-20% have extra-pulmonary disease, however
it is the pulmonary form that is infectious
 There should be an increased suspicion for the possibility of TB in people from high prevalence
countries – China, SE Asia, India, Africa, Middle East, Pacific Islands, Eastern Europe and some South
American countries; Aboriginal and Torres Strait Islander peoples; people who misuse alcohol; HIV
positive people; close contacts of people with infectious pulmonary TB; the elderly and
immunosuppressed people
Related topics:
 HIV infection, page 503
 Physical examination of the patient, page 12
1.
May present with:
 Usually, abnormal respiratory symptoms and signs but may present with symptoms and signs
emanating from the genitourinary system, meninges, cervical lymph nodes, skeletal system or
indeed any organ or system
Extra-pulmonary TB often mimics other diseases
 Cough for more than three weeks, haemoptysis (coughing blood)
 Pleuritic chest pain and breathlessness, unresolved pneumonia
 Unexplained weight loss
 Night sweating, fever of unknown origin
 Doesn’t look and feel well, with past history of, or close contact with TB
 Painless and non tender swelling of lymph nodes
 Persistent low back pain with a fluctuant swelling at the groin or loin
 Headache, photophobia, confusion, neck stiffness of 1 to 8 weeks duration
 Pus cells in the urine but no growth on MC&S
2.
Immediate management – not applicable
3.
Clinical assessment:
 Obtain a complete patient history, include past episodes or exposure to TB
 Perform standard clinical observations
 Perform a complete physical examination of patient
 Consider a HIV test with appropriate pre-test information and consent. TB may be the initial
presentation in HIV positive people. See HIV Infection
 Perform chest x-ray
4.
Management:
 Consult MO whenever TB is suspected. Early diagnosis and suitable treatment may prevent severe tissue
damage that can lead to permanent disability and sometimes death
 Specialised Health Services or one of the regional TB Control Centres should be involved in
all cases of active TB who will advise:
 chest X-ray (mandatory in all patients suspected of TB, even if the patient presents with non
respiratory symptoms and signs)
 sputum specimen for Acid Fast Bacilli on at least 3, preferably 5 consecutive mornings. If the
patient cannot produce sputum, MO may advise inhalation of hypertonic (8%) Normal Saline via
a nebuliser
 Mantoux test – the presence of a strongly positive Mantoux test (10 mm) suggests the patient
has been infected, but only 10% will progress to disease. However a large Mantoux reaction may
also be due to past BCG or to cross-reaction from environmental mycobacteria
5.
Follow up:
 Follow up after discharge from Specialised Health Services, regional TB Control Centre or hospital
will involve monitoring patient clinically:
 including regular weight
 sputum for Acid Fast Bacilli (AFB)
 chest X-ray

adverse drug reactions in close consultation with MO and Specialised Health Services or
regional TB Control Centre
 observance with medication is a major problem but is essential for successful treatment and to
protect others. Medication must be taken without fail and swallowed (not chewed) on an empty
stomach at the same time each and every day. Most patients find it best to take the medication just
before going to bed
 Adverse Drug Reactions
 there are many side effects from anti-tuberculosis drugs these include but are not limited to rash,
nausea, jaundice, abnormal lumbar puncture, joint pains, visual disturbances
6.
Referral / Consultation:
 Consult MO whenever TB is suspected. Specialised Health Services or regional TB Control Centre
must also be contacted
 All close contacts of smear positive pulmonary tuberculosis must be examined. Specialised
Health Services or regional TB Control Centre will advise
Queensland Health Fact Sheets are available:
Tuberculosis: www.health.qld.gov.au/phs/Documents/shs/20847.pdf
Tuberculosis medication: www.health.qld.gov.au/phs/documents/shs/31228.pdf
Mantoux testing: www.health.qld.gov.au/phs/Documents/shs/20864.pdf