This document discusses the diagnosis of tuberculosis (TB). It outlines the common sites where TB disease occurs, including the lungs, pleura, central nervous system, and others. It describes symptoms of TB such as fever, night sweats, and weight loss. The evaluation for TB involves testing for HIV, medical history, physical exam, and bacteriologic or histologic testing. Sputum smear microscopy and culture can detect TB bacteria, though cultures are needed to distinguish TB from other mycobacteria. Chest x-rays are also used in diagnosis but cannot confirm TB. The document provides guidance on diagnosing TB in children and notes risk factors like household TB contact.

1. Diagnosis of TB
Name: Seyedsaeid Seyedraoufi Subject: PHTISIATRY
Lecturer: Prof.Solomonia
Sep 2020
MANAGEMENT OF TUBERCULOSIS A Guide to Essential Practice
Seventh Edition 2019

2. Common Sites of TB Disease
• Lungs
• Pleura
• Central nervous system
• Lymphatic system
• Genitourinary systems
• Bones and joints
• Disseminated (miliary TB)

3. Systemic Symptoms of TB
• Fever
• Chills
• Night sweats
• Appetite loss
• Weight loss
• Fatigue

4. Evaluation for TB
1. HIV test
2. Medical history
3. Physical examination
4. Bacteriologic or histologic exam
(Chest radiograph if indicated)

5. Symptoms of Pulmonary TB
• Productive, prolonged cough
(duration of 2-3 weeks)
• Chest pain
• Hemoptysis (bloody sputum)
• Signs may vary based on HIV status

6. AFB smear-microscopy
Acid-fast bacilli (AFB) (shown in red) are tubercle bacilli

7. Acid fast smear showing TB bacilli

8. Smear positive PTB vs Smear negative PTB
• PTB+ (Pulmonary TB smear-positive)
–One AFB-positive smear; i.e. Any patient with at
least one positive smear result (irrespective of
quantity of AFBs seen on microscopy)
Recommendations to improve the diagnosis of smear negative pulmonary and extrapulmonary TB among
adults in HIV prevalent and resource constrained settings.
Draft for discussion by Strategic and Technical Advisory Group of Stop TB Department of WHOJune 2006

9. Smear positive PTB vs Smear negative PTB
• PTB- (smear-negative)
Any pulmonary TB case that does not meet the definition of being
smear-positive. This includes:
1. Patients with three negative smear results and radiological findings
and doctor’s decision to treat for TB
2. Patients with negative smear results and a positive culture result
for M. tuberculosis
3. Patients who are unable to produce sputum and with highly
suspicious radiological and clinical findings and doctor's decision
to treat for TB

10. Other Acid Fast Bacilli
• Mycobacteria other than those comprising the M. tuberculosis complex
are called Non-Tuberculous Mycobacteria (“NTM”) or Mycobacteria
Other Than Tuberculosis (“MOTT”).
• These mycobacteria may cause pulmonary disease resembling TB.
Increasingly, cases from these organisms are being reported in patients
with weakened immune systems, especially due to HIV.
• It is important to note that infection with MOTT also may produce
AFB-positive sputum smear results and positive Mantoux skin test
readings mimicking M. tuberculosis. Culture can distinguish between
M. tuberculosis and MOTT. Disease due to MOTT is usually
unresponsive to first-line anti-TB drugs.

11. Chest Radiograph
• Diagnosis of PTB solely on basis of
CXR not encouraged
• May have unusual appearance in
HIV-positive persons
• CXR is helpful in HIV+, smear- negative
patients
• Cannot confirm diagnosis of TB
Arrow points to cavity in
patient's right upper lobe

12. Cultures
• Should be requested for ALL
retreatment patients
– Relapse
– Failure
– Return after default
• Culture is indicated for
– New and retreatment PTB cases still
smear- positive at end of intensive phase
– Symptomatic contacts of known MDR
cases
Colonies of M. tuberculosis
growing on media

13. Diagnosis in Children
1. Patient history
• Contact to PTB+
• Symptoms consistent with TB
• HIV test
2. Clinical Exam
3. TST
4. Bacteriological confirmation
5. Investigations for PTB and EPTB
Guidance of National Tb Programmes for the Management of TB in Children
WHO/HTM/TB/2006.371

14. Key Risk Factors in Children
Risk Factors For Children Include:
• Household contact with a newly diagnosed smear-
positive case
• Age less than 5 years
• HIV infection
• Severe malnutrition

15. Key Features of TB in Children
The presence of three or more of the following should strongly suggest a
diagnosis of TB:
• Chronic symptoms suggestive of TB
• Physical signs highly of suggestive of TB
• A positive tuberculin skin test
• Chest X-ray suggestive of TB
(The presentation in infants may be more acute, resembling acute severe
pneumonia and should be suspected when there is a poor response to antibiotics.
In such situations, there is often an identifiable source case, usually the mother.)