Tuberculosis

Presentation

Appropriate Tests

 

Mycobacteria testing can include microscopy, culture, NAA testing, and histopathology.

Tuberculin sensitivity testing (Mantoux test) may be helpful in assessing the risk of active infection, but a negative test may be present in active disease eg miliary tuberculosis. See Table 7.

The Mycobacterium tuberculosis IGRA (interferon-gamma release assay for Mycobacterium tuberculosis) may be used as an alternative to Mantoux testing.

The possibility of tuberculosis should be considered early in patients with HIV infection and other forms of immunosuppression (eg steroid therapy, chronic lymphocytic leukaemia), in alcoholics and in those with over-whelming infections (eg meningitis).

See also Infection (increased susceptibility).

Pulmonary

Sputum, bronchoscopy brushings, pleural fluid, or gastric lavage - Mycobacteria testing.

Lung or pleural biopsy may occasionally be required.

Cough, chronic

 

Haemoptysis

 

Pneumonia

 

Pleurisy

 

Pleural effusion

 

Laryngeal infection

See Laryngitis

Extrapulmonary

 

Osteomyelitis

 

Skin Infection

 

Meningitis

Cerebrospinal fluid examination - microscopy and culture incl mycobacteria testing (see also Molecular genetics - microbial); Protein, Glucose.

Genitourinary

Urine (complete morning specimen) - Mycobacteria testing. 'Sterile pyuria' is a characteristic finding.

Peritonitis

Peritoneal fluid examination.

Pericarditis

Peritoneal fluid examination.

Miliary

Bone marrow aspiration - culture for M. tuberculosis.