wikidoc - User contributions [en]

Tuberculosis classification

2021-03-03T15:56:47Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{JS}}

==Overview==
Tuberculosis can be classified into 6 main categories according to exposure, symptoms, and diagnostic testing. The classification ranges from Class 0, in people with no previous exposure to TB and negative tuberculin skin testing and/or interferon-gamma release assay (2 methods of screening for TB), to Class 3 for active TB infection and Class 5 for suspected TB infection based on signs and symptoms of the disease. The U.S. Citizenship and Immigration Services has also designed a special classification for immigrants and refugees according to the risk of infection.

==Classification==
Below is a table of the current classification system of [[tuberculosis]] ([[TB]]), according to its [[pathogenesis]]:<ref name="CDC">{{cite web | title = TB Classification | url = http://www.cdc.gov/tb/publications/slidesets/selfstudymodules/module1/classification.htm }}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|Class}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|Type of Tuberculosis}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
0
| style="padding: 5px 5px; background: #F5F5F5;" |
No [[TB]] exposure 
Not infected
| style="padding: 5px 5px; background: #F5F5F5;" |
No history of [[TB]] exposure 
A negative [[TST]] or [[IGRA]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
1
| style="padding: 5px 5px; background: #F5F5F5;" |
[[TB]] exposure 
No evidence of [[infection]]
| style="padding: 5px 5px; background: #F5F5F5;" |
History of [[TB]] exposure 
A negative [[TST]] (given at least 8-10 weeks after exposure) or [[IGRA]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
2
| style="padding: 5px 5px; background: #F5F5F5;" |
[[TB]] infection 
No [[TB]] disease
| style="padding: 5px 5px; background: #F5F5F5;" |
Positive [[TST]] or [[IGRA]] 
Negative smears and cultures (if done) 
Absent clinical picture of active [[TB]] disease
or abnormal [[x-ray]] findings
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
3
| style="padding: 5px 5px; background: #F5F5F5;" |
Clinically active [[TB]]
| style="padding: 5px 5px; background: #F5F5F5;" |
Positive culture (if done) for ''[[M. tuberculosis]]'' 
Positive [[TST]] or [[IGRA]], and clinical, bacteriological, or [[x-ray]] evidence of [[TB]] disease
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
4
| style="padding: 5px 5px; background: #F5F5F5;" |
Previous [[TB]] disease (not clinically active)
| style="padding: 5px 5px; background: #F5F5F5;" |
Medical history of [[TB]] disease 
Abnormal but stable [[x-ray]] findings 
Positive [[TST]] or [[IGRA]] 
Negative smears and cultures (if done) 
Absent clinical picture of active [[TB]] disease
or abnormal [[x-ray]] findings
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
5
| style="padding: 5px 5px; background: #F5F5F5;" |
Suspected [[TB]]
| style="padding: 5px 5px; background: #F5F5F5;" |
Clinical manifestations of [[TB]] disease, but incomplete evaluation.
The diagnosis s pending.
The patient should not be in this class for more than three months.
|-
|}

==CDC TB Classification for Immigrants and Refugees==
Based on the U.S. Citizenship and Immigration Services, developed by the [[Centers for Disease Control and Prevention]] ([[CDC]]), tuberculosis for immigrants and refugees s classified into the following categories: <ref name="CDC2">{{cite web | title = TB Classification US Citizenship and Immigration Services | url = http://www.cdc.gov/immigrantrefugeehealth/pdf/tuberculosis-ti-2009.pdf }}</ref>
{| class="wikitable" style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 100px;" |{{fontcolor|#FFF|Class}}
! style="background: #4479BA; width: 500px;" |{{fontcolor|#FFF|Description}}
!Travel Clearance
|-
! style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
No [[TB]] Classification
| style="padding: 5px 5px; background: #F5F5F5;" |
Applicants with normal tuberculosis [[screening]] examinations. No discernible HIV infection and normal CXR.
|Valid for 6 months from evaluation
|-
! style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Class A [[TB]]
| style="padding: 5px 5px; background: #F5F5F5;" |
All applicants who have tuberculosis disease including applicants with extrapulmonary TB. In addition, CXR indicates pulmonary TB disease, regardless of sputum smear and culture results.
|Not cleared for travel until treatment is completed. Exceptions are available for granted waivers.
|-
! style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Class B0 TB, Pulmonary
|Applicants who were previously diagnosed with TB or came to the physician during the TB treatment course. Additionally, successful completion of the Division of Global Migration and Quarantine (DGMQ) prior to immigration is required.
|It can be valid for 3 months from the last negative culture results.
|-
! style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Class B1 [[TB]], [[Pulmonary]]
| style="padding: 5px 5px; background: #F5F5F5;" |
'''No treatment:'''

*Applicants with a medical history, [[physical exam]], or [[CXR]] findings that indicate [[pulmonary]] tuberculosis but:

:*Have negative [[acid-fast]] [[bacilli]] sputum smears
:*Have negative cultures
:*Are not diagnosed with tuberculosis
:*They can initiate tuberculosis treatment after immigration

'''Completed treatment:'''

*Applicants who had a previous diagnosis of pulmonary tuberculosis and successfully completed directly observed therapy prior to immigration
*The cover sheet must include whether the initial sputum smears and cultures were positive and if drug susceptibility testing results are available
|It can be valid for 3 months from the last negative culture results.
|-
! style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Class B1 TB, Extrapulmonary
| style="padding: 5px 5px; background: #F5F5F5;" |
Applicants with evidence of [[extrapulmonary tuberculosis]], with normal CXR and negative sputum smears and cultures. 
The anatomic site of [[infection]] should be documented
|It can be Valid for 3 months from the last negative culture results.
|-
! style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Class B2 TB, LTBI Evaluation
| style="padding: 5px 5px; background: #F5F5F5;" |
Applicants who have a [[TST]] ≥10 mm or positive [[IGRA]] but otherwise tuberculosis evaluation is negative 
The [[TST]] reaction size or [[IGRA]] result, the applicant’s status regarding latent TB infection (LTBI) treatment, and the medication(s) used must be included 
Applicants with more than one [[TST]] or [[IGRA]], all results and dates must be ncluded 
Contacts with [[TST]] ≥5 mm or positive [[IGRA]] should be classified according to this classification (if they are not already Class B1 TB, Pulmonary)
|Valid for 6 months from completion of evaluation.
|-
! style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Class B3 TB, Contact Evaluation
| style="padding: 5px 5px; background: #F5F5F5;" |
Applicants who have been in contact of a known tuberculosis case 
The size of the applicant’s [[TST]] reaction or [[IGRA]] result must be included 
The name, source case, alien number, relationship to contact, and type of tuberculosis must be included.
|Valid for 6 months from completion of the evaluation.
|-
|} 
{| class="wikitable"
|+
!Risk Classification
!Necessity of testing
!Frequency of testing
!
|-
|Low Risk
|Settings where Tb infected individuals are unlikely to be present
|Not required unless there has been exposure to TB
|
|-
|Medium Risk
|Settings where health care workers (HCWs) are likely to encounter individuals with TB
|Testing should be repeated every year
|
|-
|Potential Ongoing Transmission
|Settings wehere person to person transmission of TB was documented in the past year
|Testing should be repeated every 8 weeks until making sure that there has been no ongoing transmission.
|
|}
 
==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis medical therapy special conditions

2021-02-25T03:22:27Z

Mashal Awais: /* Patients Taking ART */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{JS}} {{Ammu}}

==Overview==
Medical therapy for tuberculosis in special conditions include [[HIV]] co-infection and extrapulmonary manifestations. Different approaches are taken for patients taking ART and those who do not take ART. Although WHO recommends the same drug regimen for pulmonary and extrapulmonary manifestations, various stages of skeletal tuberculosis are managed differently. For patients with [[renal]] or [[liver]] diseases, the first line of drugs are substituted with second-line drugs to prevent complications.

==HIV Coinfection==
Depending on the treatment status of each patient, different approaches may be taken:<ref name="pmid19105873">{{cite journal| author=Harries AD, Zachariah R, Lawn SD| title=Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa. | journal=Int J Tuberc Lung Dis | year= 2009 | volume= 13 | issue= 1 | pages= 6-16 | pmid=19105873 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19105873 }} </ref>
===Patients Not Taking ART===

*After the diagnosis of TB in [[HIV]]-positive patients, not taking [[antiretroviral therapy]] ([[ART]]), the priority is to initiate treatment for TB, along with [[co-trimoxazole]] and [[ART]].
*These patients should be treated with the same regimen as HIV-negative patients, with the exception that the optional 3 times/week of intensive phase treatment, is mandatory for HIV-positive patients. This leads to a decrease in incidence of TB relapse and resistance to [[rifampicin]], often seen in HIV-positive patients.<ref name="pmid20353364">{{cite journal| author=Khan FA, Minion J, Pai M, Royce S, Burman W, Harries AD et al.| title=Treatment of active tuberculosis in HIV-coinfected patients: a systematic review and meta-analysis. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 9 | pages= 1288-99 | pmid=20353364 | doi=10.1086/651686 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20353364 }} </ref><ref name="WHO 2013"> {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref>
*The retreatment regimens are the same for HIV-positive and HIV-negative patients.

According to the WHO, the following recommendations should be applied to these patients:<ref name="WHO 2013"> {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition) }}</ref>

*Patients with TB, who are known to be HIV-positive, and all TB patients who live in areas where HIV is prevalent, should be treated with at least the intensive phase of the TB treatment.

*During the continuation phase of the treatment, these patients should also receive a daily dose.

*In the impossibility of taking the daily dose, a continuation phase of 3 times/week is acceptable. Regarding the duration of therapy, some experts recommend prolongation of TB treatment in certain [[HIV]]-positive patients.<ref name="MMWR">{{cite web | title = Treatment of tuberculosis | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm }}</ref>
*[[HIV]]-positive patients with TB should receive TB treatment, at least for the same period of time as HIV-negative patients.

===Patients Taking ART===
Besides improving the survival rate of HIV-positive patients, antiretroviral therapy can decrease TB rates by about 90% at the individual level, 60% population level, and 50% reduction in recurrence rates. People with active TB and HIV must be initiated with ART irrespective of CD4 cell count. By the first 8 weeks of starting TB treatment, ART must be initiated to reduce the complications.

===Co-trimoxazole===
Preventive therapy with [[co-trimoxazole]] should be initiated as early as possible in all TB patients who are HIV-positive, and should be continued during the entire treatment of TB. Co-trimoxazol reduces the mortality rate of HIV-positive tuberculous patients, as well as infections by ''[[Pneumocystis jirovecii]]'' and [[malaria]]. After TB treatment has been complete, continuation of co-trimoxazol should be evaluated according to each country's guidelines.<ref name="pmid19105873">{{cite journal| author=Harries AD, Zachariah R, Lawn SD| title=Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa. | journal=Int J Tuberc Lung Dis | year= 2009 | volume= 13 | issue= 1 | pages= 6-16 | pmid=19105873 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19105873 }} </ref><ref name="WHO">{{cite web | title = Co-trimoxazole prophylaxis | url = http://www.who.int/hiv/pub/guidelines/ctx/en/ }}</ref>

==Extrapulmonary==
===Tuberculous Lymphadenitis===

The infectious disease society of America(IDSA) recommends treatment for 6 months for the drug-susceptible organisms.

*The regimen includes [[isoniazid]], [[rifampin]], [[pyrazinamide]] and [[ethambutol]] for 2 months followed by [[isoniazid]] and [[rifampin]] for another 4 months.
*Surgical excision as an adjuvant to antibiotic therapy for TB lymphadenitis caused by the drug-resistant organism.

Studies have shown that [[steroids]] used for local discomfort and adjuvant [[immunotherapy]] with [[anti tumor necrosis factor]] agents can be beneficial but no specific recommendation has been made. <ref name="NCBI">{{cite web | title = Oxford journal TB lymphadenitis| url = http://cid.oxfordjournals.org/content/53/6/555.long}}</ref>

===Skeletal Tuberculosis===

The mainstay of treatment for skeletal tuberculosis is antibiotics and surgery. The selection of [[antibiotics]] for skeletal tuberculosis is the same as that of pulmonary tuberculosis. <ref name="Tuberculosis">{{cite web | title = tech ortho TB| url = http://www.global-help.org/publications/articles/techortho_tuberculosismusculoskeletal.pdf }}</ref>

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Treatment}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Stage 1 (synovitis)
| style="padding: 5px 5px; background: #F5F5F5;" |   Chemotherapy    Rest    Restriction of movements    Splinting
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Stage 2 (Early arthritis)
| style="padding: 5px 5px; background: #F5F5F5;" |   Chemotherapy    Rest    Restriction of movements    Splinting    Synovectomy
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Stage 3 (Advanced arthritis)
| style="padding: 5px 5px; background: #F5F5F5;" |   Chemotherapy    Osteotomy    Arthrodesis    Arthroplasty
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Stage 4 (Advanced arthritis)
| style="padding: 5px 5px; background: #F5F5F5;" |   Chemotherapy    Osteotomy    Arthrodesis    Arthroplasty
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Stage 5
| style="padding: 5px 5px; background: #F5F5F5;" |   Chemotherapy    Osteotomy    Arthrodesis    Arthroplasty
|}

===Tuberculous Meningitis===

The treatment of TB meningitis is 2 months of isoniazid, ethambutol, pyrazinamide, and rifampicin, followed by rifampicin and isoniazid alone for a further ten months. Steroids help reduce the risk of death or disabling neurological deficit.[6] Steroids can be used in the first six weeks of treatment, but must be used with caution in individuals who also have HIV.<ref name="pmid18254003">{{cite journal| author=Prasad K, Singh MB| title=Corticosteroids for managing tuberculous meningitis. | journal=Cochrane Database Syst Rev | year= 2008 | volume= | issue= 1 | pages= CD002244 | pmid=18254003 | doi=10.1002/14651858.CD002244.pub3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18254003 }} </ref> A few patients may require immunomodulatory agents such as thalidomide. Treatment must be started as soon as there is a reasonable suspicion of the diagnosis. Treatment must not be delayed while waiting for confirmation of the diagnosis. Hydrocephalus occurs as a complication in about a third of patients with TB meningitis and will require a ventricular shunt. Aspirin may be used as an adjuvant therapy to reduce complications.<ref name="pmid20421121">{{cite journal| author=Misra UK, Kalita J, Nair PP| title=Role of aspirin in tuberculous meningitis: a randomized open-label placebo-controlled trial. | journal=J Neurol Sci | year= 2010 | volume= 293 | issue= 1-2 | pages= 12-7 | pmid=20421121 | doi=10.1016/j.jns.2010.03.025 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20421121 }} </ref> BCG vaccination has been proved to prevent tuberculous meningitis.

===Miliary Tuberculosis===
Miliary tuberculosis is a grave condition that must be treated immediately. A delay in treatment may cause serious complications and even death. 8-9 months is the time of treatment for the susceptible organisms. Treatment of miliary tuberculosis includes 6 months of daily or intermittent treatment. <ref name="pmid22771605">{{cite journal| author=Sharma SK, Mohan A, Sharma A| title=Challenges in the diagnosis & treatment of miliary tuberculosis. | journal=Indian J Med Res | year= 2012 | volume= 135 | issue= 5 | pages= 703-30 | pmid=22771605 | doi= | pmc=PMC3401706 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22771605 }} </ref>. Expert opinion suggests that corticosteroid therapy may be useful for treating respiratory failure caused by disseminated tuberculosis but there are no data to support its use.

===Tuberculosis Peritonitis===
Medical therapy for tuberculous peritonitis involves the multi drug regimen of tuberculosis consisting of 5 major drugs as the first line of treatment including [[isoniazid]], [[ethambutol]], [[pyrazinamide]], [[streptomycin]] and [[rifamppicin]]. Corticosteroids can be added to the treatment to reduce the complications. Response to treatment is manifested as disappearance of ascitis and resolution of symptoms . All lab based values return to normal baseline within 3 months of treatment initiation. <ref name="pmid16197489">{{cite journal| author=Sanai FM, Bzeizi KI| title=Systematic review: tuberculous peritonitis--presenting features, diagnostic strategies and treatment. | journal=Aliment Pharmacol Ther | year= 2005 | volume= 22 | issue= 8 | pages= 685-700 | pmid=16197489 | doi=10.1111/j.1365-2036.2005.02645.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16197489 }} </ref>.

===Tuberculous Pericarditis===

A 2 months course of [[isoniazid]], [[pyrazinamide]], [[rifampicin]], and [[ethambutol]] followed by 4 months course of [[isoniazid]] and [[rifampicin]] is shown to be effective <ref name="pmidpmid2106816">{{cite journal| author=Cohn DL, Catlin BJ, Peterson KL, Judson FN, Sbarbaro JA| title=A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis. A twice-weekly, directly observed, and cost-effective regimen. | journal=Ann Intern Med | year= 1990 | volume= 112 | issue= 6 | pages= 407-15 | pmid=pmid2106816 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2106816 }} </ref>. For patients with pericardial tuberculosis, a 6-month regimen is recommended. [[Corticosteroids]] is recommended as adjunctive therapy for tuberculous pericarditis during the first 11 weeks of antituberculosis therapy. In a randomized, double-blind, controlled trial, patients in the later effusive--constrictive phase who received [[prednisolone]] had a significantly more rapid clinical resolution compared with patients given a placebo. [[Prednisolone]] did not reduce the risk of constrictive pericarditis. It is recommended that daily adjunctive [[prednisolone]] or prednisone alone treatment be given to adults and children with tuberculous pericarditis. Following are the dosage recommendations:

*Adults: [[Prednisone]] 60 mg/day given for 4 weeks, followed by 30 mg/day for 4 weeks, 15 mg/day for 2 weeks, and finally 5 mg/day for week 11 (the final week)
*Children: Doses should be proportionate to their weight, beginning with about 1 mg/kg body weight and decreasing the dose as described for adults.<ref name="pmidpmid12836625">{{cite journal| author=American Thoracic Society. CDC. Infectious Diseases Society of America| title=Treatment of tuberculosis. | journal=MMWR Recomm Rep | year= 2003 | volume= 52 | issue= RR-11 | pages= 1-77 | pmid=pmid12836625 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12836625 }} </ref>

===Renal Tuberculosis===
Drug regimen is similar to other types of tuberculosis with a multidrug antibiotic therapy with antitubercular drugs.
According to the 4th edition of WHO recommendations;

:*Pulmonary and extrapulmonary disease should be treated with the same regimens.
:*Continuation phase for 6-9 months regimens that include [[INH]] and [[RIF]] are highly recommended.
:*Prolongation of therapy also should be considered for patients with tuberculosis in any site that is slow to respond.
:*The addition of [[corticosteroid]]s is recommended for patients with tuberculous pericarditis and tuberculous meningitis.
:*In tuberculous meningitis, ethambutol should be replaced by streptomycin.

{|
|-
| valign="top" |
{| style="border: 0px; font-size: 90%; margin: 3px; width: 500px;" align="center"
! style="padding: 0 5px; font-size: 100%; background: #4479BA" align="center" |''{{fontcolor|#FFF|Statandard Regimens For New TB Patients With Drug-Susceptible TB}}''
|-
| style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align="left" |'''''Intensive Initial Phase'''''
|-
| rowspan="1" style="font-size: 95%; padding: 0 5px; background: #DCDCDC" |▸ '''''Initial Phase''''': 2 months of '''HRZS''' †
|-
| style="padding: 0 5px; font-size: 95%; background: #F8F8FF" align="left" |'''''Continuation phase'''''
|-
| rowspan="1" style="font-size: 95%; padding: 0 5px; background: #DCDCDC" |▸ '''''Continuation Phase''''': 6-9 months ‡ of '''HR'''
|-
| rowspan="1" style="font-size: 95%; padding: 0 5px; background: #DCDCDC" |‡ In this group decisions to prolong the continuation phase should be made on an individual basis.
|}
|}

====Renal Insufficiency and End-Stage Renal Disease====
For patients undergoing [[hemodialysis]], administration of all drugs after [[dialysis]] is preferred to facilitate DOT and to avoid premature removal of drugs such as [[PZA]] and [[cycloserine]]. To avoid toxicity it is important to monitor serum drug concentrations in persons with [[renal failure]] who are taking cycloserine or [[EMB]]. There is little information concerning the effects of peritoneal dialysis on the clearance of antituberculosis drugs.

==Liver Disease==
[[INH]], [[RIF]], and [[PZA]] all can cause hepatitis that may result in additional [[liver]] damage in patients with preexisting liver disease. However, because of the effectiveness of these drugs (particularly INH and RIF), they should be used if at all possible, even in the presence of preexisting liver disease. If serum [[AST]] is more than three times normal before the initiation of treatment (and the abnormalities are not thought to be caused by tuberculosis), several treatment options exist. One option is to treat with RIF, EMB, and PZA for 6 months, avoiding INH. A second option is to treat with INH and RIF for 9 months, supplemented by EMB until INH and RIF susceptibility are demonstrated, thereby avoiding PZA. For patients with severe liver disease a regimen with only one hepatotoxic agent, generally RIF plus EMB, could be given for 12 months, preferably with another agent, such as a [[fluoroquinolone]], for the first 2 months; however, there are no data to support this recommendation.

In all patients with preexisting liver disease, frequent clinical and laboratory monitoring should be performed to detect drug-induced [[hepatic]] injury.

==Hepatitis and Anti-TB medications==

WHO Recommendation for Anti-TB drug-induced hepatitis is:

:*If TB treatment has been stopped, Wait for liver function tests to normalize and resolution of the clinical symptoms (nausea, abdominal pain) before reintroducing the anti-TB drugs.
:*If the liver function tests are not available, it is advisable to wait for extra 2 weeks after resolution of jaundice and upper abdominal tenderness before restarting TB treatment.
:*If the signs and symptoms do not resolve and the liver disease is severe, the non-hepatotoxic regimen consisting of streptomycin, ethambutol and a fluoroquinolone should be started (or continued) for a total of 18-24 months.<ref name="-2003">{{Cite journal | title = Treatment of tuberculosis.|journal = MMWR Recomm Rep | volume = 52 | issue = RR-11 | pages = 1-77 |month = Jun | year = 2003 | doi = | PMID = 12836625 }}</ref>
:*Reintroducing one drug at a time is the optimal approach, especially if the patient’s hepatitis was severe.
:*Once drug-induced hepatitis has resolved, the drugs are reintroduced one at a time. But if symptoms recur or liver function tests become abnormal again as the drugs are reintroduced, the last drug added should be stopped.
:*Some advise starting with rifampicin because it is less likely than isoniazid or pyrazinamide to cause hepatotoxicity and is the most effective agent .<ref name="-2003">{{Cite journal | title = Treatment of tuberculosis. | journal = MMWR Recomm Rep | volume = 52 | issue = RR-11 | pages = 1-77 | month = Jun | year = 2003 | doi = | PMID = 12836625 }}</ref> <ref name="Saukkonen-2006">{{Cite journal | last1 = Saukkonen | first1 = JJ.|last2 = Cohn | first2 = DL. | last3 = Jasmer | first3 = RM. | last4 = Schenker | first4 = S. | last5 = Jereb | first5 = JA. | last6 = Nolan | first6 = CM. | last7 = Peloquin | first7 = CA. | last8 = Gordin | first8 = FM. | last9 = Nunes | first9 = D. | title = An official ATS statement: hepatotoxicity of antituberculosis therapy. | journal = Am J Respir Crit Care Med | volume = 174 | issue = 8 | pages = 935-52 | month = Oct | year = 2006 | doi = 10.1164/rccm.200510-1666ST | PMID = 17021358 }}</ref> After 3–7 days, isoniazid may be reintroduced. In patients who have experienced jaundice but tolerate the reintroduction of rifampicin and isoniazid, it is advisable to avoid pyrazinamide.

===Alternative regimens in Anti-TB induced Hepatitis===
It depends on which drug is implicated as the cause of hepatitis.

:*If rifampicin is implicated, a suggested regimen without rifampicin is '''2 months''' of [[Isoniazid]], [[Ethambutol]] and [[Streptomycin]]followed by '''10 months''' of [[Isoniazid]] and [[Ethambutol]].
:*If [[Isoniazid]] cannot be used, '''6-9 months''' of [[Rifampicin]], [[Pyrazinamide]] and [[Ethambutol]] can be considered.
:*If [[Pyrazinamide]] is discontinued before the patient has completed the intensive phase, the total duration of isoniazid and rifampicin therapy may be extended to '''9 months'''.<ref name="-2003">{{Cite journal | title = Treatment of tuberculosis. | journal = MMWR Recomm Rep | volume = 52|issue = RR-11 | pages = 1-77 | month = Jun | year = 2003 | doi = | PMID = 12836625 }}</ref>
:*If neither isoniazid nor rifampicin can be used, the non-hepatotoxic regimen consisting of [[Streptomycin]], [[ethambutol]] and a[[fluoroquinolone]] should be continued for a total of '''18-24 months'''.
:*Hepatitis during the intensive phase of TB treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol: once hepatitis has resolved, restart the same drugs '''EXCEPT''' replace pyrazinamide with streptomycin to '''complete the 2-month course''' of initial therapy, followed by [[Rifampicin]] and [[Isoniazid]] for the 6-month continuation phase.
:*Hepatitis during the continuation phase: once hepatitis has resolved, '''restart''' [[Isoniazid]] and [[Rifampicin]] to '''complete the 4-month continuation'''phase of therapy.

==Referencies==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis CT

2021-02-09T22:43:45Z

Mashal Awais: /* Computed Tomography */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Most patients with pulmonary tuberculosis will have abnormal findings in a chest [[CT]], which include micronodules, interlobular septal thickening, [[cavitation]] and consolidation. CT scans are more sensitive than an [[X-ray]] to detect [[lymphadenopathy|lymphadenopathies]].

==Computed Tomography==
===Pulmonary Tuberculosis===

*Chest CT abnormalities are seen in the majority of patients with active [[pulmonary tuberculosis.]]
*CT findings include:<ref>{{Cite journal
| author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]]
| title = Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging
| journal = [[Chest]]
| year = 2014
| month = June
| doi = 10.1378/chest.14-0196
| pmid = 25086249
}}</ref>

:*Micronodules
::*Most commonly found in the [[subpleural]] region and [[peribronchovascular interstitium]].
::*CT scan allows early and accurate detection of [[micronodules.]]
:*Interlobular septal thickening
:*Cavitation is the most important finding in secondary tuberculosis
::*Appears as a lesion with thick walls and irregular margins.
::*It may be observed in almost 50% of patients.
::*It is most commonly seen in the upper lung.
::*Cavities in the lower lung can be found in [[diabetes]] and [[HIV]] infection.<ref name="PatelRami2011">{{cite journal|last1=Patel|first1=AnandK|last2=Rami|first2=KiranC|last3=Ghanchi|first3=FerozD|title=Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus|journal=Lung India|volume=28|issue=1|year=2011|pages=70|issn=0970-2113|doi=10.4103/0970-2113.76308}}</ref><ref name="PadyanaBhat2012">{{cite journal|last1=Padyana|first1=Mahesha|last2=Bhat|first2=RaghavendraV|last3=Dinesha|first3=M|last4=Nawaz|first4=Alam|title=HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count|journal=North American Journal of Medical Sciences|volume=4|issue=5|year=2012|pages=221|issn=1947-2714|doi=10.4103/1947-2714.95904}}</ref>
::*Although it is rare, cavities may become [[superinfected]] and an air-fluid level is seen inside the cavity.
::*After the active infection is treated and resolved, small cavities with thin walls may remain as a residual finding.
:*Homogeneous and dense consolidation

*CT is more sensitive to detect hilar lymphadenopathy.
*The "tree-in-bud" sign is a CT finding that may be seen in [[pulmonary tuberculosis]] and it is caused by mucus or pus [[impaction]] into the small airways that accentuates the branching course of peripheral airways.<ref name="Eisenhuber2002">{{cite journal|last1=Eisenhuber|first1=Edith|title=The Tree-in-Bud Sign1|journal=Radiology|volume=222|issue=3|year=2002|pages=771–772|issn=0033-8419|doi=10.1148/radiol.2223991980}}</ref>

{|
|[[File:Pulmonary Tuberculosis CT.jpg|thumb|280px|left|Pulmonary Tuberculosis Image courtesy of Dr Natalie Yang, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pulmonary-tuberculosis-6 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[File:Pulmonary Tuberculosis CT 2.jpg|thumb|280px|left|Pulmonary Tuberculosis Image courtesy of Dr Natalie Yang, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pulmonary-tuberculosis-6 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[File:Cavitary tuberculosis - CT scan.jpg|thumb|320px|Chest CT showing a tuberculous cavity in the left lung. Image courtesy of Wikimedia Commons.]]
|}

===Extrapulmonary Tuberculosis===
====Cardiac Tuberculosis====

*Pericardial thickening may be seen on a CT scan, specially if it is more than 3 mm.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>
*Lymph node enlargement is also a common CT finding in [[cardiac tuberculosis]].<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>
*Pericardial effusion is rare and is seen in less than 20% of patients.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

====Miliary Tuberculosis====
CT findings include multiple [[pulmonary nodules]] with a diameter of 1-2mm, distributed in a random pattern sometimes presenting with [[pleural effusion]] as well.
{|
|[[Image:Miliary Tuberculosis CT.jpg|thumb|300px|left|Miliary Tuberculosis Image courtesy of Dr Frank Gaillard, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/miliary-tuberculosis-ct here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image:Miliary Tuberculosis CT 2.jpg|thumb|300px|left|Miliary Tuberculosis Image courtesy of Dr Frank Gaillard, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/miliary-tuberculosis-ct here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

===Tuberculous Meningitis===

*Head CT findings in [[tuberculous meningitis]] include meningeal enhancement indicating meningeal [[inflammation]] and [[Choroid plexus|choroidal]] calcifications.<ref name="KomolafeSunmonu2008">{{cite journal|last1=Komolafe|first1=Morenikeji A|last2=Sunmonu|first2=Taofiki A|last3=Esan|first3=Olufunmi A|title=Tuberculous meningitis presenting with unusual clinical features in Nigerians: Two case reports|journal=Cases Journal|volume=1|issue=1|year=2008|pages=180|issn=1757-1626|doi=10.1186/1757-1626-1-180}}</ref>
*Areas of [[infarction and hemorrhage]] may also be seen in cases of [[miliary tuberculosis]].
*Patients with late complications may show hydrocephalus.

[[Image:Tuberculous meningitis.jpg|thumb|none|350px|Image courtesy of Wikimedia Commons.]]

====Abdominal Tuberculosis====

*CT findings in a pancreatic and spleen infection with [[tuberculosis]] may mimic a [[pancreatic cancer]].<ref name="RongLou2008">{{cite journal|last1=Rong|first1=YF|last2=Lou|first2=WH|last3=Jin|first3=DY|title=Pancreatic tuberculosis with splenic tuberculosis mimicking advanced [[pancreatic cancer]] with [[splenic]] metastasizes: a case report|journal=Cases Journal|volume=1|issue=1|year=2008|pages=84|issn=1757-1626|doi=10.1186/1757-1626-1-84}}</ref>
*Shown below there is a CT scan of the [[pancreas]] demonstrating a mass in the pancreatic tail and metastasizes in the [[spleen]].

{|
|[[Image:Pancreas_and_spleen-tuberculosis.jpg|thumb|none|350px|Image courtesy of Wikimedia Commons.]]
|[[Image:Pancreas_and_spleen-tuberculosis2.jpg |thumb|none|350px|Image courtesy of Wikimedia Commons.]]
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category: Needs overview]]
[[Category: Needs content]]
[[Category:Bacterial diseases]]

Tuberculosis history and symptoms

2021-02-09T22:42:12Z

Mashal Awais: /* Pulmonary Tuberculosis */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
The common symptoms of tuberculosis include [[weakness]], [[weight loss]], [[fever]], and [[night sweats]]. Pulmonary tuberculosis presents with [[cough]], [[chest pain]], and [[hemoptysis]]. [[Tuberculosis]] is particularly difficult to diagnose in children, as these may not present with common findings.

==History and Symptoms==

Clinicians should be mindful of the patient’s history of TB exposure, [[infection]], or [[disease]]. It is also crucial to consider demographic factors (e.g., country of origin, age, ethnic or racial group, occupation) that may increase the patient’s risk for exposure to TB or to [[drug-resistant TB]]. Also, clinicians should find out for other medical conditions decreasing immunity, especially [[HIV]] infection, that increase the risk of latent TB infection progressing to TB disease.

===Pulmonary Tuberculosis===
When the disease becomes active, 75% of the cases involve the lungs. [[Pulmonary tuberculosis]] should be suspected in persons who have the following symptoms:<ref name="Mandell">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>

*[[Cough]] (most common symptom)

:*Initially dry cough that progresses to productive.
:*Persistent cough, usually for more than three weeks.

*[[Fever]]
*[[Night sweats]]
*Unexplained [[weight loss]]
*[[Hemoptysis]]
*[[Chest pain]]
*[[Anorexia]]
*[[Malaise]]
*[[Chills]]
*[[Fatigue]]
*[[Dyspnea]]
*[[Lymphadenopathy]]

===Extra-Pulmonary Tuberculosis===
Other 25% of active cases moves from the [[lungs]], causing other kinds of TB more common in [[immunosuppressed]] persons and young children.

Another especially dangerous form is [[disseminated]] TB, more commonly known as [[miliary tuberculosis]]. Although extrapulmonary TB is not contagious, it may co-exist with pulmonary TB, which is contagious.<ref name="CDCcourse">[[Centers for Disease Control and Prevention]] (CDC), Division of Tuberculosis Elimination. [http://www.cdc.gov/nchstp/tb/pubs/corecurr/default.htm Core Curriculum on Tuberculosis: What the Clinician Should Know.] 4th edition (2000). Updated Aug 2003.</ref>

All forms of [[extra-pulmonary tuberculosis]] can include symptoms of [[pulmonary tuberculosis]] such as [[malaise]], [[night sweats]], [[cough]], [[weight loss]], and can be associated with an active pulmonary infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width:600px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Extra-Pulmonary Location}}
! style="background: #4479BA; width: 400px;" |{{fontcolor|#FFF|History and Symptoms}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous Lymphadenitis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fever]], painless lymph node swelling.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Pott's disease/Skeletal Tuberculosis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Low back pain]], [[stiffness]], joint swelling, limited mobility, pain in the affected joint or extremity.

|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Central Nervous System Tuberculosis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Headache]], [[seizures]], [[weakness]], [[vomiting]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Tuberculous Peritonitis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Abdominal pain]], [[fever]], [[ascites]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Tuberculous Pericarditis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Shortness of breath]], [[chest pain]], [[cough]], [[pedal edema]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Renal Tuberculosis
| style="padding: 5px 5px; background: #F5F5F5;" |Symptoms of [[UTI]], such as [[polyuria]], [[dysuria]], [[hematuria]], [[flank pain]] Symptoms of [[obstructive uropathy]], such as [[oliguria]] or [[anuria]], pelvic pain.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Adapted from Asian Spine J. Feb 2014; 8(1): 97–111<ref name="Moon2014">{{cite journal|last1=Moon|first1=Myung-Sang|title=Tuberculosis of Spine: Current Views in Diagnosis and Management|journal=Asian Spine Journal|volume=8|issue=1|year=2014|pages=97|issn=1976-1902|doi=10.4184/asj.2014.8.1.97}}</ref>; Handbook of Clinical Neurology<ref name="Garcia-Monco2014">{{cite journal|last1=Garcia-Monco|first1=Juan Carlos|title=Tuberculosis|volume=121|year=2014|pages=1485–1499|issn=00729752|doi=10.1016/B978-0-7020-4088-7.00100-0}}</ref>Circulation Dec 2005 vol.112 no.23 3608-3616<ref name="Mayosi2005">{{cite journal|last1=Mayosi|first1=B. M.|title=Tuberculous Pericarditis|journal=Circulation|volume=112|issue=23|year=2005|pages=3608–3616|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.105.543066}}</ref>; Am J Trop Med Hyg 2013 vol. 88 no. 1 54-64<ref name="Daherda Silva Junior2013">{{cite journal|last1=Daher|first1=E. D. F.|last2=da Silva Junior|first2=G. B.|last3=Barros|first3=E. J. G.|title=Renal Tuberculosis in the Modern Era|journal=American Journal of Tropical Medicine and Hygiene|volume=88|issue=1|year=2013|pages=54–64|issn=0002-9637|doi=10.4269/ajtmh.2013.12-0413}}</ref>; Clin Infect Dis.(2011)53(6):555-562.<ref name="FontanillaBarnes2011">{{cite journal|last1=Fontanilla|first1=J.-M.|last2=Barnes|first2=A.|last3=von Reyn|first3=C. F.|title=Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis|journal=Clinical Infectious Diseases|volume=53|issue=6|year=2011|pages=555–562|issn=1058-4838|doi=10.1093/cid/cir454}}</ref>
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Bacterial diseases]]
[[Category:Disease]]
[[Category: Pulmonology]]

Tuberculosis other diagnostic studies

2021-02-04T06:02:10Z

Mashal Awais: /* Nucleic Acid Amplification Tests (NAAT) Adapted from CDC [4] */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==

Diagnostic studies that could be performed in patients with tuberculosis beside X-rays, CT scans, MRI are the Xpert MTB/RIF test, Adenosine Deaminase Test, and Nucleic Acid Amplification Test (NAAT).Other diagnostic studies that would be performed during a patient with tuberculosis are the Xpert MTB/RIF test, ADA Test, and macromolecule Amplification Test(NAAT).

 
==Other Diagnostic Studies==
====Xpert MTB/RIF Test====

*The Xpert MTB/RIF test is a molecular test that detects the DNA of the tubercule bacillus complex (MTBC) and also the genetic mutations related to resistance to rifampin (RMP) in unprocessed sputum and concentrated sputum sediments <ref> {{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6241a1.htm | title=Availability of an Assay for Detecting Mycobacterium tuberculosis, Including Rifampin-Resistant Strains, and Considerations for Its Use — the United States, 2013}}</ref>
*WHO recommends the Xpert MTB/RIF test for the initial diagnosis of MDR-TB or HIV-TB co-infection.<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>
*The advantages of this rapid Tuberculosis test are the following:<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>

:*Detects [[M. tuberculosis]] and [[rifampicin]] drug resistance simultaneously.
:*Results are available in less than 2 hours so the patient can be treated the same day of the test.
:*The [[bio-safety]] requirements and training are minimal.
:*It can be stored in non-conventional laboratories.

====Adenosine Deaminase====
It is usually an additional test if tuberculosis is suspected in the patient.<ref name="pmid24319523">{{cite journal| author=Farazi A, Moharamkhani A, Sofian M| title=Validity of serum adenosine deaminase in diagnosis of tuberculosis. | journal=Pan Afr Med J | year= 2013 | volume= 15 | issue= | pages= 133 | pmid=24319523 | doi=10.11604/pamj.2013.15.133.2100 | pmc=PMC3852508 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24319523 }} </ref>

*ADA is used for diagnosing tuberculosis in endemic countries where TB diagnostic procedures are not affordable.
*isoenzymes are more accurate. For both pleural TB and TB meningitis , ADA has a high degree of sensitivity.

====Nucleic Acid Amplification Tests (NAAT) Adapted from CDC <ref name="CDC NAAT"> {{Cite web| url=http://www.cdc.gov/tb/publications/guidelines/amplification_tests/reccomendations.htm| title= CDC Report of an Expert Consultation on the Uses of Nucleic Acid Amplification Tests for the Diagnosis of Tuberculosis}}</ref>====

*This is a heterogeneous group of tests that use [[polymerase chain reaction (PCR)]] to detect a mycobacterial macromolecule.
*These tests vary during which [[macromolecule]] sequence they detect and vary in their accuracy.
*The two commonest commercially available tests are the amplified tubercle bacillus direct test (MTD, Gen-Probe) and Amplicor (Roche Diagnostics).
*The CDC recommends that [[NAA testing]] should be performed on a respiratory specimen from each patient with signs and symptoms of active pulmonary TB disease for whom a diagnosis of TB is being considered (i.e., TB suspect), but has not been established.
*[[NAA testing]] doesn't replace the necessity for AFB smear and culture. All current guidelines and proposals for [[culture-based testing]] should remain in effect, especially recommended rotate times for culture and DST.
*A single positive NAA test result can support the diagnosis of TB during a patient for whom there's an inexpensive index of suspicion. This result should trigger reporting to public health officials, initiation of treatment if not already started, and vigorous efforts to get an isolate for drug susceptibility testing.
*In a patient with little suspicion of getting active TB, one positive NAA test result should be viewed with suspicion (i.e., a possible false-positive result) and interpreted within the same way as one [[culture-positive]] result, i.e., by correlating the results with other diagnostic findings.
*A single negative NAA test result should never be used as a specific test to exclude TB, especially in suspects with a moderate to high clinical suspicion of TB. Rather, the negative NAA test result should be used as additional information to assist in making clinical decisions to expedite a work-up for an alternate diagnosis or to stop unnecessary use of TB treatment in suspected cases.
*The [[FDA-approved]] NAAT tests for TB have slightly less sensitivity than [[culture-isolation methods]], and therefore the 15% -20% of U.S. TB cases that are reported with negative culture results can also have negative NAA test results. Thus, a negative NAA test result doesn't exclude the diagnosis of TB.
*Further research is required before specific recommendations are often made on the utilization of NAAT testing within the diagnosis of TB in children who cannot produce [[sputum]] and within the diagnosis of [[extrapulmonary]] TB, although there's much scientific evidence of the utility of such testing in individual cases.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other diagnostic studies

2021-02-04T05:57:06Z

Mashal Awais: /* Nucleic Acid Amplification Tests (NAAT) Adapted from CDC [4] */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==

Diagnostic studies that could be performed in patients with tuberculosis beside X-rays, CT scans, MRI are the Xpert MTB/RIF test, Adenosine Deaminase Test, and Nucleic Acid Amplification Test (NAAT).Other diagnostic studies that would be performed during a patient with tuberculosis are the Xpert MTB/RIF test, ADA Test, and macromolecule Amplification Test(NAAT).

 
==Other Diagnostic Studies==
====Xpert MTB/RIF Test====

*The Xpert MTB/RIF test is a molecular test that detects the DNA of the tubercule bacillus complex (MTBC) and also the genetic mutations related to resistance to rifampin (RMP) in unprocessed sputum and concentrated sputum sediments <ref> {{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6241a1.htm | title=Availability of an Assay for Detecting Mycobacterium tuberculosis, Including Rifampin-Resistant Strains, and Considerations for Its Use — the United States, 2013}}</ref>
*WHO recommends the Xpert MTB/RIF test for the initial diagnosis of MDR-TB or HIV-TB co-infection.<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>
*The advantages of this rapid Tuberculosis test are the following:<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>

:*Detects [[M. tuberculosis]] and [[rifampicin]] drug resistance simultaneously.
:*Results are available in less than 2 hours so the patient can be treated the same day of the test.
:*The [[bio-safety]] requirements and training are minimal.
:*It can be stored in non-conventional laboratories.

====Adenosine Deaminase====
It is usually an additional test if tuberculosis is suspected in the patient.<ref name="pmid24319523">{{cite journal| author=Farazi A, Moharamkhani A, Sofian M| title=Validity of serum adenosine deaminase in diagnosis of tuberculosis. | journal=Pan Afr Med J | year= 2013 | volume= 15 | issue= | pages= 133 | pmid=24319523 | doi=10.11604/pamj.2013.15.133.2100 | pmc=PMC3852508 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24319523 }} </ref>

*ADA is used for diagnosing tuberculosis in endemic countries where TB diagnostic procedures are not affordable.
*isoenzymes are more accurate. For both pleural TB and TB meningitis , ADA has a high degree of sensitivity.

====Nucleic Acid Amplification Tests (NAAT) Adapted from CDC <ref name="CDC NAAT"> {{Cite web| url=http://www.cdc.gov/tb/publications/guidelines/amplification_tests/reccomendations.htm| title= CDC Report of an Expert Consultation on the Uses of Nucleic Acid Amplification Tests for the Diagnosis of Tuberculosis}}</ref>====

*This is a heterogeneous group of tests that use [[polymerase chain reaction (PCR)]] to detect a mycobacterial macromolecule.
*These tests vary during which [[macromolecule]] sequence they detect and vary in their accuracy.
*The two commonest commercially available tests are the amplified tubercle bacillus direct test (MTD, Gen-Probe) and Amplicor (Roche Diagnostics).
*The CDC recommends that [[NAA testing]] should be performed on a respiratory specimen from each patient with signs and symptoms of active pulmonary TB disease for whom a diagnosis of TB is being considered (i.e., TB suspect), but has not been established.
*NAA testing doesn't replace the necessity for AFB smear and culture. All current guidelines and proposals for [[culture-based testing]] should remain in effect, especially recommended rotate times for culture and DST.
*A single positive NAA test result can support the diagnosis of TB during a patient for whom there's an inexpensive index of suspicion. This result should trigger reporting to public health officials, initiation of treatment if not already started, and vigorous efforts to get an isolate for drug susceptibility testing.
*In a patient with little suspicion of getting active TB, one positive NAA test result should be viewed with suspicion (i.e., a possible false-positive result) and interpreted within the same way as one [[culture-positive]] result, i.e., by correlating the results with other diagnostic findings.
*A single negative NAA test result should never be used as a specific test to exclude TB, especially in suspects with a moderate to high clinical suspicion of TB. Rather, the negative NAA test result should be used as additional information to assist in making clinical decisions to expedite a work-up for an alternate diagnosis or to stop unnecessary use of TB treatment in suspected cases.
*The [[FDA-approved]] NAAT tests for TB have slightly less sensitivity than [[culture-isolation methods]], and therefore the 15% -20% of U.S. TB cases that are reported with negative culture results can also have negative NAA test results. Thus, a negative NAA test result doesn't exclude the diagnosis of TB.
*Further research is required before specific recommendations are often made on the utilization of NAAT testing within the diagnosis of TB in children who cannot produce [[sputum]] and within the diagnosis of [[extrapulmonary]] TB, although there's much scientific evidence of the utility of such testing in individual cases.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other imaging findings

2021-02-03T07:18:56Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{JS}}; {{AL}}

==Overview==
The [[abreugraphy]] is a smaller variant of the [[chest X-ray]] that allows the identification of lung abnormalities that may suggest the diagnosis of TB. With the decrease of [[incidence]] of TB, the [[abreugraphy]] is no longer recommended in most countries for low-risk populations. However, depending on the screening resources of each country, it may be used for the screening of high-risk groups, such as [[HIV]]-positive patients and alcoholics.

==Other Imaging Findings==
===Osteoarticular Tuberculosis X-ray===

*X-ray findings in [[osteoarticular]] tuberculosis include:<ref name="pmid25163241">{{cite journal| author=Grubisić F, Borić I, Segota A, Kruslin B, Grazio S| title=An unusual manifestation of osteoarticular tuberculosis: case report. | journal=Acta Clin Croat | year= 2014 | volume= 53 | issue= 2 | pages= 237-41 | pmid=25163241 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25163241 }} </ref>

:*Demineralization

:*Narrowing of the joint space

:*Bone and cartilage erosion

:*[[Calcifications]]

{|
|[[Image: Tuberculosis Arthritis X-ray.jpg|thumb|300px|left|Tuberculous arthritis of the hip Image courtesy of Dr Matt Skalski, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculous-arthritis-with-phemister-triad here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]|link=Special:FilePath/Tuberculosis_Arthritis_X-ray.jpg]]
|[[Image: Shoulder Tuberculosis.jpg|thumb|340px|left|Shoulder tuberculous Image courtesy of Dr Gagandeep Choudhary, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/caries-sicca-shoulder-tuberculosis-1 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]|link=Special:FilePath/Shoulder_Tuberculosis.jpg]]
|}

===Abreugraphy===
Abreugraphy is a variant of the [[chest X-ray]], and it is named after Dr. Manuel Dias de Abreu who was its inventor. It provides a small radiographic image, which is also known as ''miniature chest radiograph'', or ''Miniature Mass Radiography'' (MMR). Despite its limited resolution, which limits its use in some cases, such as [[lung cancer]], it allows the identification of lung abnormalities, which may suggest the [[diagnosis]] of tuberculosis.

It is less expensive than the traditional [[chest X-ray]], which allows its use in mass situations such as the TB [[screening]] of prisoners and immigrants. With the decrease of [[incidence]] of TB, this exam is no longer recommended among low-risk populations. However, MMR may still be used in high prevalence groups for the early diagnosis of the disease in [[asymptomatic]] patients.<ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref><ref name="pmid1804678">{{cite journal| author=Clancy L, Rieder HL, Enarson DA, Spinaci S| title=Tuberculosis elimination in the countries of Europe and other industrialized countries. | journal=Eur Respir J | year= 1991 | volume= 4 | issue= 10 | pages= 1288-95 | pmid=1804678 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1804678 }} </ref><ref name="pmid822464">{{cite journal| author=Horwitz O, Darrow MM| title=Principles and effects of mass screening: Danish experience in tuberculosis screening. | journal=Public Health Rep | year= 1976 | volume= 91 | issue= 2 | pages= 146-53 | pmid=822464 | doi= | pmc=PMC1438528 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=822464 }} </ref><ref name="pmid2496633">{{cite journal| author=Gordin FM, Slutkin G, Schecter G, Goodman PC, Hopewell PC| title=Presumptive diagnosis and treatment of pulmonary tuberculosis based on radiographic findings. | journal=Am Rev Respir Dis | year= 1989 | volume= 139 | issue= 5 | pages= 1090-3 | pmid=2496633 | doi=10.1164/ajrccm/139.5.1090 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2496633 }} </ref>

Some countries still use the abreugraphy to screen refugees, new workers and students who come from countries with high prevalence of TB. In the case of radiographic abnormalities on the MMR, the person is redirected to a medical center for further studies. <ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref>

In countries with low prevalence of TB, depending on the availability of screening methods, mass screening may be justified in some high-risk groups, such as homeless persons, alcoholics and HIV-positive patients.<ref name="pmid3094079">{{cite journal| author=Barry MA, Wall C, Shirley L, Bernardo J, Schwingl P, Brigandi E et al.| title=Tuberculosis screening in Boston's homeless shelters. | journal=Public Health Rep | year= 1986 | volume= 101 | issue= 5 | pages= 487-94 | pmid=3094079 | doi= | pmc=PMC1477764 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3094079 }} </ref><ref name="pmid3109292">{{cite journal| author=Grzybowski S, Allen EA, Black WA, Chao CW, Enarson DA, Isaac-Renton JL et al.| title=Inner-city survey for tuberculosis: evaluation of diagnostic methods. | journal=Am Rev Respir Dis | year= 1987 | volume= 135 | issue= 6 | pages= 1311-5 | pmid=3109292 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3109292 }} </ref>

{{details|Abreugraphy}}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other imaging findings

2021-02-03T07:18:00Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{JS}}; {{AL}}

==Overview==
The [[abreugraphy]] is a smaller variant of the [[chest X-ray]] that allows the identification of lung abnormalities that may suggest the diagnosis of TB. With the decrease of [[incidence]] of TB, the [[abreugraphy]] is no longer recommended in most countries for low-risk populations. However, depending on the screening resources of each country, it may be used for the screening of high-risk groups, such as [[HIV]]-positive patients and alcoholics.

==Other Imaging Findings==
===Osteoarticular Tuberculosis X-ray===

*X-ray findings in [[osteoarticular]] tuberculosis include:<ref name="pmid25163241">{{cite journal| author=Grubisić F, Borić I, Segota A, Kruslin B, Grazio S| title=An unusual manifestation of osteoarticular tuberculosis: case report. | journal=Acta Clin Croat | year= 2014 | volume= 53 | issue= 2 | pages= 237-41 | pmid=25163241 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25163241 }} </ref>

:*Demineralization

:*Narrowing of the joint space

:*Bone and cartilage erosion

:*Calcifications

{|
|[[Image: Tuberculosis Arthritis X-ray.jpg|thumb|300px|left|Tuberculous arthritis of the hip Image courtesy of Dr Matt Skalski, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculous-arthritis-with-phemister-triad here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]|link=Special:FilePath/Tuberculosis_Arthritis_X-ray.jpg]]
|[[Image: Shoulder Tuberculosis.jpg|thumb|340px|left|Shoulder tuberculous Image courtesy of Dr Gagandeep Choudhary, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/caries-sicca-shoulder-tuberculosis-1 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]|link=Special:FilePath/Shoulder_Tuberculosis.jpg]]
|}

===Abreugraphy===
Abreugraphy is a variant of the [[chest X-ray]], and it is named after Dr. Manuel Dias de Abreu who was its inventor. It provides a small radiographic image, which is also known as ''miniature chest radiograph'', or ''Miniature Mass Radiography'' (MMR). Despite its limited resolution, which limits its use in some cases, such as [[lung cancer]], it allows the identification of lung abnormalities, which may suggest the [[diagnosis]] of tuberculosis.

It is less expensive than the traditional [[chest X-ray]], which allows its use in mass situations such as the TB [[screening]] of prisoners and immigrants. With the decrease of [[incidence]] of TB, this exam is no longer recommended among low-risk populations. However, MMR may still be used in high prevalence groups for the early diagnosis of the disease in [[asymptomatic]] patients.<ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref><ref name="pmid1804678">{{cite journal| author=Clancy L, Rieder HL, Enarson DA, Spinaci S| title=Tuberculosis elimination in the countries of Europe and other industrialized countries. | journal=Eur Respir J | year= 1991 | volume= 4 | issue= 10 | pages= 1288-95 | pmid=1804678 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1804678 }} </ref><ref name="pmid822464">{{cite journal| author=Horwitz O, Darrow MM| title=Principles and effects of mass screening: Danish experience in tuberculosis screening. | journal=Public Health Rep | year= 1976 | volume= 91 | issue= 2 | pages= 146-53 | pmid=822464 | doi= | pmc=PMC1438528 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=822464 }} </ref><ref name="pmid2496633">{{cite journal| author=Gordin FM, Slutkin G, Schecter G, Goodman PC, Hopewell PC| title=Presumptive diagnosis and treatment of pulmonary tuberculosis based on radiographic findings. | journal=Am Rev Respir Dis | year= 1989 | volume= 139 | issue= 5 | pages= 1090-3 | pmid=2496633 | doi=10.1164/ajrccm/139.5.1090 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2496633 }} </ref>

Some countries still use the abreugraphy to screen refugees, new workers and students who come from countries with high prevalence of TB. In the case of radiographic abnormalities on the MMR, the person is redirected to a medical center for further studies. <ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref>

In countries with low prevalence of TB, depending on the availability of screening methods, mass screening may be justified in some high-risk groups, such as homeless persons, alcoholics and HIV-positive patients.<ref name="pmid3094079">{{cite journal| author=Barry MA, Wall C, Shirley L, Bernardo J, Schwingl P, Brigandi E et al.| title=Tuberculosis screening in Boston's homeless shelters. | journal=Public Health Rep | year= 1986 | volume= 101 | issue= 5 | pages= 487-94 | pmid=3094079 | doi= | pmc=PMC1477764 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3094079 }} </ref><ref name="pmid3109292">{{cite journal| author=Grzybowski S, Allen EA, Black WA, Chao CW, Enarson DA, Isaac-Renton JL et al.| title=Inner-city survey for tuberculosis: evaluation of diagnostic methods. | journal=Am Rev Respir Dis | year= 1987 | volume= 135 | issue= 6 | pages= 1311-5 | pmid=3109292 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3109292 }} </ref>

{{details|Abreugraphy}}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis echocardiography or ultrasound

2021-02-03T07:16:14Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{Ammu}}

==Overview==
[[Echocardiography]] or [[Ultrasound]] can be helpful in patients who develop [[pericardial effusion]] secondary to TB.<ref name="pmid19006110">{{cite journal| author=Kil UH, Jung HO, Koh YS, Park HJ, Park CS, Kim PJ et al.| title=Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis. | journal=Clin Cardiol | year= 2008 | volume= 31 | issue= 11 | pages= 531-7 | pmid=19006110 | doi=10.1002/clc.20305 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19006110 }} </ref> On rare occasions TB may lead to [[congestive heart failure]], in which case [[echocardiograph]] may also help in the diagnosis. Common findings in [[CHF]] on the [[echocardiogram]] include [[hypokinesia]]; valvular insufficiency; and enlargement of all heart chambers.

*[[Tuberculosis]] involves the heart in 1-2% of the cases, and the [[pericardium]] is the most commonly affected structure.<ref name="CusterCharr1939">{{cite journal|last1=Custer|first1=Edward W.|last2=Charr|first2=Robert|title=TUBERCULOSIS OF THE MYOCARDIUM|journal=Journal of the American Medical Association|volume=112|issue=14|year=1939|pages=1333|issn=0002-9955|doi=10.1001/jama.1939.62800140003009a}}</ref><ref name="Fowler1991">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref> Patients with [[HIV]] have a high susceptibility for [[extrapulmonary]] tuberculosis including [[tuberculous pericarditis]]. [[Echocardiography]] is a good tool in diagnosing this [[extrapulmonary]] manifestation.

*The common findings in [[echocardiography]] include:<ref name="pmid15486140">{{cite journal| author=George S, Salama AL, Uthaman B, Cherian G| title=Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion. | journal=Heart | year= 2004 | volume= 90 | issue= 11 | pages= 1338-9 | pmid=15486140 | doi=10.1136/hrt.2003.020081 | pmc=PMC1768544 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15486140 }} </ref>

:*[[Pericardial]] thickening
:*[[Pericardial effusion]] classified as mild, moderate, and severe
:*[[Exudative]] deposits with echo dense mass around [[epicardium]]
:*[[Fibrin]] strands from [[pericardium]] protruding or crossing the [[pericardial]] space

*Although rare, the [[myocardium]] may also be involved in TB and should be suspected in patients with [[congestive heart failure]] and clinical features suggestive of TB.
*[[Echocardiographic]] findings may include:<ref name="pmid2389712">{{cite journal| author=Bali HK, Wahi S, Sharma BK, Anand IS, Datta BN, Wahi PL| title=Myocardial tuberculosis presenting as restrictive cardiomyopathy. | journal=Am Heart J | year= 1990 | volume= 120 | issue= 3 | pages= 703-6 | pmid=2389712 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2389712 }} </ref><ref name="pmid15857515">{{cite journal| author=Agarwal R, Malhotra P, Awasthi A, Kakkar N, Gupta D| title=Tuberculous dilated cardiomyopathy: an under-recognized entity? | journal=BMC Infect Dis | year= 2005 | volume= 5 | issue= | pages= 29 | pmid=15857515 | doi=10.1186/1471-2334-5-29 | pmc=PMC1090580 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15857515 }} </ref>

:*[[Hypokinesia]]
:*Enlargement of all heart chambers
:*[[Mitral regurgitation]]
:*[[Tricuspid regurgitation]]
:*[[Left ventricular systolic dysfunction]]

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis chest x ray

2021-02-03T07:10:28Z

Mashal Awais: /* Secondary Tuberculosis */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
An X-ray is very important in diagnosing [[pulmonary tuberculosis]]. Chest X-ray findings may present with parenchymal infiltrates, hilar [[adenopathy]], cavitation, [[nodules]] and [[pleural effusion]]. Pulmonary tuberculosis is most commonly located in the upper lobes.

==Chest X-Ray==
An anteroposterior chest X-ray is one of the most important tests to be performed in a patient with tuberculosis or suspected tuberculosis.<ref>{{Cite journal
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]]
| title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review
| journal = [[The Journal of rheumatology. Supplement]]
| volume = 91
| pages = 32–40
| year = 2014
| month = May
| doi = 10.3899/jrheum.140100
| pmid = 24788998
}}</ref>

===Primary Tuberculosis===

*The 3 main X-ray findings in primary tuberculosis include parenchymal infiltrates, hilar [[adenopathy]], and [[pleural effusion]].
*Primary tuberculosis may appear at any location in the lung.
*Hilar [[lymphadenopathy]] is commonly seen in children, and maybe present in up to 95% of children with active tuberculosis.
*Less than half of adults with primary tuberculosis present with [[lymphadenopathy]]. <ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>
*[[Tuberculomas]], which are opacities similar to a lung mass, may be observed in 5% of patients and can be almost 4 cm in size.<ref name="KimSong2001">{{cite journal|last1=Kim|first1=Hyae Young|last2=Song|first2=Koun-Sik|last3=Goo|first3=Jin Mo|last4=Lee|first4=Jin Seong|last5=Lee|first5=Kyoung Soo|last6=Lim|first6=Tae-Hwan|title=Thoracic Sequelae and Complications of Tuberculosis1|journal=RadioGraphics|volume=21|issue=4|year=2001|pages=839–858|issn=0271-5333|doi=10.1148/radiographics.21.4.g01jl06839}}</ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866 }} </ref>
*Unilateral [[pleural effusion]] may be observed and it is commonly related to complicated primary tuberculosis.

===Secondary Tuberculosis===

*The most common location of secondary tuberculosis is in the upper lobes, especially in the apical and posterior segments. However, lesions may appear anywhere in the [[lungs]].
*The X-ray findings in secondary or r[[eactivated tuberculosis]] include:<ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>

:*Patchy consolidation is poorly defined.
:*[[Cavitation]], which is the most important finding in secondary tuberculosis
::*Appears as a lesion with irregular margins and thick walls.
::*It may be observed in almost 50% of patients.
::*It is most commonly seen in the upper lung.
::*[[Cavities]] in the lower lung can be found in [[diabetes]] and [[HIV]] infection.<ref name="PatelRami2011">{{cite journal|last1=Patel|first1=AnandK|last2=Rami|first2=KiranC|last3=Ghanchi|first3=FerozD|title=Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus|journal=Lung India|volume=28|issue=1|year=2011|pages=70|issn=0970-2113|doi=10.4103/0970-2113.76308}}</ref><ref name="PadyanaBhat2012">{{cite journal|last1=Padyana|first1=Mahesha|last2=Bhat|first2=RaghavendraV|last3=Dinesha|first3=M|last4=Nawaz|first4=Alam|title=HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count|journal=North American Journal of Medical Sciences|volume=4|issue=5|year=2012|pages=221|issn=1947-2714|doi=10.4103/1947-2714.95904}}</ref>
::*Although it is rare, cavities can become [[superinfected]] and an air-fluid level is seen inside the cavity.
:*[[Pneumothorax]] is rare but may be seen in 5% of patients.
:*[[Lymphadenopathy]] is also uncommon in secondary tuberculosis.
:*Small [[pleural effusion]] may occur in 18% of patients.

*In the majority of cases the consolidation involves more than one lobe.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

=====Chest X-Ray Images in Pulmonary Tuberculosis=====
<gallery>
File:Pulmonary Tuberculosis X-ray.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray2.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray3.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray4.jpg|Bilateral Pulmonary Tuberculosis
File:TB CXR.jpg|Pulmonary Tuberculosis
</gallery>

===Common Findings of Miliary Tuberculosis on Chest X-Ray===

*Fine, pinpoint approximately 1-2mm in size, discrete, uniform distribution, soft mottlings.
*Commonly found throughout both lungs.
{{further|'''[[Miliary tuberculosis chest x ray|Miliary tuberculosis]]'''}}

=====Chest X-Ray Images in Miliary Tuberculosis=====
<gallery>
File:Miliary Tuberculosis.jpg|Miliary Tuberculosis
File:Disseminated-TB-001.jpg|Miliary Tuberculosis
File:Disseminated-TB-002.jpg|Miliary Tuberculosis
</gallery>

==CDC Guidelines for Evaluating Chest X-Ray<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref>==
A medical examination is compulsory for all refugees coming to the U.S. and all applicants outside the U.S. applying for an immigrant visa. The purpose of the medical examination is to identify applicants with inadmissible health-related conditions such as active tuberculosis. Outside the U.S., medical examinations are performed by approximately 400 physicians (panel physicians) selected by United States Department of State consular officials. In the U.S., medical examinations are performed by approximately 3,000 physicians (civil surgeons) designated by district directors of the U.S. Citizenship and Immigration Services. Guidelines were developed by the [[Centers for Disease Control and Prevention]] (CDC).

The [[chest X-ray]] and classification system is designed to group findings into categories based on their likelihood of being related to TB or non-TB conditions needing medical follow-up (either at the time of the [[chest X-ray]] or after resettlement).

===Abnormal Findings===

====Chest X-Ray Findings that Can Suggest Active TB====

This category comprises all findings typically associated with active pulmonary TB. An applicant with any of the following findings must undergo [[sputum]] specimens for examination.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Infiltrate or consolidation
| style="padding: 5px 5px; background: #F5F5F5;" |Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Any cavitary lesion
| style="padding: 5px 5px; background: #F5F5F5;" |Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Nodule with poorly defined margins
| style="padding: 5px 5px; background: #F5F5F5;" |Round density within the lung parenchyma, also called a tuberculoma. Nodules included in this category are those with margins that are indistinct or poorly defined. The surrounding haziness can be either subtle or readily apparent and suggests coexisting airspace consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural effusion
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of a significant amount of fluid within the pleural space. This finding must be distinguished from blunting of the costophrenic angle, which may or may not represent a small amount of fluid within the pleural space (except in children when even minor blunting must be considered a finding that can suggest active TB).
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Hilar or mediastinal lymphadenopathy ([[bihilar lymphadenopathy]])
| style="padding: 5px 5px; background: #F5F5F5;" |Enlargement of lymph nodes in one or both hila or within the [[mediastinum]], with or without associated atelectasis or consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Linear, interstitial disease (in children only)
| style="padding: 5px 5px; background: #F5F5F5;" |Prominence of linear, interstitial (septal) markings.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of active TB, such as [[miliary TB]]. Miliary findings are nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Chest X-Ray Findings that Can Suggest Inactive TB====

This includes findings that are suggestive of prior TB, that is inactive. It must be remembered that active TB cannot be diagnosed on the basis of a single radiograph alone. If there is any question of active TB, sputum smears must be obtained. Furthermore, if there are any signs or symptoms of TB, [[sputum]] smears must be obtained then as well. Therefore, any applicant might have findings grouped in this category, but still have active TB as suggested by:

*The presence of signs or symptoms of TB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B1]]).
*[[Sputum]] smears positive for AFB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class A]]).

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar or linear opacity
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a fibrocalcific scar.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) without calcification
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and without any surrounding airspace opacification. Nodules are generally round or have rounded edges. These features allow them to be distinguished from infiltrates or airspace opacities. To be included here, these nodules must be noncalcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear densities with reduction in the space occupied by the upper lobe. Associated signs include upward deviation of the fissure or hilum on the corresponding side with asymmetry of the volumes of the two thoracic cavities.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and no surrounding airspace opacification with reduction in the space occupied by the upper lobe. Nodules are generally round or have rounded edges.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of prior TB, such as upper lobe bronchiectasis. Bronchiectasis is bronchial dilation with bronchial wall thickening.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

===Other Chest X-Ray Findings===
====Follow-up====
This category includes findings that suggest the need for a follow-up evaluation for non-TB conditions either at the time of the chest X-ray or after resettlement of the applicant in the United States.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Musculoskeletal abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |New bony fractures or radiographically apparent bony abnormalities that need follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cardiac abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Cardiac enlargement or anomalies, vascular abnormalities, or any other radiographically apparent cardiovascular abnormality of significant nature to require follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Pulmonary finding of a non-TB nature, such as a mass, that needs follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding that the panel physician believes needs follow-up, but is not one of the above.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Follow-up Not Required====

This includes findings that are minor and not suggestive of TB disease. This does not require follow-up evaluation after the resettlement of the applicant.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural thickening
| style="padding: 5px 5px; background: #F5F5F5;" |Irregularity or abnormal prominence of the pleural margin, including apical capping (thickening of the pleura in the apical region). Pleural thickening can be calcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Diaphragmatic tenting

| style="padding: 5px 5px; background: #F5F5F5;" |A localized accentuation of the normal convexity of the hemidiaphragm as if 'pulled upwards by a string'.

|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Blunting of [[costophrenic angle]] (in adults)
| style="padding: 5px 5px; background: #F5F5F5;" |Loss of sharpness of one or both [[costophrenic angle]]s. Blunting can be related to a small amount of fluid in the pleural space or to pleural thickening and, by itself, is a non-specific finding (except in children, when even minor blunting may suggest active TB). In contrast a large pleural effusion, or the presence of a significant amount of fluid in the pleural space, may be a sign of active TB at any age.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Solitary calcified nodules or [[granuloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete calcified nodule or [[granuloma]], or calcified [[lymph node]]. The calcified nodule can be within the lung, hilium, or mediastinum. The borders must be sharp, distinct, and well defined. This was considered a [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] TB in the past; however, [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] has been omitted from the classification scheme because it has not been found to be associated with active TB.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

==X-Ray Findings in Complications of Tuberculosis==
{| style="border: 0px; font-size: 90%; margin: 3px; width:700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|X-Ray Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cicatrization<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Upper lobe [[atelectasis]]
*Compensatory hyperinflation of the lower lobe
*[[Hilar]] retraction
*[[Mediastinal]] shift
*Parenchymal bands
*Fibrotic cavities
*Fibrotic nodules
*Traction [[bronchiectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Thin-walled cavity
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present in active and inactive forms of the disease
*May regress with treatment
*Air-filled [[cysts]] may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
*Maybe misidentified as an [[Emphysema|emphysematous]] bulla or pneumatocelle.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Aspergilloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mobile mass ringed by an air shadow.
*Calcifications
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Broncholithiasis<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Calcified material within the tracheobronchial lumen, originated on a calcified [[lymph node]]
*[[Airway]] obstruction
*[[Atelectasis]]
*[[Air trapping]] on the expiration
*Frequent change in position of the calcified material
*Mucoid impaction
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Fibrosing [[mediastinitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Mediastinal]] widening
*Localized mass
*[[Hilar]] or [[mediastinal]] mass
*Calcification
*Pulmonary infiltrates
*[[Atelectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous spondylitis ([[Pott's disease]])
| style="padding: 5px 5px; background: #F5F5F5;" |
*Vertebral endplate irregularities
*Reduction of the intervertebral disk space
*Adjacent bone sclerosis
*In later stages of the disease, [[kyphosis]], due to anterior compression of the [[vertebral bodies]], and paravertebral [[abscess]]es may occur
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Malignancy]]<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Bone destruction around the region of the [[empyema]]
*Increased [[thoracic cavity]] opacity
*Medial deviation of the affected [[pleura]]
*Swelling of the soft-tissue
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis electrocardiogram

2021-02-03T07:02:35Z

Mashal Awais: /* Electrocardiogram */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Patients with pulmonary tuberculosis usually have a normal [[EKG]], but [[pericardial effusion]] might develop and lead to [[EKG]] changes. Extra-pulmonary tuberculosis, such as [[tuberculous pericarditis]], can show [[EKG]] changes.

==Electrocardiogram==

*Patients can develop a [[pericardial effusion]] secondary to [[tuberculosis]] and this might be manifested as low [[voltage]] and [[tachycardia]] on an [[EKG]].
*In in cases of [[tuberculous pericarditis]] the [[ECG]] may show non-specific ST-T-wave changes.<ref name="pmid14443596">{{cite journal| author=SCHRIRE V| title=Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period. | journal=S Afr Med J | year= 1959 | volume= 33 | issue= | pages= 810-7 | pmid=14443596 | doi= | pmc= | url= }} </ref><ref name="pmid11447490">{{cite journal| author=Smedema JP, Katjitae I, Reuter H, Burgess L, Louw V, Pretorius M et al.| title=Twelve-lead electrocardiography in tuberculous pericarditis. | journal=Cardiovasc J S Afr | year= 2001 | volume= 12 | issue= 1 | pages= 31-4 | pmid=11447490 | doi= | pmc= | url= }} </ref>
*Characteristic EKG finding of [[acute pericarditis]], [[PR-segment depression]], and [[diffuse ST-segment elevation]] are found in only 9-11% of cases<ref name="pmid5410398">{{cite journal| author=Rooney JJ, Crocco JA, Lyons HA| title=Tuberculous pericarditis. | journal=Ann Intern Med | year= 1970 | volume= 72 | issue= 1 | pages= 73-81 | pmid=5410398 | doi= | pmc= | url= }} </ref><ref name="pmid11447490">{{cite journal| author=Smedema JP, Katjitae I, Reuter H, Burgess L, Louw V, Pretorius M et al.| title=Twelve-lead electrocardiography in tuberculous pericarditis. | journal=Cardiovasc J S Afr | year= 2001 | volume= 12 | issue= 1 | pages= 31-4 | pmid=11447490 | doi= | pmc= | url= }} </ref>.
*The presence of a [[low QRS voltage]] and [[electrical alternans]] suggests the presence of a [[pericardial effusion]] and / or [[tamponade]].

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category: Needs content]]
[[Category:Bacterial diseases]]

Tuberculosis history and symptoms

2021-02-03T06:58:29Z

Mashal Awais: /* Extra-Pulmonary Tuberculosis */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
The common symptoms of tuberculosis include [[weakness]], [[weight loss]], [[fever]], and [[night sweats]]. Pulmonary tuberculosis presents with [[cough]], [[chest pain]], and [[hemoptysis]]. Tuberculosis is particularly difficult to diagnose in children, as these may not present with common findings.

==History and Symptoms==

Clinicians should be mindful of the patient’s history of TB exposure, [[infection]], or [[disease]]. It is also crucial to consider demographic factors (e.g., country of origin, age, ethnic or racial group, occupation) that may increase the patient’s risk for exposure to TB or to [[drug-resistant TB]]. Also, clinicians should find out for other medical conditions decreasing immunity, especially [[HIV]] infection, that increase the risk of latent TB infection progressing to TB disease.

===Pulmonary Tuberculosis===
When the disease becomes active, 75% of the cases involve the lungs. Pulmonary tuberculosis should be suspected in persons who have the following symptoms:<ref name="Mandell">{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>

*[[Cough]] (most common symptom)

:*Initially dry cough that progresses to productive.
:*Persistent cough, usually for more than three weeks.

*[[Fever]]
*[[Night sweats]]
*Unexplained [[weight loss]]
*[[Hemoptysis]]
*[[Chest pain]]
*[[Anorexia]]
*[[Malaise]]
*[[Chills]]
*[[Fatigue]]
*[[Dyspnea]]
*[[Lymphadenopathy]]

===Extra-Pulmonary Tuberculosis===
Other 25% of active cases moves from the [[lungs]], causing other kinds of TB more common in [[immunosuppressed]] persons and young children.

Another especially dangerous form is [[disseminated]] TB, more commonly known as [[miliary tuberculosis]]. Although extrapulmonary TB is not contagious, it may co-exist with pulmonary TB, which is contagious.<ref name="CDCcourse">[[Centers for Disease Control and Prevention]] (CDC), Division of Tuberculosis Elimination. [http://www.cdc.gov/nchstp/tb/pubs/corecurr/default.htm Core Curriculum on Tuberculosis: What the Clinician Should Know.] 4th edition (2000). Updated Aug 2003.</ref>

All forms of [[extra-pulmonary tuberculosis]] can include symptoms of pulmonary tuberculosis such as [[malaise]], [[night sweats]], [[cough]], [[weight loss]], and can be associated with an active pulmonary infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width:600px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Extra-Pulmonary Location}}
! style="background: #4479BA; width: 400px;" |{{fontcolor|#FFF|History and Symptoms}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous Lymphadenitis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fever]], painless lymph node swelling.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Pott's disease/Skeletal Tuberculosis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Low back pain]], [[stiffness]], joint swelling, limited mobility, pain in the affected joint or extremity.

|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Central Nervous System Tuberculosis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Headache]], [[seizures]], [[weakness]], [[vomiting]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Tuberculous Peritonitis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Abdominal pain]], [[fever]], [[ascites]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Tuberculous Pericarditis
| style="padding: 5px 5px; background: #F5F5F5;" |[[Shortness of breath]], [[chest pain]], [[cough]], [[pedal edema]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Renal Tuberculosis
| style="padding: 5px 5px; background: #F5F5F5;" |Symptoms of [[UTI]], such as [[polyuria]], [[dysuria]], [[hematuria]], [[flank pain]] Symptoms of [[obstructive uropathy]], such as [[oliguria]] or [[anuria]], pelvic pain.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Adapted from Asian Spine J. Feb 2014; 8(1): 97–111<ref name="Moon2014">{{cite journal|last1=Moon|first1=Myung-Sang|title=Tuberculosis of Spine: Current Views in Diagnosis and Management|journal=Asian Spine Journal|volume=8|issue=1|year=2014|pages=97|issn=1976-1902|doi=10.4184/asj.2014.8.1.97}}</ref>; Handbook of Clinical Neurology<ref name="Garcia-Monco2014">{{cite journal|last1=Garcia-Monco|first1=Juan Carlos|title=Tuberculosis|volume=121|year=2014|pages=1485–1499|issn=00729752|doi=10.1016/B978-0-7020-4088-7.00100-0}}</ref>Circulation Dec 2005 vol.112 no.23 3608-3616<ref name="Mayosi2005">{{cite journal|last1=Mayosi|first1=B. M.|title=Tuberculous Pericarditis|journal=Circulation|volume=112|issue=23|year=2005|pages=3608–3616|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.105.543066}}</ref>; Am J Trop Med Hyg 2013 vol. 88 no. 1 54-64<ref name="Daherda Silva Junior2013">{{cite journal|last1=Daher|first1=E. D. F.|last2=da Silva Junior|first2=G. B.|last3=Barros|first3=E. J. G.|title=Renal Tuberculosis in the Modern Era|journal=American Journal of Tropical Medicine and Hygiene|volume=88|issue=1|year=2013|pages=54–64|issn=0002-9637|doi=10.4269/ajtmh.2013.12-0413}}</ref>; Clin Infect Dis.(2011)53(6):555-562.<ref name="FontanillaBarnes2011">{{cite journal|last1=Fontanilla|first1=J.-M.|last2=Barnes|first2=A.|last3=von Reyn|first3=C. F.|title=Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis|journal=Clinical Infectious Diseases|volume=53|issue=6|year=2011|pages=555–562|issn=1058-4838|doi=10.1093/cid/cir454}}</ref>
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Bacterial diseases]]
[[Category:Disease]]
[[Category: Pulmonology]]

Tuberculosis primary prevention

2021-01-29T18:48:12Z

Mashal Awais: /* Determining the Infectiousness of TB Patients */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Primary prevention in [[tuberculosis]] is required to avoid the disease transmission and causing infection in healthy individuals. The [[BCG]] vaccine is given to children susceptible to [[TB]] infections, such as children living in endemic areas or who have close contact with a confirmed case of [[TB]]. Several preventive measures are used to avoid the transmission of the [[mycobacteria]], such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.

==Primary Prevention==
===BCG Vaccine===

*[[Bacille Calmmette-Guerin|Bacille Calmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]].
*[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that living in a highly endemic area of TB or who has a high risk of getting the infection due to exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*The administration of the vaccine is beneficial and is protective against severe types of tuberculosis infections, such as [[miliary TB|military]] or [[tuberculous meningitis|meningeal tuberculosis]].
*[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref>
*BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

:*A high percentage of TB patients have infected with TB strains resistant to both [[isoniazid]] and [[rifampin]]
:*There are ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful.

*Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be cautioned regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and also treatment of latent TB infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align="center"
| valign="top" |
|+
! colspan="2" style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Contraindications for BCG}}
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]]
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are candidates for [[organ transplant]]).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

|}

===Prevention for International Travelers===

*Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
*Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a [[tuberculin skin test]] (TST) or [[interferon-gamma release assay]] (IGRA) test before leaving the United States. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref>

===Prevention in Health-Care Settings===

*Confirmed cases of TB during hospitalization should meet the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref>

:*Single-patient room with private bathroom.
:*Healthcare workers and visitors should wear disposable respirators (at least N95).
:*Doors should be closed as much time as possible.
:*Adequate room ventilation or negative pressure should be monitored daily.

===Determining the Infectiousness of TB Patients===

{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Airborne Precautions}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:

*They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for [[acid-fast bacilli]] (AFB); and
*They are not receiving adequate [[antituberculosis therapy]], have just started therapy, or have a poor clinical or bacteriologic response to therapy.
|-
| style=" padding: 5px 5px; background: #F5F5F5;" |[[Airborne]] precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals.

|-
| style="padding: 5px 5px; background: #DCDCDC;" |If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard [[multidrug antituberculosis]] treatment (minimum of 2 weeks) and demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have [[drug-susceptible]] TB should remain under airborne precautions until they meet all of the following:

*Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
*Receive standard multidrug antituberculosis treatment (minimum of 2 weeks period).
*Demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref>

|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis future or investigational therapies

2021-01-29T05:54:13Z

Mashal Awais: /* Tuberculosis vaccine development */

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}} ; {{marjan}}
==Overview==
Since new drug-resistant tuberculosis has been emerging, the role of future therapies is vital in curbing outbreaks. The new drugs are required to be more effective than the current regimen and a few drugs in clinical trials have been showing good results.

==Future investigations==

===Principles of future investigations===
Any future regimen should satisfy the following principles. <ref name="Cost">{{cite web | title = Future therapy purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

*It should not have more than a maximum duration of 6 months
*The dosing schedule must be simple
*The number of drugs ideally should not be more than 3-5 drug from a different class
*It should have a minimum side effect profile so that we could have minimum monitoring
*It should be effective against [[MDR]], [[XDR]], and [[XXDR]] strains
*It should be administered orally
*It should have minimum interaction with antiretroviral drugs.
*It should have at least one new class of drug

===New drugs involved in a clinical trial for the treatment of tuberculosis===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Drug}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Phase}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Class}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Moxifloxacin]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fluoroquinolone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Linezolid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |AZD-5847
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Sutezolid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Clofazimine]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Riminophenazine]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |SQ-109
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Ethylenediamine]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |PA-824
| style="padding: 5px 5px; background: #F5F5F5;" |Phase IIb
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nitroimidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Delamanid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nitroimidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Bedaquiline]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diarylquinoline]]
|-
| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" |Data provided by WHO<ref name="CDC">{{cite web | title = Tuberculosis (TB) Future drugs| url = http://www.who.int/bulletin/volumes/92/1/BLT-13-122028-table-T1.html }}</ref>
|}

==Tuberculosis vaccine development==

*Neonatal BCG vaccination is partially effective at protecting infants and children, particularly from the most severe consequences of TB disease.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*BCG is poorly protective against pulmonary disease in adults, and therefore at reducing Mycobacterium tuberculosis transmission.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A new novel vaccine is warranted in decreasing the incidence and mortality of Tuberculosis; a vaccine that is effective in adult individuals who have not yet been infected with Mycobacterium tuberculosis, as well as in those with latent Mycobacterium tuberculosis infection.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*This new novel vaccine will also offer the best chance to contain the accelerating spread of multi-drug resistant tuberculosis.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*To this date, this new vaccine has not been developed but many TB vaccine candidates are in pipeline.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Potential vaccines are either whole-cell vaccines, adjuvanted proteins, and vectored subunit vaccines.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Up till now, there was no communicated consensus as to the preferred product characteristics (PPC) that would adequately support favorable policy recommendations for implementation where needed.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A document highlighting WHO preferred Product Characteristics (PPC) for new TB vaccines has been devised based on a high unmet medical need and technical feasibility assessment.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The preferred product characteristics (PPC) describe WHO preferences for parameters of vaccines, in particular their indications, target groups, possible immunization strategies, and features of clinical data desired related to safety and efficacy, supportive of policy decision making.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The vaccine PPCs are built through a wide consensus building process and result from interactions with a variety of stakeholders.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa, and Zambia.
*All of them already had latent tuberculosis, Of those who got two doses of the GSK vaccine, only 13 developed active tuberculosis during three years of follow-up, according to the new study published in The New England Journal of Medicine. By contrast, 26 of those who got a placebo progressed to active tuberculosis.

 
==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis future or investigational therapies

2021-01-29T05:48:43Z

Mashal Awais: /* Future investigations */

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}} ; {{marjan}}
==Overview==
Since new drug-resistant tuberculosis has been emerging, the role of future therapies is vital in curbing outbreaks. The new drugs are required to be more effective than the current regimen and a few drugs in clinical trials have been showing good results.

==Future investigations==

===Principles of future investigations===
Any future regimen should satisfy the following principles. <ref name="Cost">{{cite web | title = Future therapy purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

*It should not have more than a maximum duration of 6 months
*The dosing schedule must be simple
*The number of drugs ideally should not be more than 3-5 drug from a different class
*It should have a minimum side effect profile so that we could have minimum monitoring
*It should be effective against [[MDR]], [[XDR]], and [[XXDR]] strains
*It should be administered orally
*It should have minimum interaction with antiretroviral drugs.
*It should have at least one new class of drug

===New drugs involved in a clinical trial for the treatment of tuberculosis===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Drug}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Phase}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Class}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Moxifloxacin]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fluoroquinolone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Linezolid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |AZD-5847
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Sutezolid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Clofazimine]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Riminophenazine]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |SQ-109
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Ethylenediamine]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |PA-824
| style="padding: 5px 5px; background: #F5F5F5;" |Phase IIb
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nitroimidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Delamanid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nitroimidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Bedaquiline]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diarylquinoline]]
|-
| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" |Data provided by WHO<ref name="CDC">{{cite web | title = Tuberculosis (TB) Future drugs| url = http://www.who.int/bulletin/volumes/92/1/BLT-13-122028-table-T1.html }}</ref>
|}

==Tuberculosis vaccine development==

*Neonatal BCG vaccination is partially effective at protecting infants and children, particularly from the most severe consequences of TB disease.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*BCG is poorly protective against pulmonary disease in adults, and therefore at reducing Mycobactarium tuberculosis transmission.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A new novel vaccine is warranted in decreasing the incidence and mortality of Tuberculosis; a vaccine that is effective in adult individuals who have not yet been infected with Mycobacterium tuberculosis, as well as in those with latent Mycobacterium tuberculosis infection.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*This new novel vaccines will also offer the best chance to contain the accelerating spread of multi-drug resistant tuberculosis.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*To this date this new vaccine has not been develop but many TB vaccine candidate are in pipeline.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Potential vaccines are either whole cell vaccines, adjuvanted proteins, and vectored subunit vaccines.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Up till now, there was no communicated consensus as to the preferred product characteristics (PPC) that would adequately support favorable policy recommendations for implementation where needed.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A document highlighting WHO preferred Product Characteristics (PPC) for new TB vaccines has been devised based on a high unmet medical need and technical feasibility assessment.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The preferred product characteristics (PPC) describe WHO preferences for parameters of vaccines, in particular their indications, target groups, possible immunization strategies, and features of clinical data desired related to safety and efficacy, supportive of policy decision making.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The vaccine PPCs are built through a wide consensus building process and result from interactions with a variety of stakeholders.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa, and Zambia.
*All of them already had latent tuberculosis, Of those who got two doses of the GSK vaccine, only 13 developed active tuberculosis during three years of follow-up, according to the new study published in The New England Journal of Medicine. By contrast, 26 of those who got a placebo progressed to active tuberculosis.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis future or investigational therapies

2021-01-29T05:47:45Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}} ; {{marjan}}
==Overview==
Since new drug-resistant tuberculosis has been emerging, the role of future therapies is vital in curbing outbreaks. The new drugs are required to be more effective than the current regimen and a few drugs in clinical trials have been showing good results.

==Future investigations==

===Principles of future investigations===
Any future regimen should satisfy the following principles. <ref name="Cost">{{cite web | title = Future therapy purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

*It should not have more than a maximum duration of 6 months
*The dosing schedule must be simple
*The number of drugs in it should be ideally not more than 3-5 drug each from a different class
*It should have a minimum side effect profile so that we could have minimum monitoring
*It should be effective against [[MDR]], [[XDR]] and [[XXDR]] strains
*It should be administered orally
*It should have minimum interaction with antiretroviral drugs.
*It should have at least one new class of drug

===New drugs involved in a clinical trial for the treatment of tuberculosis===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Drug}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Phase}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Class}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Moxifloxacin]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fluoroquinolone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Linezolid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |AZD-5847
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Sutezolid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Clofazimine]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Riminophenazine]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |SQ-109
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Ethylenediamine]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |PA-824
| style="padding: 5px 5px; background: #F5F5F5;" |Phase IIb
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nitroimidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Delamanid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nitroimidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Bedaquiline]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diarylquinoline]]
|-
| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" |Data provided by WHO<ref name="CDC">{{cite web | title = Tuberculosis (TB) Future drugs| url = http://www.who.int/bulletin/volumes/92/1/BLT-13-122028-table-T1.html }}</ref>
|}

==Tuberculosis vaccine development==

*Neonatal BCG vaccination is partially effective at protecting infants and children, particularly from the most severe consequences of TB disease.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*BCG is poorly protective against pulmonary disease in adults, and therefore at reducing Mycobactarium tuberculosis transmission.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A new novel vaccine is warranted in decreasing the incidence and mortality of Tuberculosis; a vaccine that is effective in adult individuals who have not yet been infected with Mycobacterium tuberculosis, as well as in those with latent Mycobacterium tuberculosis infection.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*This new novel vaccines will also offer the best chance to contain the accelerating spread of multi-drug resistant tuberculosis.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*To this date this new vaccine has not been develop but many TB vaccine candidate are in pipeline.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Potential vaccines are either whole cell vaccines, adjuvanted proteins, and vectored subunit vaccines.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Up till now, there was no communicated consensus as to the preferred product characteristics (PPC) that would adequately support favorable policy recommendations for implementation where needed.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A document highlighting WHO preferred Product Characteristics (PPC) for new TB vaccines has been devised based on a high unmet medical need and technical feasibility assessment.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The preferred product characteristics (PPC) describe WHO preferences for parameters of vaccines, in particular their indications, target groups, possible immunization strategies, and features of clinical data desired related to safety and efficacy, supportive of policy decision making.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The vaccine PPCs are built through a wide consensus building process and result from interactions with a variety of stakeholders.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa, and Zambia.
*All of them already had latent tuberculosis, Of those who got two doses of the GSK vaccine, only 13 developed active tuberculosis during three years of follow-up, according to the new study published in The New England Journal of Medicine. By contrast, 26 of those who got a placebo progressed to active tuberculosis.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis future or investigational therapies

2021-01-29T05:46:04Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}} ; {{marjan}}
==Overview==
Since new drug-resistant tuberculosis has been emerging, the role of future therapies is vital in curbing outbreaks. The new drugs should be more effective than the current regimen and a few drugs in clinical trials have been showing good results.

==Future investigations==

===Principles of future investigations===
Any future regimen should satisfy the following principles. <ref name=Cost>{{cite web | title = Future therapy purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

* It should not have more than a maximum duration of 6 months
* The dosing schedule must be simple
* The number of drugs in it should be ideally not more than 3-5 drug each from a different class
* It should have a minimum side effect profile so that we could have minimum monitoring
* It should be effective against [[MDR]], [[XDR]] and [[XXDR]] strains
* It should be administered orally
* It should have minimum interaction with antiretroviral drugs.
* It should have at least one new class of drug

===New drugs involved in a clinical trial for the treatment of tuberculosis===

{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Drug}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Phase}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Class}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Moxifloxacin]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fluoroquinolone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Linezolid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |AZD-5847
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Sutezolid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Oxazolidinone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Clofazimine]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Riminophenazine]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |SQ-109
| style="padding: 5px 5px; background: #F5F5F5;" |Phase II
| style="padding: 5px 5px; background: #F5F5F5;" |[[Ethylenediamine]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |PA-824
| style="padding: 5px 5px; background: #F5F5F5;" |Phase IIb
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nitroimidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Delamanid]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nitroimidazole]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Bedaquiline]]
| style="padding: 5px 5px; background: #F5F5F5;" |Phase III
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diarylquinoline]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan="3"|Data provided by WHO<ref name=CDC>{{cite web | title = Tuberculosis (TB) Future drugs| url = http://www.who.int/bulletin/volumes/92/1/BLT-13-122028-table-T1.html }}</ref>
|}

==Tuberculosis vaccine development==
*Neonatal BCG vaccination is partially effective at protecting infants and children, particularly from the most severe consequences of TB disease.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*BCG is poorly protective against pulmonary disease in adults, and therefore at reducing Mycobactarium tuberculosis transmission.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A new novel vaccine is warranted in decreasing the incidence and mortality of Tuberculosis; a vaccine that is effective in adult individuals who have not yet been infected with Mycobacterium tuberculosis, as well as in those with latent Mycobacterium tuberculosis infection.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*This new novel vaccines will also offer the best chance to contain the accelerating spread of multi-drug resistant tuberculosis.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*To this date this new vaccine has not been develop but many TB vaccine candidate are in pipeline.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Potential vaccines are either whole cell vaccines, adjuvanted proteins, and vectored subunit vaccines.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Up till now, there was no communicated consensus as to the preferred product characteristics (PPC) that would adequately support favorable policy recommendations for implementation where needed.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A document highlighting WHO preferred Product Characteristics (PPC) for new TB vaccines has been devised based on a high unmet medical need and technical feasibility assessment.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The preferred product characteristics (PPC) describe WHO preferences for parameters of vaccines, in particular their indications, target groups, possible immunization strategies, and features of clinical data desired related to safety and efficacy, supportive of policy decision making.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The vaccine PPCs are built through a wide consensus building process and result from interactions with a variety of stakeholders.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa, and Zambia.
*All of them already had latent tuberculosis, Of those who got two doses of the GSK vaccine, only 13 developed active tuberculosis during three years of follow-up, according to the new study published in The New England Journal of Medicine. By contrast, 26 of those who got a placebo progressed to active tuberculosis.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis cost-effectiveness of therapy

2021-01-29T05:45:22Z

Mashal Awais: /* Cost effectiveness of therapy */

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}}
==Overview==
Treatment of tuberculosis must be investigated for relative cost-effectiveness of inpatient and outpatient models of care as it will benefit regions where tuberculosis is highly prevalent. Unless there are severe complications it is highly recommended to treat the TB patient in ambulatory care rather than inpatient services.<ref name="pmid22070215">{{cite journal| author=Fitzpatrick C, Floyd K| title=A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. | journal=Pharmacoeconomics | year= 2012 | volume= 30 | issue= 1 | pages= 63-80 | pmid=22070215 | doi=10.2165/11595340-000000000-00000 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070215 }} </ref>

==Cost effectiveness of therapy==
While measurements of morbidity and mortality are key considerations for estimating the burden of disease in populations, they provide an incomplete picture of the adverse impact of ill health on human welfare. In particular, the economic consequences of poor health can be substantial.

Analysis of the economic impact of the disease addresses a number of policy questions concerning the consequences of disease or injury. Some of these questions are related to the microeconomic level of households, firms, or government – such as the impact of the disease on a household’s income or a firm’s profits – while others relate to the macroeconomic level, including the aggregate impact of a disease on a country’s current and future gross domestic product (GDP).

WHO proposes a defined conceptual framework within which the economic impact of diseases and injuries can be considered and appropriately estimated. <ref name="WHO">{{cite web | title = Cost-effectiveness and strategic planning| url = http://www.who.int/choice/economicburden/en/ }}</ref>

The current regimen costs about US$ 4000 per patient, which does not include laboratory, human resource, and patient opportunity costs. <ref name="Cost">{{cite web | title = Cost effectiveness purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

The cost-effectiveness in various tubercular control interventions in Africa region is given below. <ref name="Cost">{{cite web | title = Cost effectiveness with TB control interventions| url = http://www.who.int/choice/publications/p_2005_MDG_series_TB.pdf?ua=1}}</ref>

{| style="border: 0px; font-size: 90%; margin: 3px; width: 500px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Intervention}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Yearly costs with 95% coverage level}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |366.3 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |612.2 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS with resistant cases
| style="padding: 5px 5px; background: #F5F5F5;" |495.9 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full combination
| style="padding: 5px 5px; background: #F5F5F5;" |739.4 million $
|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis cost-effectiveness of therapy

2021-01-29T05:44:08Z

Mashal Awais: /* Cost effectiveness of therapy */

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}}
==Overview==
Treatment of tuberculosis must be investigated for relative cost-effectiveness of inpatient and outpatient models of care as it will benefit regions where tuberculosis is highly prevalent. Unless there are severe complications it is highly recommended to treat the TB patient in ambulatory care rather than inpatient services.<ref name="pmid22070215">{{cite journal| author=Fitzpatrick C, Floyd K| title=A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. | journal=Pharmacoeconomics | year= 2012 | volume= 30 | issue= 1 | pages= 63-80 | pmid=22070215 | doi=10.2165/11595340-000000000-00000 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070215 }} </ref>

==Cost effectiveness of therapy==
While measurements of morbidity and mortality are key considerations for estimating the burden of disease in populations, they provide an incomplete picture of the adverse impact of ill health on human welfare. In particular, the economic consequences of poor health can be substantial.

Analysis of the economic impact of ill-health addresses a number of policy questions concerning the consequences of disease or injury. Some of these questions relate to the microeconomic level of households, firms, or government – such as the impact of the disease on a household’s income or a firm’s profits – while others relate to the macroeconomic level, including the aggregate impact of a disease on a country’s current and future gross domestic product (GDP).

WHO proposes a defined conceptual framework within which the economic impact of diseases and injuries can be considered and appropriately estimated. <ref name="WHO">{{cite web | title = Cost-effectiveness and strategic planning| url = http://www.who.int/choice/economicburden/en/ }}</ref>

The current regimen costs about US$ 4000 per patient, which does not include laboratory, human resource, and patient opportunity costs. <ref name="Cost">{{cite web | title = Cost effectiveness purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

The cost-effectiveness in various tubercular control interventions in Africa region is given below. <ref name="Cost">{{cite web | title = Cost effectiveness with TB control interventions| url = http://www.who.int/choice/publications/p_2005_MDG_series_TB.pdf?ua=1}}</ref>

{| style="border: 0px; font-size: 90%; margin: 3px; width: 500px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Intervention}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Yearly costs with 95% coverage level}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |366.3 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |612.2 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS with resistant cases
| style="padding: 5px 5px; background: #F5F5F5;" |495.9 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full combination
| style="padding: 5px 5px; background: #F5F5F5;" |739.4 million $
|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis cost-effectiveness of therapy

2021-01-29T05:43:50Z

Mashal Awais: /* Cost effectiveness of therapy */

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}}
==Overview==
Treatment of tuberculosis must be investigated for relative cost-effectiveness of inpatient and outpatient models of care as it will benefit regions where tuberculosis is highly prevalent. Unless there are severe complications it is highly recommended to treat the TB patient in ambulatory care rather than inpatient services.<ref name="pmid22070215">{{cite journal| author=Fitzpatrick C, Floyd K| title=A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. | journal=Pharmacoeconomics | year= 2012 | volume= 30 | issue= 1 | pages= 63-80 | pmid=22070215 | doi=10.2165/11595340-000000000-00000 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070215 }} </ref>

==Cost effectiveness of therapy==
While measurements of morbidity and mortality are key considerations for estimating the burden of disease in populations, they provide an incomplete picture of the adverse impact of ill health on human welfare. In particular, the economic consequences of poor health can be substantial.

Analysis of the economic impact of ill-health addresses a number of policy questions concerning the consequences of disease or injury. Some of these questions relate to the microeconomic level of households, firms, or government – such as the impact of disease on a household’s income or a firm’s profits – while others relate to the macroeconomic level, including the aggregate impact of a disease on a country’s current and future gross domestic product (GDP).

WHO proposes a defined conceptual framework within which the economic impact of diseases and injuries can be considered and appropriately estimated. <ref name="WHO">{{cite web | title = Cost-effectiveness and strategic planning| url = http://www.who.int/choice/economicburden/en/ }}</ref>

The current regimen costs about US$ 4000 per patient, which does not include laboratory, human resource, and patient opportunity costs. <ref name="Cost">{{cite web | title = Cost effectiveness purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

The cost-effectiveness in various tubercular control interventions in Africa region is given below. <ref name="Cost">{{cite web | title = Cost effectiveness with TB control interventions| url = http://www.who.int/choice/publications/p_2005_MDG_series_TB.pdf?ua=1}}</ref>

{| style="border: 0px; font-size: 90%; margin: 3px; width: 500px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Intervention}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Yearly costs with 95% coverage level}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |366.3 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |612.2 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS with resistant cases
| style="padding: 5px 5px; background: #F5F5F5;" |495.9 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full combination
| style="padding: 5px 5px; background: #F5F5F5;" |739.4 million $
|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis cost-effectiveness of therapy

2021-01-29T05:42:38Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}}
==Overview==
Treatment of tuberculosis must be investigated for relative cost-effectiveness of inpatient and outpatient models of care as it will benefit regions where tuberculosis is highly prevalent. Unless there is severe complications it is highly recommended to treat the TB patient in ambulatory care rather than inpatient services.<ref name="pmid22070215">{{cite journal| author=Fitzpatrick C, Floyd K| title=A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. | journal=Pharmacoeconomics | year= 2012 | volume= 30 | issue= 1 | pages= 63-80 | pmid=22070215 | doi=10.2165/11595340-000000000-00000 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070215 }} </ref>

==Cost effectiveness of therapy==
While measurements of morbidity and mortality are key considerations for estimating the burden of disease in populations, they provide an incomplete picture of the adverse impact of ill health on human welfare. In particular, the economic consequences of poor health can be substantial.

Analysis of the economic impact of ill-health addresses a number of policy questions concerning the consequences of disease or injury. Some of these questions relate to the microeconomic level of households, firms, or government – such as the impact of disease on a household’s income or a firm’s profits – while others relate to the macroeconomic level, including the aggregate impact of a disease on a country’s current and future gross domestic product (GDP).

WHO proposes a defined conceptual framework within which the economic impact of diseases and injuries can be considered and appropriately estimated. <ref name="WHO">{{cite web | title = Cost-effectiveness and strategic planning| url = http://www.who.int/choice/economicburden/en/ }}</ref>

The current regimen costs about US$ 4000 per patient, which does not include laboratory, human resource and patient opportunity costs. <ref name="Cost">{{cite web | title = Cost effectiveness purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

The cost-effectiveness in various tubercular control interventions in Africa region is give below. <ref name="Cost">{{cite web | title = Cost effectiveness with TB control interventions| url = http://www.who.int/choice/publications/p_2005_MDG_series_TB.pdf?ua=1}}</ref>

{| style="border: 0px; font-size: 90%; margin: 3px; width: 500px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Intervention}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Yearly costs with 95% coverage level}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |366.3 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |612.2 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS with resistant cases
| style="padding: 5px 5px; background: #F5F5F5;" |495.9 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full combination
| style="padding: 5px 5px; background: #F5F5F5;" |739.4 million $
|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis cost-effectiveness of therapy

2021-01-29T05:39:53Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}}
==Overview==
Treatment of tuberculosis must be analyzed for relative cost-effectiveness of inpatient and outpatient models of care as it will benefit regions where tuberculosis is highly prevalent. Unless there is severe complications it is highly recommended to treat the TB patient in ambulatory care rather than inpatient services.<ref name="pmid22070215">{{cite journal| author=Fitzpatrick C, Floyd K| title=A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. | journal=Pharmacoeconomics | year= 2012 | volume= 30 | issue= 1 | pages= 63-80 | pmid=22070215 | doi=10.2165/11595340-000000000-00000 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070215 }} </ref>

==Cost effectiveness of therapy==
While measurements of morbidity and mortality are key considerations for estimating the burden of disease in populations, they provide an incomplete picture of the adverse impact of ill health on human welfare. In particular, the economic consequences of poor health can be substantial.

Analysis of the economic impact of ill-health addresses a number of policy questions concerning the consequences of disease or injury. Some of these questions relate to the microeconomic level of households, firms, or government – such as the impact of ill-health on a household’s income or a firm’s profits – while others relate to the macroeconomic level, including the aggregate impact of a disease on a country’s current and future gross domestic product (GDP).

WHO proposes a defined conceptual framework within which the economic impact of diseases and injuries can be considered and appropriately estimated. <ref name="WHO">{{cite web | title = Cost-effectiveness and strategic planning| url = http://www.who.int/choice/economicburden/en/ }}</ref>

The current regimen costs about US$ 4000 per patient, exclusive of laboratory, human resource and patient opportunity costs. <ref name="Cost">{{cite web | title = Cost effectiveness purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

The cost-effectiveness in various tubercular control interventions in Africa region is give below. <ref name="Cost">{{cite web | title = Cost effectiveness with TB control interventions| url = http://www.who.int/choice/publications/p_2005_MDG_series_TB.pdf?ua=1}}</ref>

{| style="border: 0px; font-size: 90%; margin: 3px; width: 500px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Intervention}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Yearly costs with 95% coverage level}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |366.3 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |612.2 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS with resistant cases
| style="padding: 5px 5px; background: #F5F5F5;" |495.9 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full combination
| style="padding: 5px 5px; background: #F5F5F5;" |739.4 million $
|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis cost-effectiveness of therapy

2021-01-29T05:38:43Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}}
==Overview==
Treatment of tuberculosis must be analysed for relative cost effectiveness of inpatient and outpatient models of care as it will benefit regions where tuberculosis is highly prevalent. Unless there is severe complications it is highly recommended to treat the TB patient in ambulatory care rather than inpatient services.<ref name="pmid22070215">{{cite journal| author=Fitzpatrick C, Floyd K| title=A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. | journal=Pharmacoeconomics | year= 2012 | volume= 30 | issue= 1 | pages= 63-80 | pmid=22070215 | doi=10.2165/11595340-000000000-00000 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070215 }} </ref>

==Cost effectiveness of therapy==
While measurements of morbidity and mortality are key considerations for estimating the burden of disease in populations, they provide an incomplete picture of the adverse impact of ill health on human welfare. In particular, the economic consequences of poor health can be substantial.

Analysis of the economic impact of ill-health addresses a number of policy questions concerning the consequences of disease or injury. Some of these questions relate to the microeconomic level of households, firms, or government – such as the impact of ill-health on a household’s income or a firm’s profits – while others relate to the macroeconomic level, including the aggregate impact of a disease on a country’s current and future gross domestic product (GDP).

WHO proposes a defined conceptual framework within which the economic impact of diseases and injuries can be considered and appropriately estimated. <ref name=WHO>{{cite web | title = Cost-effectiveness and strategic planning| url = http://www.who.int/choice/economicburden/en/ }}</ref>

The current regimen costs about US$ 4000 per patient, exclusive of laboratory, human resource and patient opportunity costs. <ref name=Cost>{{cite web | title = Cost effectiveness purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>

The cost effectiveness in various tubercular control interventions in Africa region is give below. <ref name=Cost>{{cite web | title = Cost effectiveness with TB control interventions| url = http://www.who.int/choice/publications/p_2005_MDG_series_TB.pdf?ua=1}}</ref>

{| style="border: 0px; font-size: 90%; margin: 3px; width: 500px;" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Intervention}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Yearly costs with 95% coverage level}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS
| style="padding: 5px 5px; background: #F5F5F5;" | 366.3 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full DOTS
| style="padding: 5px 5px; background: #F5F5F5;" |612.2 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Minimal DOTS with resistant cases
| style="padding: 5px 5px; background: #F5F5F5;" |495.9 million $
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Full combination
| style="padding: 5px 5px; background: #F5F5F5;" |739.4 million $
|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis secondary prevention

2021-01-29T05:38:03Z

Mashal Awais: /* Tuberculin Skin Test */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Secondary prevention for tuberculosis includes methods for screening and early diagnosis, such as [[tuberculin skin test]] (TST) and [[IGRAs]]; and to guarantee the correct treatment regimen at the right time to prevent disease progression.

==Secondary Prevention==

===Screening===
{{further|[[Tuberculosis screening]]}}

=====Tuberculin Skin Test=====

*Children having close contact with a TB confirmed case should be evaluated for tuberculosis infection.
*[[TST]] is the test of choice for screening for tuberculosis infection.

====Interferon-Gamma Release Assays (IGRAs)====

*IGRA can be used in place of (but not in addition to) TST in screening for [[M. tuberculosis]] infection in the following conditions:<ref name="CDC TST">{{cite web|url= http://www.cdc.gov/tb/publications/factsheets/testing/IGRA.htm|title= CDC Interferon-Gamma Release Assays (IGRAs) - Blood Tests for TB Infection }}</ref>

:*A patient has received BCG vaccination
:*Groups that historically have poor follow up return for TST reading.

*TST preferred compared to IGRA for TB screening due to its low cost and high accessibility.<ref>{{Cite journal
| author = [[Hong-Van Tieu]], [[Piyarat Suntarattiwong]], [[Thanyawee Puthanakit]], [[Tawee Chotpitayasunondh]], [[Kulkanya Chokephaibulkit]], [[Sunee Sirivichayakul]], [[Supranee Buranapraditkun]], [[Patcharawee Rungrojrat]], [[Nitiya Chomchey]], [[Simon Tsiouris]], [[Scott Hammer]], [[Vijay Nandi]] & [[Jintanat Ananworanich]]
| title = Comparing interferon-gamma release assays to tuberculin skin test in thai children with tuberculosis exposure
| journal = [[PloS one]]
| volume = 9
| issue = 8
| pages = e105003
| year = 2014
| month =
| doi = 10.1371/journal.pone.0105003
| pmid = 25121513
}}</ref>

===Early Diagnosis===

*Early detection of tuberculosis disease is important to give treatment at the appropriate time and prevent complications.
*All patients should be routinely asked about:<ref name="CDC Guidelines"> {{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e | title=CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005}} </ref>

:*History of TB exposure, infection, or disease
:*Symptoms or signs of TB disease
:*Medical conditions that increase their risk for TB disease

*Patients with the following characteristics should be tested for tuberculosis:<ref name="CDC Guidelines"> {{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e | title=CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005}} </ref>

:*[[Cough]] for ≥3 weeks
:*[[Loss of appetite]]
:*Unexplained [[weight loss]]
:*[[Night sweats]]
:*[[Hemoptysis]]
:*[[Hoarseness]]
:*[[Fever]]
:*[[Fatigue]]
:*[[Chest pain]]
:*Patient from an endemic area of TB

===Prompt Treatment===

*Empiric therapy should be started as soon as a patient has tuberculosis disease confirmed.
*Sputum specimens should be sent for culture and [[DST]] before starting treatment.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis secondary prevention

2021-01-29T05:36:24Z

Mashal Awais: /* Interferon-Gamma Release Assays (IGRAs) */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Secondary prevention for tuberculosis includes methods for screening and early diagnosis, such as [[tuberculin skin test]] (TST) and [[IGRAs]]; and to guarantee the correct treatment regimen at the right time to prevent disease progression.

==Secondary Prevention==

===Screening===
{{further|[[Tuberculosis screening]]}}

=====Tuberculin Skin Test=====

*Children with close contact with a TB confirmed case should be evaluated for tuberculosis infection.
*[[TST]] is the test of choice for screening for tuberculosis infection.

====Interferon-Gamma Release Assays (IGRAs)====

*IGRA can be used in place of (but not in addition to) TST in screening for [[M. tuberculosis]] infection in the following conditions:<ref name="CDC TST">{{cite web|url= http://www.cdc.gov/tb/publications/factsheets/testing/IGRA.htm|title= CDC Interferon-Gamma Release Assays (IGRAs) - Blood Tests for TB Infection }}</ref>

:*A patient has received BCG vaccination
:*groups that historically have poor rates of return for TST reading.

*TST preferred compared to IGRA for TB screening due to its low cost and high accessibility.<ref>{{Cite journal
| author = [[Hong-Van Tieu]], [[Piyarat Suntarattiwong]], [[Thanyawee Puthanakit]], [[Tawee Chotpitayasunondh]], [[Kulkanya Chokephaibulkit]], [[Sunee Sirivichayakul]], [[Supranee Buranapraditkun]], [[Patcharawee Rungrojrat]], [[Nitiya Chomchey]], [[Simon Tsiouris]], [[Scott Hammer]], [[Vijay Nandi]] & [[Jintanat Ananworanich]]
| title = Comparing interferon-gamma release assays to tuberculin skin test in thai children with tuberculosis exposure
| journal = [[PloS one]]
| volume = 9
| issue = 8
| pages = e105003
| year = 2014
| month =
| doi = 10.1371/journal.pone.0105003
| pmid = 25121513
}}</ref>

===Early Diagnosis===

*Early detection of tuberculosis disease is important to give treatment at the appropriate time and prevent complications.
*All patients should be routinely asked about:<ref name="CDC Guidelines"> {{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e | title=CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005}} </ref>

:*History of TB exposure, infection, or disease
:*Symptoms or signs of TB disease
:*Medical conditions that increase their risk for TB disease

*Patients with the following characteristics should be tested for tuberculosis:<ref name="CDC Guidelines"> {{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e | title=CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005}} </ref>

:*[[Cough]] for ≥3 weeks
:*[[Loss of appetite]]
:*Unexplained [[weight loss]]
:*[[Night sweats]]
:*[[Hemoptysis]]
:*[[Hoarseness]]
:*[[Fever]]
:*[[Fatigue]]
:*[[Chest pain]]
:*Patient from an endemic area of TB

===Prompt Treatment===

*Empiric therapy should be started as soon as a patient has tuberculosis disease confirmed.
*Sputum specimens should be sent for culture and [[DST]] before starting treatment.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis secondary prevention

2021-01-29T05:35:17Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Secondary prevention for tuberculosis includes methods for screening and early diagnosis, such as [[tuberculin skin test]] (TST) and [[IGRAs]]; and to guarantee the correct treatment regimen at the right time to prevent disease progression.

==Secondary Prevention==

===Screening===
{{further|[[Tuberculosis screening]]}}

=====Tuberculin Skin Test=====
*Children with close contact with a TB confirmed case should be evaluated for tuberculosis infection.
*[[TST]] is the test of choice for screening for tuberculosis infection.

====Interferon-Gamma Release Assays (IGRAs)====
*IGRA can be used in place of (but not in addition to) TST in screening for [[M. tuberculosis]] infection in the following conditions:<ref name="CDC TST">{{cite web|url= http://www.cdc.gov/tb/publications/factsheets/testing/IGRA.htm|title= CDC Interferon-Gamma Release Assays (IGRAs) - Blood Tests for TB Infection }}</ref>
:*A patient have received BCG vaccination
:*groups that historically have poor rates of return for TST reading.
*TST preferred compared to IGRA for TB screening due to its low cost and high accessibility.<ref>{{Cite journal
| author = [[Hong-Van Tieu]], [[Piyarat Suntarattiwong]], [[Thanyawee Puthanakit]], [[Tawee Chotpitayasunondh]], [[Kulkanya Chokephaibulkit]], [[Sunee Sirivichayakul]], [[Supranee Buranapraditkun]], [[Patcharawee Rungrojrat]], [[Nitiya Chomchey]], [[Simon Tsiouris]], [[Scott Hammer]], [[Vijay Nandi]] & [[Jintanat Ananworanich]]
| title = Comparing interferon-gamma release assays to tuberculin skin test in thai children with tuberculosis exposure
| journal = [[PloS one]]
| volume = 9
| issue = 8
| pages = e105003
| year = 2014
| month =
| doi = 10.1371/journal.pone.0105003
| pmid = 25121513
}}</ref>

===Early Diagnosis===
*Early detection of tuberculosis disease is important to give treatment at the appropriate time and prevent complications.
*All patients should be routinely asked about:<ref name="CDC Guidelines"> {{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e | title=CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005}} </ref>
:* History of TB exposure, infection, or disease
:* Symptoms or signs of TB disease
:* Medical conditions that increase their risk for TB disease
*Patients with the following characteristics should be tested for tuberculosis:<ref name="CDC Guidelines"> {{cite web| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e | title=CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005}} </ref>
:* [[Cough]] for ≥3 weeks
:* [[Loss of appetite]]
:* Unexplained [[weight loss]]
:* [[Night sweats]]
:* [[Hemoptysis]]
:* [[Hoarseness]]
:* [[Fever]]
:* [[Fatigue]]
:* [[Chest pain]]
:* Patient from an endemic area of TB

===Prompt Treatment===
*Empiric therapy should be started as soon as a patient has tuberculosis disease confirmed.
*Sputum specimens should be sent for culture and [[DST]] before starting treatment.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis primary prevention

2021-01-29T05:34:36Z

Mashal Awais: /* Determining the Infectiousness of TB Patients */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Primary prevention in [[tuberculosis]] is required to avoid the disease transmission and causing infection in healthy individuals. The [[BCG]] vaccine is given to children susceptible to [[TB]] infections, such as children living in endemic areas or who have close contact with a confirmed case of [[TB]]. Several preventive measures are used to avoid the transmission of the [[mycobacteria]], such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.

==Primary Prevention==
===BCG Vaccine===

*[[Bacille Calmmette-Guerin|Bacille Calmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]].
*[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that living in a highly endemic area of TB or who has a high risk of getting the infection due to exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*The administration of the vaccine is beneficial and is protective against severe types of tuberculosis infections, such as [[miliary TB|military]] or [[tuberculous meningitis|meningeal tuberculosis]].
*[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref>
*BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

:*A high percentage of TB patients have infected with TB strains resistant to both [[isoniazid]] and [[rifampin]]
:*There are ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful.

*Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be cautioned regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and also treatment of latent TB infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align="center"
| valign="top" |
|+
! colspan="2" style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Contraindications for BCG}}
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]]
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are candidates for [[organ transplant]]).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

|}

===Prevention for International Travelers===

*Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
*Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a [[tuberculin skin test]] (TST) or [[interferon-gamma release assay]] (IGRA) test before leaving the United States. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref>

===Prevention in Health-Care Settings===

*Confirmed cases of TB during hospitalization should meet the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref>

:*Single-patient room with private bathroom.
:*Healthcare workers and visitors should wear disposable respirators (at least N95).
:*Doors should be closed as much time as possible.
:*Adequate room ventilation or negative pressure should be monitored daily.

===Determining the Infectiousness of TB Patients===

{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Airborne Precautions}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:

*They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and
*They are not receiving adequate antituberculosis therapy, have just started therapy, or have a poor clinical or bacteriologic response to therapy.
|-
| style=" padding: 5px 5px; background: #F5F5F5;" |Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals.

|-
| style="padding: 5px 5px; background: #DCDCDC;" |If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis treatment (minimum of 2 weeks) and demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:

*Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
*Receive standard multidrug antituberculosis treatment (minimum of 2 weeks period).
*Demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref>

|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis primary prevention

2021-01-29T05:32:37Z

Mashal Awais: /* Primary Prevention */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Primary prevention in [[tuberculosis]] is required to avoid the disease transmission and causing infection in healthy individuals. The [[BCG]] vaccine is given to children susceptible to [[TB]] infections, such as children living in endemic areas or who have close contact with a confirmed case of [[TB]]. Several preventive measures are used to avoid the transmission of the [[mycobacteria]], such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.

==Primary Prevention==
===BCG Vaccine===

*[[Bacille Calmmette-Guerin|Bacille Calmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]].
*[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that living in a highly endemic area of TB or who has a high risk of getting the infection due to exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*The administration of the vaccine is beneficial and is protective against severe types of tuberculosis infections, such as [[miliary TB|military]] or [[tuberculous meningitis|meningeal tuberculosis]].
*[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref>
*BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

:*A high percentage of TB patients have infected with TB strains resistant to both [[isoniazid]] and [[rifampin]]
:*There are ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful.

*Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be cautioned regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and also treatment of latent TB infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align="center"
| valign="top" |
|+
! colspan="2" style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Contraindications for BCG}}
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]]
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are candidates for [[organ transplant]]).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

|}

===Prevention for International Travelers===

*Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
*Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a [[tuberculin skin test]] (TST) or [[interferon-gamma release assay]] (IGRA) test before leaving the United States. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref>

===Prevention in Health-Care Settings===

*Confirmed cases of TB during hospitalization should meet the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref>

:*Single-patient room with private bathroom.
:*Healthcare workers and visitors should wear disposable respirators (at least N95).
:*Doors should be closed as much time as possible.
:*Adequate room ventilation or negative pressure should be monitored daily.

===Determining the Infectiousness of TB Patients===

{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Airborne Precautions}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:

*They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and
*They are not receiving adequate antituberculosis therapy, have just started therapy, or have a poor clinical or bacteriologic response to therapy.
|-
| style=" padding: 5px 5px; background: #F5F5F5;" |Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals.

|-
| style="padding: 5px 5px; background: #DCDCDC;" |If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis treatment (minimum of 2 weeks) and demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:

*Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
*Receive standard multidrug antituberculosis treatment (minimum of 2 weeks).
*Demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref>

|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis primary prevention

2021-01-29T05:27:38Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Primary prevention in [[tuberculosis]] is required to avoid the disease transmission and causing infection in healthy individuals. The [[BCG]] vaccine is given to children susceptible to [[TB]] infections, such as children living in endemic areas or who have close contact with a confirmed case of [[TB]]. Several preventive measures are used to avoid the transmission of the [[mycobacteria]], such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.

==Primary Prevention==
===BCG Vaccine===

*[[Bacille Calmmette-Guerin|Bacille Calmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]].
*[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that living in a highly endemic area of TB or who has a high risk of getting the infection due to exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*The administration of the vaccine is beneficial and is protective against severe types of tuberculosis infections, such as [[miliary TB|military]] or [[tuberculous meningitis|meningeal tuberculosis]].
*[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref>
*BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

:*A high percentage of TB patients have infected with TB strains resistant to both [[isoniazid]] and [[rifampin]]
:*There are ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful.

*Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be cautioned regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and also treatment of latent TB infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align="center"
| valign="top" |
|+
! colspan="2" style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Contraindications for BCG}}
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]]
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are candidates for [[organ transplant]]).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

|}

===Prevention for International Travelers===

*Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
*Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a [[tuberculin skin test]] (TST) or [[interferon-gamma release assay]] (IGRA) test before leaving the United States. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref>

===Prevention in Health-Care Settings===

*Confirmed cases of TB during hospitalization should meet the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref>

:*Single-patient room with private bathroom.
:*Healthcare workers and visitors should wear disposable respirators (at least N95).
:*Doors should be closed as much time as possible.
:*Adequate room ventilation or negative pressure should be assessed daily.

===Determining the Infectiousness of TB Patients===

{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Airborne Precautions}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:

*They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and
*They are not receiving adequate antituberculosis therapy, have just started therapy, or have a poor clinical or bacteriologic response to therapy.
|-
| style=" padding: 5px 5px; background: #F5F5F5;" |Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals.

|-
| style="padding: 5px 5px; background: #DCDCDC;" |If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis treatment (minimum of 2 weeks) and demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:

*Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
*Receive standard multidrug antituberculosis treatment (minimum of 2 weeks).
*Demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref>

|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis primary prevention

2021-01-29T05:03:07Z

Mashal Awais: /* Primary Prevention */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Primary prevention in [[tuberculosis]] is targeted to avoid the disease transmission and infection of healthy individuals. The [[BCG]] vaccine is used in children susceptible to [[TB]] infections, such as children living in endemic areas or having close contact with a confirmed case of [[TB]]. Several preventive measures are used to avoid the transmission of the [[mycobacteria]], such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.

==Primary Prevention==
===BCG Vaccine===

*[[Bacille Calmmette-Guerin|Bacille Calmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]].
*[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that lives in a highly endemic area of TB or has a high risk of exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*The administration of the vaccine protects against severe types of tuberculosis, such as [[miliary TB|military]] or [[tuberculous meningitis|meningeal tuberculosis]].
*[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref>
*BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

:*A high percentage of TB patients have infected with TB strains resistant to both [[isoniazid]] and [[rifampin]]
:*There are ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful.

*Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be counseled regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and treatment of latent TB infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align="center"
| valign="top" |
|+
! colspan="2" style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Contraindications for BCG}}
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]]
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are candidates for [[organ transplant]]).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

|}

===Prevention for International Travelers===

*Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
*Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a [[tuberculin skin test]] (TST) or [[interferon-gamma release assay]] (IGRA) test before leaving the United States. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref>

===Prevention in Health-Care Settings===

*Confirmed cases of TB during hospitalization should meet the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref>

:*Single-patient room with private bathroom.
:*Healthcare workers and visitors should wear disposable respirators (at least N95).
:*Doors should be closed as much time as possible.
:*Adequate room ventilation or negative pressure should be assessed daily.

===Determining the Infectiousness of TB Patients===

{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Airborne Precautions}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:

*They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and
*They are not receiving adequate antituberculosis therapy, have just started therapy, or have a poor clinical or bacteriologic response to therapy.
|-
| style=" padding: 5px 5px; background: #F5F5F5;" |Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals.

|-
| style="padding: 5px 5px; background: #DCDCDC;" |If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis treatment (minimum of 2 weeks) and demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:

*Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
*Receive standard multidrug antituberculosis treatment (minimum of 2 weeks).
*Demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref>

|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis primary prevention

2021-01-29T05:01:41Z

Mashal Awais: /* BCG Vaccine */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Primary prevention in [[tuberculosis]] is targeted to avoid the disease transmission and infection of healthy individuals. The [[BCG]] vaccine is used in children susceptible to [[TB]] infections, such as children living in endemic areas or having close contact with a confirmed case of [[TB]]. Several preventive measures are used to avoid the transmission of the [[mycobacteria]], such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.

== Primary Prevention ==
===BCG Vaccine===
*[[Bacille Calmmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]].
*[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that lives in a highly endemic area of TB or has a high risk of exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*The administration of the vaccine protects against severe types of tuberculosis, such as [[miliary TB|military]] or [[tuberculous meningitis|meningeal tuberculosis]].
*[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref>
*BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>
:*A high percentage of TB patients have infected with TB strains resistant to both [[isoniazid]] and [[rifampin]]
:*There are ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful.
*Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be counseled regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and treatment of latent TB infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align=center
|valign=top|
|+
!style="background: #4479BA; width: 150px;" colspan=2| {{fontcolor|#FFF|Contraindications for BCG}}
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]]
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are candidates for [[organ transplant]]).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety.
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2 | Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

|}

===Prevention for International Travelers===
*Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
*Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a [[tuberculin skin test]] (TST) or [[interferon-gamma release assay]] (IGRA) test before leaving the United States. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref>

===Prevention in Health-Care Settings===
*Confirmed cases of TB during hospitalization should meet the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref>

:*Single-patient room with private bathroom.
:*Healthcare workers and visitors should wear disposable respirators (at least N95).
:*Doors should be closed as much time as possible.
:*Adequate room ventilation or negative pressure should be assessed daily.

===Determining the Infectiousness of TB Patients===

{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Airborne Precautions}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:
* They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and
* They are not receiving adequate antituberculosis therapy, have just started therapy, or have a poor clinical or bacteriologic response to therapy.
|-
| style=" padding: 5px 5px; background: #F5F5F5;" | Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals.

|-
| style="padding: 5px 5px; background: #DCDCDC;" | If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis treatment (minimum of 2 weeks) and demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:
* Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
* Receive standard multidrug antituberculosis treatment (minimum of 2 weeks).
* Demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref>

|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis primary prevention

2021-01-29T05:01:11Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Primary prevention in [[tuberculosis]] is targeted to avoid the disease transmission and infection of healthy individuals. The [[BCG]] vaccine is used in children susceptible to [[TB]] infections, such as children living in endemic areas or having close contact with a confirmed case of [[TB]]. Several preventive measures are used to avoid the transmission of the [[mycobacteria]], such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.

== Primary Prevention ==
===BCG Vaccine===
*[[Bacille Calmmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]].
*[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that lives in a highly endemic area of TB or has a high risk of exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*The administration of the vaccine protects against severe types of tuberculosis, such as [[miliary TB|military]] or [[tuberculous meningitis|meningeal tuberculosis]].
*[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref>
*BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>
:*A high percentage of TB patients have infected with TB strains resistant to both [[isoniazid]] and [[rifampin]]
:*There is ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful.
*Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be counseled regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and treatment of latent TB infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align=center
|valign=top|
|+
!style="background: #4479BA; width: 150px;" colspan=2| {{fontcolor|#FFF|Contraindications for BCG}}
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]]
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are candidates for [[organ transplant]]).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety.
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2 | Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

|}

===Prevention for International Travelers===
*Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
*Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a [[tuberculin skin test]] (TST) or [[interferon-gamma release assay]] (IGRA) test before leaving the United States. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref>

===Prevention in Health-Care Settings===
*Confirmed cases of TB during hospitalization should meet the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref>

:*Single-patient room with private bathroom.
:*Healthcare workers and visitors should wear disposable respirators (at least N95).
:*Doors should be closed as much time as possible.
:*Adequate room ventilation or negative pressure should be assessed daily.

===Determining the Infectiousness of TB Patients===

{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Airborne Precautions}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:
* They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and
* They are not receiving adequate antituberculosis therapy, have just started therapy, or have a poor clinical or bacteriologic response to therapy.
|-
| style=" padding: 5px 5px; background: #F5F5F5;" | Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals.

|-
| style="padding: 5px 5px; background: #DCDCDC;" | If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis treatment (minimum of 2 weeks) and demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:
* Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
* Receive standard multidrug antituberculosis treatment (minimum of 2 weeks).
* Demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref>

|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis primary prevention

2021-01-29T05:00:49Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{AL}}

==Overview==
Primary prevention in [[tuberculosis]] is targeted to avoid the disease transmission and infection of healthy individuals. The [[BCG]] vaccine is used in children susceptible to [[TB]] infections, such as children living in endemic areas or having close contact with a confirmed case of [[TB]]. Several preventive measures are used to avoid the transmission of the [[mycobacteria]], such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.

== Primary Prevention ==
===BCG Vaccine===
*[[Bacille Calmmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]].
*[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that lives in a highly endemic area of TB or has a high risk of exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*The administration of the vaccine protects against severe types of tuberculosis, such as [[miliary TB|military]] or [[tuberculous meningitis|meningeal tuberculosis]].
*[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref>
*There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref>
*BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>
:*A high percentage of TB patients have infected with TB strains resistant to both [[isoniazid]] and [[rifampin]]
:*There is ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful.
*Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be counseled regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and treatment of latent TB infection.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align=center
|valign=top|
|+
!style="background: #4479BA; width: 150px;" colspan=2| {{fontcolor|#FFF|Contraindications for BCG}}
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]]
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are candidates for [[organ transplant]]).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety.
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2 | Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref>

|}

===Prevention for International Travelers===
*Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
*Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a [[tuberculin skin test]] (TST) or [[interferon-gamma release assay]] (IGRA) test before leaving the United States. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref>

===Prevention in Health-Care Settings===
*Confirmed cases of TB during hospitalization should meet the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref>

:*Single-patient room with private bathroom.
:*Healthcare workers and visitors should wear disposable respirators (at least N95).
:*Doors should be closed as much time as possible.
:*Adequate room ventilation or negative pressure should be assessed daily.

===Determining the Infectiousness of TB Patients===

{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Airborne Precautions}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:
* They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and
* They are not receiving adequate antituberculosis therapy, have just started therapy, or have a poor clinical or bacteriologic response to therapy.
|-
| style=" padding: 5px 5px; background: #F5F5F5;" | Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals.

|-
| style="padding: 5px 5px; background: #DCDCDC;" | If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis treatment (minimum of 2 weeks) and demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:
* Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
* Receive standard multidrug antituberculosis treatment (minimum of 2 weeks).
* Demonstrate clinical improvement.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref>

|}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other diagnostic studies

2021-01-24T08:23:05Z

Mashal Awais: /* Xpert MTB/RIF Test */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==

Diagnostic studies that could be performed in patients with tuberculosis beside X-rays, CT scans, MRI are the Xpert MTB/RIF test, Adenosine Deaminase Test, and Nucleic Acid Amplification Test (NAAT).Other diagnostic studies that would be performed during a patient with tuberculosis are the Xpert MTB/RIF test, ADA Test, and macromolecule Amplification Test(NAAT).

 
==Other Diagnostic Studies==
====Xpert MTB/RIF Test====

*The Xpert MTB/RIF test is a molecular test that detects the DNA of the tubercule bacillus complex (MTBC) and also the genetic mutations related to resistance to rifampin (RMP) in unprocessed sputum and concentrated sputum sediments <ref> {{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6241a1.htm | title=Availability of an Assay for Detecting Mycobacterium tuberculosis, Including Rifampin-Resistant Strains, and Considerations for Its Use — the United States, 2013}}</ref>
*WHO recommends the Xpert MTB/RIF test for the initial diagnosis of MDR-TB or HIV-TB co-infection.<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>
*The advantages of this rapid Tuberculosis test are the following:<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>

:*Detects [[M. tuberculosis]] and [[rifampicin]] drug resistance simultaneously.
:*Results are available in less than 2 hours so the patient can be treated the same day of the test.
:*The bio-safety requirements and training are minimal.
:*It can be stored in non-conventional laboratories.

====Adenosine Deaminase====
It is usually an additional test if tuberculosis is suspected in the patient.<ref name="pmid24319523">{{cite journal| author=Farazi A, Moharamkhani A, Sofian M| title=Validity of serum adenosine deaminase in diagnosis of tuberculosis. | journal=Pan Afr Med J | year= 2013 | volume= 15 | issue= | pages= 133 | pmid=24319523 | doi=10.11604/pamj.2013.15.133.2100 | pmc=PMC3852508 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24319523 }} </ref>

*ADA is used for diagnosing tuberculosis in endemic countries where TB diagnostic procedures are not affordable.
*isoenzymes are more accurate. For both pleural TB and TB meningitis , ADA has a high degree of sensitivity.

====Nucleic Acid Amplification Tests (NAAT) Adapted from CDC <ref name="CDC NAAT"> {{Cite web| url=http://www.cdc.gov/tb/publications/guidelines/amplification_tests/reccomendations.htm| title= CDC Report of an Expert Consultation on the Uses of Nucleic Acid Amplification Tests for the Diagnosis of Tuberculosis}}</ref>====

*This is a heterogeneous group of tests that use [[polymerase chain reaction (PCR)]] to detect a mycobacterial macromolecule.
*These tests vary during which [[macromolecule]] sequence they detect and vary in their accuracy.
*The two commonest commercially available tests are the amplified tubercle bacillus direct test (MTD, Gen-Probe) and Amplicor (Roche Diagnostics).
*The CDC recommends that [[NAA testing]] should be performed on a respiratory specimen from each patient with signs and symptoms of active pulmonary TB disease for whom a diagnosis of TB is being considered (i.e., TB suspect), but has not been established.
*NAA testing doesn't replace the necessity for AFB smear and culture. All current guidelines and proposals for [[culture-based testing]] should remain in effect, especially recommended rotate times for culture and DST.
*A single positive NAA test result can support the diagnosis of TB during a patient for whom there's an inexpensive index of suspicion. This result should trigger reporting to public health officials, initiation of treatment if not already started, and vigorous efforts to get an isolate for drug susceptibility testing.
*In a patient with little suspicion of getting active TB, one positive NAA test result should be viewed with suspicion (i.e., a possible false-positive result) and interpreted within the same way as one [[culture-positive]] result, i.e., by correlating the results with other diagnostic findings.
*A single negative NAA test result should never be used as a specific test to exclude TB, especially in suspects with a moderate to high clinical suspicion of TB. Rather, the negative NAA test result should be used as additional information to assist in making clinical decisions to expedite a work-up for an alternate diagnosis or to stop unnecessary use of TB treatment in suspected cases.
*The [[FDA-approved]] NAAT tests for TB have slightly less sensitivity than [[culture-isolation methods]], and therefore the 15% -20% of U.S. TB cases that are reported with negative culture results can also have negative NAA test results. Thus, a negative NAA test result doesn't exclude the diagnosis of TB.
*Further research is required before specific recommendations are often made on the utilization of NAAT testing within the diagnosis of TB in children who cannot produce [[sputum]] and within the diagnosis of [[extrapulmonary]] TB, although there's much scientific evidence of the utility of such testing in individual cases.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other diagnostic studies

2021-01-24T08:18:13Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==

Diagnostic studies that could be performed in patients with tuberculosis beside X-rays, CT scans, MRI are the Xpert MTB/RIF test, Adenosine Deaminase Test, and Nucleic Acid Amplification Test (NAAT).Other diagnostic studies that would be performed during a patient with tuberculosis are the Xpert MTB/RIF test, ADA Test, and macromolecule Amplification Test(NAAT).

 
==Other Diagnostic Studies==
====Xpert MTB/RIF Test====

*The Xpert MTB/RIF test is a molecular test that detects the DNA of the tubercule bacillus complex (MTBC) and also the genetic mutations related to resistance to rifampin (RMP) in unprocessed sputum and concentrated sputum sediments <ref> {{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6241a1.htm | title=Availability of an Assay for Detecting Mycobacterium tuberculosis, Including Rifampin-Resistant Strains, and Considerations for Its Use — the United States, 2013}}</ref>
*WHO recommends the Xpert MTB/RIF test for the initial diagnosis of MDR-TB or HIV-TB co-infection.<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>
*The advantages of this rapid TB test are the following:<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>

:*Detects [[M. tuberculosis]] and [[rifampicin]] drug resistance simultaneously.
:*Results are available in less than 2 hours so the patient can be treated the same day of the test.
:*The bio-safety requirements and training are minimal.
:*It can be stored in non-conventional laboratories.

====Adenosine Deaminase====
It is usually an additional test if tuberculosis is suspected in the patient.<ref name="pmid24319523">{{cite journal| author=Farazi A, Moharamkhani A, Sofian M| title=Validity of serum adenosine deaminase in diagnosis of tuberculosis. | journal=Pan Afr Med J | year= 2013 | volume= 15 | issue= | pages= 133 | pmid=24319523 | doi=10.11604/pamj.2013.15.133.2100 | pmc=PMC3852508 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24319523 }} </ref>

*ADA is used for diagnosing tuberculosis in endemic countries where TB diagnostic procedures are expensive.
*isoenzymes are more accurate. For both pleural TB and TB meningitis , ADA has a high degree of sensitivity.

====Nucleic Acid Amplification Tests (NAAT) Adapted from CDC <ref name="CDC NAAT"> {{Cite web| url=http://www.cdc.gov/tb/publications/guidelines/amplification_tests/reccomendations.htm| title= CDC Report of an Expert Consultation on the Uses of Nucleic Acid Amplification Tests for the Diagnosis of Tuberculosis}}</ref>====

*This is a heterogeneous group of tests that use [[polymerase chain reaction (PCR)]] to detect a mycobacterial macromolecule.
*These tests vary during which [[macromolecule]] sequence they detect and vary in their accuracy.
*The two commonest commercially available tests are the amplified tubercle bacillus direct test (MTD, Gen-Probe) and Amplicor (Roche Diagnostics).
*The CDC recommends that [[NAA testing]] should be performed on a respiratory specimen from each patient with signs and symptoms of active pulmonary TB disease for whom a diagnosis of TB is being considered (i.e., TB suspect), but has not been established.
*NAA testing doesn't replace the necessity for AFB smear and culture. All current guidelines and proposals for [[culture-based testing]] should remain in effect, especially recommended rotate times for culture and DST.
*A single positive NAA test result can support the diagnosis of TB during a patient for whom there's an inexpensive index of suspicion. This result should trigger reporting to public health officials, initiation of treatment if not already started, and intensified efforts to get an isolate for drug susceptibility testing.
*In a patient with little suspicion of getting active TB, one positive NAA test result should be viewed with suspicion (i.e., a possible false-positive result) and interpreted within the same way as one [[culture-positive]] result, i.e., by correlating the results with other diagnostic findings.
*A single negative NAA test result should never be used as a definitive test to exclude TB, especially in suspects with a moderate to high clinical suspicion of TB. Rather, the negative NAA test result should be used as additional information to assist in making clinical decisions to expedite a work-up for an alternate diagnosis or to stop unnecessary use of TB treatment in suspects with a coffee clinical suspicion.
*The [[FDA-approved]] NAAT tests for TB have slightly less sensitivity than [[culture-isolation methods]], and therefore the 15% -20% of U.S. TB cases that are reported with negative culture results can also have negative NAA test results. Thus, a negative NAA test result doesn't exclude the diagnosis of TB.
*Further research is required before specific recommendations are often made on the utilization of NAAT testing within the diagnosis of TB in children who cannot produce [[sputum]] and within the diagnosis of [[extrapulmonary]] TB, although there's much anecdotal evidence of the utility of such testing in individual cases.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other diagnostic studies

2021-01-24T07:58:30Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==

Other diagnostic studies that could be performed in a patient with tuberculosis are the Xpert MTB/RIF test, Adenosine Deaminase Test, and Nucleic Acid Amplification Test(NAAT).

==Other Diagnostic Studies==
====Xpert MTB/RIF Test====
* The Xpert MTB/RIF test is a molecular test that detects the DNA of the Mycobacterium tuberculosis complex (MTBC) and genetic mutations associated with resistance to rifampin (RMP) in unprocessed sputum and concentrated sputum sediments <ref> {{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6241a1.htm | title=Availability of an Assay for Detecting Mycobacterium tuberculosis, Including Rifampin-Resistant Strains, and Considerations for Its Use — the United States, 2013}}</ref>
*WHO recommends the Xpert MTB/RIF test for the initial diagnosis of MDR-TB or HIV-TB co-infection.<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>
*The advantages of this rapid TB test are the following:<ref name="WHO XPERT"> {{cite web| url=http://who.int/tb/features_archive/factsheet_xpert.pdf| title=WHO Tuberculosis Diagnosis Xpert MTB/RIF Test 2013}} </ref>

:*Detects [[M. tuberculosis]] and [[rifampicin]] drug resistance simultaneously.
:*Results are available in < 2 hours so the patient can be treated the same day of the test.
:*The bio-safety requirements and training are minimal.
:*It can be stored in non-conventional laboratories.

====Adenosine Deaminase====
It is usually an auxiliary test if tuberculosis is suspected in the patient.<ref name="pmid24319523">{{cite journal| author=Farazi A, Moharamkhani A, Sofian M| title=Validity of serum adenosine deaminase in diagnosis of tuberculosis. | journal=Pan Afr Med J | year= 2013 | volume= 15 | issue= | pages= 133 | pmid=24319523 | doi=10.11604/pamj.2013.15.133.2100 | pmc=PMC3852508 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24319523 }} </ref>
*ADA is used for diagnosing tuberculosis in endemic countries where TB diagnostic procedures are expensive.
*ADA isoenzymes are more accurate. For both pleural TB and TB meningitis , ADA has a high degree of sensitivity.

====Nucleic Acid Amplification Tests (NAAT) Adapted from CDC <ref name="CDC NAAT"> {{Cite web| url=http://www.cdc.gov/tb/publications/guidelines/amplification_tests/reccomendations.htm| title= CDC Report of an Expert Consultation on the Uses of Nucleic Acid Amplification Tests for the Diagnosis of Tuberculosis}}</ref>====
*This is a heterogeneous group of tests that use [[polymerase chain reaction]] (PCR) to detect a mycobacterial nucleic acid.
*These tests vary in which nucleic acid sequence they detect and vary in their accuracy.
*The two most common commercially available tests are the amplified [[Mycobacterium tuberculosis]] direct test (MTD, Gen-Probe) and Amplicor (Roche Diagnostics).
*The CDC recommends that NAA testing should be performed on a respiratory specimen from each patient with signs and symptoms of active pulmonary TB disease for whom a diagnosis of TB is being considered (i.e., TB suspect), but has not been established.
*NAA testing does not replace the need for AFB smear and culture. All current guidelines and recommendations for culture-based testing should remain in effect, especially recommended turn around times for culture and DST.
*A single positive NAA test result can support the diagnosis of TB in a patient for whom there is a reasonable index of suspicion. This result should trigger reporting to public health officials, initiation of treatment if not already started, and intensified efforts to obtain an isolate for drug susceptibility testing.
*In a patient with little suspicion of having active TB, a single positive NAA test result should be viewed with suspicion (i.e., a possible false-positive result) and interpreted in the same way as a single culture-positive result, i.e., by correlating the results with other diagnostic findings.
*A single negative NAA test result should never be used as a definitive test to exclude TB, especially in suspects with a moderate to high clinical suspicion of TB. Rather, the negative NAA test result should be used as additional information to aid in making clinical decisions to expedite a work-up for an alternative diagnosis or to prevent unnecessary use of TB treatment in suspects with a low clinical suspicion.
*The [[FDA]]-approved NAA tests for TB have slightly less sensitivity than culture-isolation methods, and the 15% to 20% of U.S. TB cases that are reported with negative culture results may also have negative NAA test results. Thus, a negative NAA test result does not exclude the diagnosis of TB.
*Further research is needed before specific recommendations can be made on the use of NAA testing in the diagnosis of TB in children who cannot produce [[sputum]] and in the diagnosis of extrapulmonary TB, although there is much anecdotal evidence of the utility of such testing in individual cases.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other imaging findings

2021-01-24T07:57:59Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{JS}}; {{AL}}

==Overview==
The abreugraphy is a smaller variant of the [[chest X-ray]] that allows the identification of lung abnormalities that may suggest the diagnosis of TB. With the decrease of [[incidence]] of TB, the abreugraphy is no longer recommended in most countries for low-risk populations. However, depending on the screening resources of each country, it may be used for the screening of high-risk groups, such as [[HIV]]-positive patients and alcoholics.

==Other Imaging Findings==
===Osteoarticular Tuberculosis X-ray===

*X-ray findings in osteoarticular tuberculosis include:<ref name="pmid25163241">{{cite journal| author=Grubisić F, Borić I, Segota A, Kruslin B, Grazio S| title=An unusual manifestation of osteoarticular tuberculosis: case report. | journal=Acta Clin Croat | year= 2014 | volume= 53 | issue= 2 | pages= 237-41 | pmid=25163241 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25163241 }} </ref>

:*Demineralization

:*Narrowing of the joint space

:*Bone and cartilage erosion

:*Calcifications

{|
|[[Image: Tuberculosis Arthritis X-ray.jpg|thumb|300px|left|Tuberculous arthritis of the hip Image courtesy of Dr Matt Skalski, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculous-arthritis-with-phemister-triad here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Shoulder Tuberculosis.jpg|thumb|340px|left|Shoulder tuberculous Image courtesy of Dr Gagandeep Choudhary, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/caries-sicca-shoulder-tuberculosis-1 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

===Abreugraphy===
Abreugraphy is a variant of the [[chest X-ray]], and it is named after Dr. Manuel Dias de Abreu who was its inventor. It provides a small radiographic image, which is also known as ''miniature chest radiograph'', or ''Miniature Mass Radiography'' (MMR). Despite its limited resolution, which limits its use in some cases, such as [[lung cancer]], it allows the identification of lung abnormalities, which may suggest the [[diagnosis]] of tuberculosis.

It is less expensive than the traditional [[chest X-ray]], which allows its use in mass situations such as the TB [[screening]] of prisoners and immigrants. With the decrease of [[incidence]] of TB, this exam is no longer recommended among low-risk populations. However, MMR may still be used in high prevalence groups for the early diagnosis of the disease in [[asymptomatic]] patients.<ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref><ref name="pmid1804678">{{cite journal| author=Clancy L, Rieder HL, Enarson DA, Spinaci S| title=Tuberculosis elimination in the countries of Europe and other industrialized countries. | journal=Eur Respir J | year= 1991 | volume= 4 | issue= 10 | pages= 1288-95 | pmid=1804678 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1804678 }} </ref><ref name="pmid822464">{{cite journal| author=Horwitz O, Darrow MM| title=Principles and effects of mass screening: Danish experience in tuberculosis screening. | journal=Public Health Rep | year= 1976 | volume= 91 | issue= 2 | pages= 146-53 | pmid=822464 | doi= | pmc=PMC1438528 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=822464 }} </ref><ref name="pmid2496633">{{cite journal| author=Gordin FM, Slutkin G, Schecter G, Goodman PC, Hopewell PC| title=Presumptive diagnosis and treatment of pulmonary tuberculosis based on radiographic findings. | journal=Am Rev Respir Dis | year= 1989 | volume= 139 | issue= 5 | pages= 1090-3 | pmid=2496633 | doi=10.1164/ajrccm/139.5.1090 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2496633 }} </ref>

Some countries still use the abreugraphy to screen refugees, new workers and students who come from countries with high prevalence of TB. In the case of radiographic abnormalities on the MMR, the person is redirected to a medical center for further studies. <ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref>

In countries with low prevalence of TB, depending on the availability of screening methods, mass screening may be justified in some high-risk groups, such as homeless persons, alcoholics and HIV-positive patients.<ref name="pmid3094079">{{cite journal| author=Barry MA, Wall C, Shirley L, Bernardo J, Schwingl P, Brigandi E et al.| title=Tuberculosis screening in Boston's homeless shelters. | journal=Public Health Rep | year= 1986 | volume= 101 | issue= 5 | pages= 487-94 | pmid=3094079 | doi= | pmc=PMC1477764 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3094079 }} </ref><ref name="pmid3109292">{{cite journal| author=Grzybowski S, Allen EA, Black WA, Chao CW, Enarson DA, Isaac-Renton JL et al.| title=Inner-city survey for tuberculosis: evaluation of diagnostic methods. | journal=Am Rev Respir Dis | year= 1987 | volume= 135 | issue= 6 | pages= 1311-5 | pmid=3109292 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3109292 }} </ref>

{{details|Abreugraphy}}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other imaging findings

2021-01-24T07:39:11Z

Mashal Awais: /* Abreugraphy */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{JS}}; {{AL}}

==Overview==
The abreugraphy is a smaller variant of the [[chest X-ray]] that allows the identification of lung abnormalities that may suggest the diagnosis of TB. With the decrease of [[incidence]] of TB, the abreugraphy is no longer recommended in most countries for low-risk populations. However, depending on the screening resources of each country, it may be used for the screening of high-risk groups, such as [[HIV]]-positive patients and alcoholics.

==Other Imaging Findings==
===Osteoarticular Tuberculosis X-ray===

*X-ray findings in osteoarticular tuberculosis include:<ref name="pmid25163241">{{cite journal| author=Grubisić F, Borić I, Segota A, Kruslin B, Grazio S| title=An unusual manifestation of osteoarticular tuberculosis: case report. | journal=Acta Clin Croat | year= 2014 | volume= 53 | issue= 2 | pages= 237-41 | pmid=25163241 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25163241 }} </ref>

:*Demineralization

:*Narrowing of the joint space

:*Bone and cartilage erosion

:*Calcifications

{|
|[[Image: Tuberculosis Arthritis X-ray.jpg|thumb|300px|left|Tuberculous arthritis of the hip Image courtesy of Dr Matt Skalski, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculous-arthritis-with-phemister-triad here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Shoulder Tuberculosis.jpg|thumb|340px|left|Shoulder tuberculous Image courtesy of Dr Gagandeep Choudhary, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/caries-sicca-shoulder-tuberculosis-1 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

===Abreugraphy===
Abreugraphy is a variant of the [[chest X-ray]], and it is named after Dr. Manuel Dias de Abreu who was its inventor. It provides a small radiographic image, which is also known as ''miniature chest radiograph'', or ''Miniature Mass Radiography'' (MMR). Despite its limited resolution, which limits its use in some cases, such as [[lung cancer]], it allows the identification of lung abnormalities, which may suggest the [[diagnosis]] of tuberculosis.

It is less expensive than the traditional [[chest X-ray]], which allows its use in mass situations such as the TB [[screening]] of prisoners and immigrants. With the decrease of [[incidence]] of TB, this exam is no longer recommended among low-risk populations. However, MMR may still be used in high prevalence groups for the early diagnosis of the disease in [[asymptomatic]] patients.<ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref><ref name="pmid1804678">{{cite journal| author=Clancy L, Rieder HL, Enarson DA, Spinaci S| title=Tuberculosis elimination in the countries of Europe and other industrialized countries. | journal=Eur Respir J | year= 1991 | volume= 4 | issue= 10 | pages= 1288-95 | pmid=1804678 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1804678 }} </ref><ref name="pmid822464">{{cite journal| author=Horwitz O, Darrow MM| title=Principles and effects of mass screening: Danish experience in tuberculosis screening. | journal=Public Health Rep | year= 1976 | volume= 91 | issue= 2 | pages= 146-53 | pmid=822464 | doi= | pmc=PMC1438528 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=822464 }} </ref><ref name="pmid2496633">{{cite journal| author=Gordin FM, Slutkin G, Schecter G, Goodman PC, Hopewell PC| title=Presumptive diagnosis and treatment of pulmonary tuberculosis based on radiographic findings. | journal=Am Rev Respir Dis | year= 1989 | volume= 139 | issue= 5 | pages= 1090-3 | pmid=2496633 | doi=10.1164/ajrccm/139.5.1090 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2496633 }} </ref>

Some countries still use the abreugraphy to screen refugees, new workers and students who come from countries with high prevalence of TB. In the case of radiographic abnormalities on the MMR, the person is redirected to a medical center for further studies. <ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref>

In countries with low prevalence of TB, depending on the availability of screening methods, mass screening may be justified in some high-risk groups, such as homeless persons, alcoholics and HIV-positive patients.<ref name="pmid3094079">{{cite journal| author=Barry MA, Wall C, Shirley L, Bernardo J, Schwingl P, Brigandi E et al.| title=Tuberculosis screening in Boston's homeless shelters. | journal=Public Health Rep | year= 1986 | volume= 101 | issue= 5 | pages= 487-94 | pmid=3094079 | doi= | pmc=PMC1477764 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3094079 }} </ref><ref name="pmid3109292">{{cite journal| author=Grzybowski S, Allen EA, Black WA, Chao CW, Enarson DA, Isaac-Renton JL et al.| title=Inner-city survey for tuberculosis: evaluation of diagnostic methods. | journal=Am Rev Respir Dis | year= 1987 | volume= 135 | issue= 6 | pages= 1311-5 | pmid=3109292 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3109292 }} </ref>

{{details|Abreugraphy}}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis other imaging findings

2021-01-24T07:38:35Z

Mashal Awais: /* Abreugraphy */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{JS}}; {{AL}}

==Overview==
The abreugraphy is a smaller variant of the [[chest X-ray]] that allows the identification of lung abnormalities that may suggest the diagnosis of TB. With the decrease of [[incidence]] of TB, the abreugraphy is no longer recommended in most countries for low-risk populations. However, depending on the screening resources of each country, it may be used for the screening of high-risk groups, such as [[HIV]]-positive patients and alcoholics.

==Other Imaging Findings==
===Osteoarticular Tuberculosis X-ray===

*X-ray findings in osteoarticular tuberculosis include:<ref name="pmid25163241">{{cite journal| author=Grubisić F, Borić I, Segota A, Kruslin B, Grazio S| title=An unusual manifestation of osteoarticular tuberculosis: case report. | journal=Acta Clin Croat | year= 2014 | volume= 53 | issue= 2 | pages= 237-41 | pmid=25163241 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25163241 }} </ref>

:*Demineralization

:*Narrowing of the joint space

:*Bone and cartilage erosion

:*Calcifications

{|
|[[Image: Tuberculosis Arthritis X-ray.jpg|thumb|300px|left|Tuberculous arthritis of the hip Image courtesy of Dr Matt Skalski, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculous-arthritis-with-phemister-triad here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Shoulder Tuberculosis.jpg|thumb|340px|left|Shoulder tuberculous Image courtesy of Dr Gagandeep Choudhary, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/caries-sicca-shoulder-tuberculosis-1 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

===Abreugraphy===
Abreugraphy is a variant of the [[chest X-ray]], and it is named after Dr. Manuel Dias de Abreu who was it's inventor. It provides a small radiographic image, which is also known as ''miniature chest radiograph'', or ''Miniature Mass Radiography'' (MMR). Despite its limited resolution, which limits its use in some cases, such as [[lung cancer]], it allows the identification of lung abnormalities, which may suggest the [[diagnosis]] of tuberculosis.

It is less expensive than the traditional [[chest X-ray]], which allows its use in mass situations such as the TB [[screening]] of prisoners and immigrants. With the decrease of [[incidence]] of TB, this exam is no longer recommended among low-risk populations. However, MMR may still be used in high prevalence groups for the early diagnosis of the disease in [[asymptomatic]] patients.<ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref><ref name="pmid1804678">{{cite journal| author=Clancy L, Rieder HL, Enarson DA, Spinaci S| title=Tuberculosis elimination in the countries of Europe and other industrialized countries. | journal=Eur Respir J | year= 1991 | volume= 4 | issue= 10 | pages= 1288-95 | pmid=1804678 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1804678 }} </ref><ref name="pmid822464">{{cite journal| author=Horwitz O, Darrow MM| title=Principles and effects of mass screening: Danish experience in tuberculosis screening. | journal=Public Health Rep | year= 1976 | volume= 91 | issue= 2 | pages= 146-53 | pmid=822464 | doi= | pmc=PMC1438528 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=822464 }} </ref><ref name="pmid2496633">{{cite journal| author=Gordin FM, Slutkin G, Schecter G, Goodman PC, Hopewell PC| title=Presumptive diagnosis and treatment of pulmonary tuberculosis based on radiographic findings. | journal=Am Rev Respir Dis | year= 1989 | volume= 139 | issue= 5 | pages= 1090-3 | pmid=2496633 | doi=10.1164/ajrccm/139.5.1090 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2496633 }} </ref>

Some countries still use the abreugraphy to screen refugees, new workers and students who come from countries with high prevalence of TB. In the case of radiographic abnormalities on the MMR, the person is redirected to a medical center for further studies. <ref name="pmid1292710">{{cite journal| author=Bonvin L, Zellweger JP| title=Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland. | journal=Tuber Lung Dis | year= 1992 | volume= 73 | issue= 6 | pages= 322-5 | pmid=1292710 | doi=10.1016/0962-8479(92)90034-H | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1292710 }} </ref>

In countries with low prevalence of TB, depending on the availability of screening methods, mass screening may be justified in some high-risk groups, such as homeless persons, alcoholics and HIV-positive patients.<ref name="pmid3094079">{{cite journal| author=Barry MA, Wall C, Shirley L, Bernardo J, Schwingl P, Brigandi E et al.| title=Tuberculosis screening in Boston's homeless shelters. | journal=Public Health Rep | year= 1986 | volume= 101 | issue= 5 | pages= 487-94 | pmid=3094079 | doi= | pmc=PMC1477764 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3094079 }} </ref><ref name="pmid3109292">{{cite journal| author=Grzybowski S, Allen EA, Black WA, Chao CW, Enarson DA, Isaac-Renton JL et al.| title=Inner-city survey for tuberculosis: evaluation of diagnostic methods. | journal=Am Rev Respir Dis | year= 1987 | volume= 135 | issue= 6 | pages= 1311-5 | pmid=3109292 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3109292 }} </ref>

{{details|Abreugraphy}}

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis echocardiography or ultrasound

2021-01-24T07:36:04Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{Ammu}}

==Overview==
[[Echocardiography]] or [[Ultrasound]] can be helpful in patients who develop [[pericardial effusion]] secondary to TB.<ref name="pmid19006110">{{cite journal| author=Kil UH, Jung HO, Koh YS, Park HJ, Park CS, Kim PJ et al.| title=Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis. | journal=Clin Cardiol | year= 2008 | volume= 31 | issue= 11 | pages= 531-7 | pmid=19006110 | doi=10.1002/clc.20305 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19006110 }} </ref> On rare occasions TB may lead to congestive heart failure, in which case [[echocardiograph]] may also help in the diagnosis. Common findings in [[CHF]] on the [[echocardiogram]] include [[hypokinesia]]; valvular insufficiency; and enlargement of all heart chambers.

*Tuberculosis involves the heart in 1-2% of the cases, and the [[pericardium]] is the most commonly affected structure.<ref name="CusterCharr1939">{{cite journal|last1=Custer|first1=Edward W.|last2=Charr|first2=Robert|title=TUBERCULOSIS OF THE MYOCARDIUM|journal=Journal of the American Medical Association|volume=112|issue=14|year=1939|pages=1333|issn=0002-9955|doi=10.1001/jama.1939.62800140003009a}}</ref><ref name="Fowler1991">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref> Patients with [[HIV]] have a high susceptibility for extrapulmonary tuberculosis including [[tuberculous pericarditis]]. [[Echocardiography]] is a good tool in diagnosing this extrapulmonary manifestation.

*The common findings in [[echocardiography]] include:<ref name="pmid15486140">{{cite journal| author=George S, Salama AL, Uthaman B, Cherian G| title=Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion. | journal=Heart | year= 2004 | volume= 90 | issue= 11 | pages= 1338-9 | pmid=15486140 | doi=10.1136/hrt.2003.020081 | pmc=PMC1768544 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15486140 }} </ref>

:*[[Pericardial]] thickening
:*[[Pericardial effusion]] classified as mild, moderate, and severe
:*[[Exudative]] deposits with echo dense mass around [[epicardium]]
:*[[Fibrin]] strands from [[pericardium]] protruding or crossing the [[pericardial]] space

*Although rare, the [[myocardium]] may also be involved in TB and should be suspected in patients with [[congestive heart failure]] and clinical features suggestive of TB.
*[[Echocardiographic]] findings may include:<ref name="pmid2389712">{{cite journal| author=Bali HK, Wahi S, Sharma BK, Anand IS, Datta BN, Wahi PL| title=Myocardial tuberculosis presenting as restrictive cardiomyopathy. | journal=Am Heart J | year= 1990 | volume= 120 | issue= 3 | pages= 703-6 | pmid=2389712 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2389712 }} </ref><ref name="pmid15857515">{{cite journal| author=Agarwal R, Malhotra P, Awasthi A, Kakkar N, Gupta D| title=Tuberculous dilated cardiomyopathy: an under-recognized entity? | journal=BMC Infect Dis | year= 2005 | volume= 5 | issue= | pages= 29 | pmid=15857515 | doi=10.1186/1471-2334-5-29 | pmc=PMC1090580 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15857515 }} </ref>

:*[[Hypokinesia]]
:*Enlargement of all heart chambers
:*[[Mitral regurgitation]]
:*[[Tricuspid regurgitation]]
:*Left ventricular systolic dysfunction

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis echocardiography or ultrasound

2021-01-24T07:34:56Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{Ammu}}

==Overview==
[[Echocardiography]] or [[Ultrasound]] can be helpful in patients who develop [[pericardial effusion]] secondary to TB.<ref name="pmid19006110">{{cite journal| author=Kil UH, Jung HO, Koh YS, Park HJ, Park CS, Kim PJ et al.| title=Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis. | journal=Clin Cardiol | year= 2008 | volume= 31 | issue= 11 | pages= 531-7 | pmid=19006110 | doi=10.1002/clc.20305 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19006110 }} </ref> On rare occasions TB may lead to congestive heart failure, in which case [[echocardiograph]] may also help in the diagnosis. Common findings in [[CHF]] on the [[echocardiogram]] include [[hypokinesia]]; valvular insufficiency; and enlargement of all heart chambers.

*Tuberculosis involves the heart in 1-2% of the cases, and the [[pericardium]] is its the most commonly affected structure.<ref name="CusterCharr1939">{{cite journal|last1=Custer|first1=Edward W.|last2=Charr|first2=Robert|title=TUBERCULOSIS OF THE MYOCARDIUM|journal=Journal of the American Medical Association|volume=112|issue=14|year=1939|pages=1333|issn=0002-9955|doi=10.1001/jama.1939.62800140003009a}}</ref><ref name="Fowler1991">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref> Patients with [[HIV]] have a high susceptibility for extra pulmonary tuberculosis including [[tuberculous pericarditis]]. [[Echocardiography]] is a good tool in diagnosing this extra pulmonary manifestation.

*The common findings in [[echocardiography]] include:<ref name="pmid15486140">{{cite journal| author=George S, Salama AL, Uthaman B, Cherian G| title=Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion. | journal=Heart | year= 2004 | volume= 90 | issue= 11 | pages= 1338-9 | pmid=15486140 | doi=10.1136/hrt.2003.020081 | pmc=PMC1768544 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15486140 }} </ref>

:*[[Pericardial]] thickening
:*[[Pericardial effusion]] classified as mild, moderate, and severe
:*[[Exudative]] deposits with echo dense mass around [[epicardium]]
:*[[Fibrin]] strands from [[pericardium]] protruding or crossing the [[pericardial]] space

*Although rare, the [[myocardium]] may also be involved in TB and should be suspected in patients with [[congestive heart failure]] and clinical features suggestive of TB.
*[[Echocardiographic]] findings may include:<ref name="pmid2389712">{{cite journal| author=Bali HK, Wahi S, Sharma BK, Anand IS, Datta BN, Wahi PL| title=Myocardial tuberculosis presenting as restrictive cardiomyopathy. | journal=Am Heart J | year= 1990 | volume= 120 | issue= 3 | pages= 703-6 | pmid=2389712 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2389712 }} </ref><ref name="pmid15857515">{{cite journal| author=Agarwal R, Malhotra P, Awasthi A, Kakkar N, Gupta D| title=Tuberculous dilated cardiomyopathy: an under-recognized entity? | journal=BMC Infect Dis | year= 2005 | volume= 5 | issue= | pages= 29 | pmid=15857515 | doi=10.1186/1471-2334-5-29 | pmc=PMC1090580 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15857515 }} </ref>

:*[[Hypokinesia]]
:*Enlargement of all heart chambers
:*[[Mitral regurgitation]]
:*[[Tricuspid regurgitation]]
:*Left ventricular systolic dysfunction

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis echocardiography or ultrasound

2021-01-24T07:32:34Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{Ammu}}

==Overview==
[[Echocardiography]] or [[Ultrasound]] can be helpful in patients who develop [[pericardial effusion]] secondary to TB.<ref name="pmid19006110">{{cite journal| author=Kil UH, Jung HO, Koh YS, Park HJ, Park CS, Kim PJ et al.| title=Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis. | journal=Clin Cardiol | year= 2008 | volume= 31 | issue= 11 | pages= 531-7 | pmid=19006110 | doi=10.1002/clc.20305 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19006110 }} </ref> In rare occasions TB may lead to congestive heart failure, in which case [[echocardiograph]] may also help in the diagnosis. Common findings in [[CHF]] on the [[echocardiogram]] include: [[hypokinesia]]; valvular insufficiency; and enlargement of all heart chambers.

==Echocardiography==
*Tuberculosis involves the heart in 1-2% of the cases, and the [[pericardium]] is its the most commonly affected structure.<ref name="CusterCharr1939">{{cite journal|last1=Custer|first1=Edward W.|last2=Charr|first2=Robert|title=TUBERCULOSIS OF THE MYOCARDIUM|journal=Journal of the American Medical Association|volume=112|issue=14|year=1939|pages=1333|issn=0002-9955|doi=10.1001/jama.1939.62800140003009a}}</ref><ref name="Fowler1991">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref> Patients with [[HIV]] have a high susceptibility for extra pulmonary tuberculosis including [[tuberculous pericarditis]]. [[Echocardiography]] is a good tool in diagnosing this extra pulmonary manifestation.

*The common findings in [[echocardiography]] include:<ref name="pmid15486140">{{cite journal| author=George S, Salama AL, Uthaman B, Cherian G| title=Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion. | journal=Heart | year= 2004 | volume= 90 | issue= 11 | pages= 1338-9 | pmid=15486140 | doi=10.1136/hrt.2003.020081 | pmc=PMC1768544 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15486140 }} </ref>
:*[[Pericardial]] thickening
:*[[Pericardial effusion]] classified as mild, moderate, and severe
:*[[Exudative]] deposits with echo dense mass around [[epicardium]]
:*[[Fibrin]] strands from [[pericardium]] protruding or crossing the [[pericardial]] space

*Although rare, the [[myocardium]] may also be involved in TB and should be suspected in patients with [[congestive heart failure]] and clinical features suggestive of TB.
*[[Echocardiographic]] findings may include:<ref name="pmid2389712">{{cite journal| author=Bali HK, Wahi S, Sharma BK, Anand IS, Datta BN, Wahi PL| title=Myocardial tuberculosis presenting as restrictive cardiomyopathy. | journal=Am Heart J | year= 1990 | volume= 120 | issue= 3 | pages= 703-6 | pmid=2389712 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2389712 }} </ref><ref name="pmid15857515">{{cite journal| author=Agarwal R, Malhotra P, Awasthi A, Kakkar N, Gupta D| title=Tuberculous dilated cardiomyopathy: an under-recognized entity? | journal=BMC Infect Dis | year= 2005 | volume= 5 | issue= | pages= 29 | pmid=15857515 | doi=10.1186/1471-2334-5-29 | pmc=PMC1090580 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15857515 }} </ref>
:*[[Hypokinesia]]
:*Enlargement of all heart chambers
:*[[Mitral regurgitation]]
:*[[Tricuspid regurgitation]]
:*Left ventricular systolic dysfunction

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis MRI

2021-01-24T07:32:01Z

Mashal Awais: /* CNS Tuberculosis */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
MRI is used for the assessment of extra-pulmonary tuberculosis, such as [[Tuberculous meningitis|CNS tuberculosis]], osteoarticular tuberculosis, [[Pott's disease]], and [[parotid gland]] tuberculosis.

==MRI==
====CNS Tuberculosis====

*MRI is most commonly used if there is CNS infection with tuberculosis.
*The following findings may be seen in CNS tuberculosis:<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

:*Ring-enhancing mass in T2 and hypodense lesion in case of a non-caseating tuberculoma.
:*A caseating tuberculoma may present as a hypodense lesion in both T1 and T2.
:*Cerebral edema
:*Diffuse enhancement in case of meningitis

{|
|[[Image: Tuberculoma CNS.jpg|thumb|300px|left|CNS Tuberculoma Image courtesy of Dr Praveen Jha, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculoma here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Tuberculoma CNS 2.jpg|thumb|300px|left|CNS Tuberculoma Image courtesy of Dr Praveen Jha, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculoma here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

====Pott's Disease====

*Spinal MRI is the image diagnostic test of choice for tuberculosis involving spine.
*Findings include: <ref name="pmid24887691">{{cite journal| author=Torres C, Riascos R, Figueroa R, Gupta RK| title=Central nervous system tuberculosis. | journal=Top Magn Reson Imaging | year= 2014 | volume= 23 | issue= 3 | pages= 173-89 | pmid=24887691 | doi=10.1097/RMR.0000000000000023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24887691 }} </ref>

:*Endplate irregularity
:*Irregular anterior aspect of the vertebral bodies
:*Edema and enhancement of the bone marrow.
:*Destruction of the vertebral body in severe cases.

{|
|[[Image: Spinal TB MRI.jpg|thumb|300px|left|Spinal Tuberculosis Image courtesy of Dr Hani Salam, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pott-s-disease here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Spinal TB MRI 2.jpg|thumb|300px|left|Spinal Tuberculosis Image courtesy of Dr Hani Salam, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pott-s-disease here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Spinal TB MRI 3.jpg|thumb|300px|left|Spinal Tuberculosis Image courtesy of Dr Hani Salam, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pott-s-disease here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

====Osteoarticular Tuberculosis====

*MRI findings in osteoarticular tuberculosis include:<ref name="pmid25163241">{{cite journal| author=Grubisić F, Borić I, Segota A, Kruslin B, Grazio S| title=An unusual manifestation of osteoarticular tuberculosis: case report. | journal=Acta Clin Croat | year= 2014 | volume= 53 | issue= 2 | pages= 237-41 | pmid=25163241 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25163241 }} </ref>

:*Demineralization

:*Narrowing of the joint space

:*Bone and cartilage erosion

:*Calcifications

====Parotid Gland Tuberculosis====

*Tuberculosis infection of the [[parotid gland]] can mimic a parotid [[neoplasm.]]
*The MRI shown below reveals a well-defined mass lesion, measuring 16 × 21 × 30 mm in size, [[hypointense]] on T1-weighted images, and [[hyperintense]] on T2-weighted images with homogenous contrast enhancement, located in the posterior part of the superficial lobe of the right parotid gland.<ref name="BirkentKarahatay2008">{{cite journal|last1=Birkent|first1=Hakan|last2=Karahatay|first2=Serdar|last3=Akcam|first3=Timur|last4=Durmaz|first4=Abdullah|last5=Ongoru|first5=Onder|title=Primary parotid tuberculosis mimicking parotid neoplasm: a case report|journal=Journal of Medical Case Reports|volume=2|issue=1|year=2008|pages=62|issn=1752-1947|doi=10.1186/1752-1947-2-62}}</ref>

{|
|[[Image:Parotid-gland-tuberculosis.jpg|thumb|300px|left|Image courtesy of Wikimedia Commons.]]
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category: Needs content]]
[[Category:Bacterial diseases]]

Tuberculosis MRI

2021-01-24T07:29:01Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overwiew==
MRI is used for the assessment of extrapulmonary tuberculosis, such as [[Tuberculous meningitis|CNS tuberculosis]], osteoarticular tuberculosis, [[Pott's disease]], and [[parotid gland]] tuberculosis.

==MRI==
====CNS Tuberculosis====
*MRI is most commonly used in cases of CNS infection with tuberculosis.
*The following findings may be seen in CNS tuberculosis:<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>
:*Ring-enhancing mass in T2 and hypodense lesion in case of a non-caseating tuberculoma.
:*A caseating tuberculoma is seen as a hypodense lesion in both T1 and T2.
:*Cerebral edema
:*Diffuse enhancement in case of meningitis
{|
|[[Image: Tuberculoma CNS.jpg|thumb|300px|left|CNS Tuberculoma Image courtesy of Dr Praveen Jha, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculoma here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Tuberculoma CNS 2.jpg|thumb|300px|left|CNS Tuberculoma Image courtesy of Dr Praveen Jha, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/tuberculoma here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

====Pott's Disease====
*Spinal MRI is the image diagnostic test of choice for spinal tuberculosis.
*Findings include: <ref name="pmid24887691">{{cite journal| author=Torres C, Riascos R, Figueroa R, Gupta RK| title=Central nervous system tuberculosis. | journal=Top Magn Reson Imaging | year= 2014 | volume= 23 | issue= 3 | pages= 173-89 | pmid=24887691 | doi=10.1097/RMR.0000000000000023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24887691 }} </ref>
:* Endplate irregularity
:* Irregular anterior aspect of the vertebral bodies
:* Edema and enhancement of the bone marrow.
:*Destruction of the vertebral body in severe cases.

{|
|[[Image: Spinal TB MRI.jpg|thumb|300px|left|Spinal Tuberculosis Image courtesy of Dr Hani Salam, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pott-s-disease here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Spinal TB MRI 2.jpg|thumb|300px|left|Spinal Tuberculosis Image courtesy of Dr Hani Salam, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pott-s-disease here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image: Spinal TB MRI 3.jpg|thumb|300px|left|Spinal Tuberculosis Image courtesy of Dr Hani Salam, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pott-s-disease here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

====Osteoarticular Tuberculosis====
*MRI findings in osteoarticular tuberculosis include:<ref name="pmid25163241">{{cite journal| author=Grubisić F, Borić I, Segota A, Kruslin B, Grazio S| title=An unusual manifestation of osteoarticular tuberculosis: case report. | journal=Acta Clin Croat | year= 2014 | volume= 53 | issue= 2 | pages= 237-41 | pmid=25163241 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25163241 }} </ref>

:*Demineralization

:*Narrowing of the joint space

:*Bone and cartilage erosion

:*Calcifications

====Parotid Gland Tuberculosis====
* Tuberculosis infection of the parotid gland con mimic a parotid neoplasm.
*The MRI shown below reveals a well-defined mass lesion, measuring 16 × 21 × 30 mm in size, hypointense on T1-weighted images, and hyperintense on T2-weighted images with homogenous contrast enhancement, located in the posterior part of the superficial lobe of the right parotid gland.<ref name="BirkentKarahatay2008">{{cite journal|last1=Birkent|first1=Hakan|last2=Karahatay|first2=Serdar|last3=Akcam|first3=Timur|last4=Durmaz|first4=Abdullah|last5=Ongoru|first5=Onder|title=Primary parotid tuberculosis mimicking parotid neoplasm: a case report|journal=Journal of Medical Case Reports|volume=2|issue=1|year=2008|pages=62|issn=1752-1947|doi=10.1186/1752-1947-2-62}}</ref>
{|
|[[Image:Parotid-gland-tuberculosis.jpg|thumb|300px|left|Image courtesy of Wikimedia Commons.]]
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category: Needs content]]
[[Category:Bacterial diseases]]

Tuberculosis CT

2021-01-24T07:28:35Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
Most patients with pulmonary tuberculosis will have abnormal findings in a chest [[CT]], which include micronodules, interlobular septal thickening, [[cavitation]] and consolidation. CT scans are more sensitive than an [[X-ray]] to detect [[lymphadenopathy|lymphadenopathies]].

==Computed Tomography==
===Pulmonary Tuberculosis===

*Chest CT abnormalities are seen in the majority of patients with active pulmonary tuberculosis.
*CT findings include:<ref>{{Cite journal
| author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]]
| title = Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging
| journal = [[Chest]]
| year = 2014
| month = June
| doi = 10.1378/chest.14-0196
| pmid = 25086249
}}</ref>

:*Micronodules
::*Most commonly found in the subpleural region and peribronchovascular interstitium.
::*CT scan allows early and accurate detection of micronodules.
:*Interlobular septal thickening
:*Cavitation is the most important finding in secondary tuberculosis
::*Appears as a lesion with thick walls and irregular margins.
::*It may be observed in almost 50% of patients.
::*It is most commonly seen in the upper lung.
::*Cavities in the lower lung can be found in [[diabetes]] and [[HIV]] infection.<ref name="PatelRami2011">{{cite journal|last1=Patel|first1=AnandK|last2=Rami|first2=KiranC|last3=Ghanchi|first3=FerozD|title=Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus|journal=Lung India|volume=28|issue=1|year=2011|pages=70|issn=0970-2113|doi=10.4103/0970-2113.76308}}</ref><ref name="PadyanaBhat2012">{{cite journal|last1=Padyana|first1=Mahesha|last2=Bhat|first2=RaghavendraV|last3=Dinesha|first3=M|last4=Nawaz|first4=Alam|title=HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count|journal=North American Journal of Medical Sciences|volume=4|issue=5|year=2012|pages=221|issn=1947-2714|doi=10.4103/1947-2714.95904}}</ref>
::*Although it is rare, cavities may become superinfected and an air-fluid level is seen inside the cavity.
::*After the active infection is treated and resolved, small cavities with thin walls may remain as a residual finding.
:*Homogeneous and dense consolidation

*CT is more sensitive to detect hilar lymphadenopathy.
*The "tree-in-bud" sign is a CT finding that may be seen in [[pulmonary tuberculosis]] and it is caused by mucus or pus [[impaction]] into the small airways that accentuates the branching course of peripheral airways.<ref name="Eisenhuber2002">{{cite journal|last1=Eisenhuber|first1=Edith|title=The Tree-in-Bud Sign1|journal=Radiology|volume=222|issue=3|year=2002|pages=771–772|issn=0033-8419|doi=10.1148/radiol.2223991980}}</ref>

{|
|[[File:Pulmonary Tuberculosis CT.jpg|thumb|280px|left|Pulmonary Tuberculosis Image courtesy of Dr Natalie Yang, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pulmonary-tuberculosis-6 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[File:Pulmonary Tuberculosis CT 2.jpg|thumb|280px|left|Pulmonary Tuberculosis Image courtesy of Dr Natalie Yang, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pulmonary-tuberculosis-6 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[File:Cavitary tuberculosis - CT scan.jpg|thumb|320px|Chest CT showing a tuberculous cavity in the left lung. Image courtesy of Wikimedia Commons.]]
|}

===Extrapulmonary Tuberculosis===
====Cardiac Tuberculosis====

*Pericardial thickening may be seen on a CT scan, specially if it is more than 3 mm.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>
*Lymph node enlargement is also a common CT finding in cardiac tuberculosis.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>
*Pericardial effusion is rare and is seen in less than 20% of patients.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

====Miliary Tuberculosis====
CT findings include multiple pulmonary nodules with a diameter of 1-2mm, distributed in a random pattern sometimes presenting with [[pleural effusion]] as well.
{|
|[[Image:Miliary Tuberculosis CT.jpg|thumb|300px|left|Miliary Tuberculosis Image courtesy of Dr Frank Gaillard, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/miliary-tuberculosis-ct here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image:Miliary Tuberculosis CT 2.jpg|thumb|300px|left|Miliary Tuberculosis Image courtesy of Dr Frank Gaillard, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/miliary-tuberculosis-ct here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

===Tuberculous Meningitis===

*Head CT findings in [[tuberculous meningitis]] include meningeal enhancement indicating meningeal [[inflammation]] and [[Choroid plexus|choroidal]] calcifications.<ref name="KomolafeSunmonu2008">{{cite journal|last1=Komolafe|first1=Morenikeji A|last2=Sunmonu|first2=Taofiki A|last3=Esan|first3=Olufunmi A|title=Tuberculous meningitis presenting with unusual clinical features in Nigerians: Two case reports|journal=Cases Journal|volume=1|issue=1|year=2008|pages=180|issn=1757-1626|doi=10.1186/1757-1626-1-180}}</ref>
*Areas of [[infarction and hemorrhage]] may also be seen in cases of miliary tuberculosis.
*Patients with late complications may show hydrocephalus.

[[Image:Tuberculous meningitis.jpg|thumb|none|350px|Image courtesy of Wikimedia Commons.]]

====Abdominal Tuberculosis====

*CT findings in a pancreatic and spleen infection with tuberculosis may mimic a [[pancreatic cancer]].<ref name="RongLou2008">{{cite journal|last1=Rong|first1=YF|last2=Lou|first2=WH|last3=Jin|first3=DY|title=Pancreatic tuberculosis with splenic tuberculosis mimicking advanced [[pancreatic cancer]] with [[splenic]] metastasizes: a case report|journal=Cases Journal|volume=1|issue=1|year=2008|pages=84|issn=1757-1626|doi=10.1186/1757-1626-1-84}}</ref>
*Shown below there is a CT scan of the [[pancreas]] demonstrating a mass in the pancreatic tail and metastasizes in the [[spleen]].

{|
|[[Image:Pancreas_and_spleen-tuberculosis.jpg|thumb|none|350px|Image courtesy of Wikimedia Commons.]]
|[[Image:Pancreas_and_spleen-tuberculosis2.jpg |thumb|none|350px|Image courtesy of Wikimedia Commons.]]
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category: Needs overview]]
[[Category: Needs content]]
[[Category:Bacterial diseases]]

Tuberculosis chest x ray

2021-01-24T07:27:58Z

Mashal Awais:

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}

==Overview==
An X-ray is very important in diagnosing pulmonary tuberculosis. Chest X-ray findings may present with parenchymal infiltrates, hilar [[adenopathy]], cavitation, [[nodules]] and [[pleural effusion]]. Pulmonary tuberculosis is most commonly located in the upper lobes.

==Chest X-Ray==
An anteroposterior chest X-ray is one of the most important tests to be performed in a patient with tuberculosis or suspected tuberculosis.<ref>{{Cite journal
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]]
| title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review
| journal = [[The Journal of rheumatology. Supplement]]
| volume = 91
| pages = 32–40
| year = 2014
| month = May
| doi = 10.3899/jrheum.140100
| pmid = 24788998
}}</ref>

===Primary Tuberculosis===

*The 3 main X-ray findings in primary tuberculosis include parenchymal infiltrates, hilar [[adenopathy]], and [[pleural effusion]].
*Primary tuberculosis may appear at any location in the lung.
*Hilar [[lymphadenopathy]] is commonly seen in children, and maybe present in up to 95% of children with active tuberculosis.
*Less than half of adults with primary tuberculosis present with [[lymphadenopathy]]. <ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>
*Tuberculomas, which are opacities similar to a lung mass, may be observed in 5% of patients and can be almost 4 cm in size.<ref name="KimSong2001">{{cite journal|last1=Kim|first1=Hyae Young|last2=Song|first2=Koun-Sik|last3=Goo|first3=Jin Mo|last4=Lee|first4=Jin Seong|last5=Lee|first5=Kyoung Soo|last6=Lim|first6=Tae-Hwan|title=Thoracic Sequelae and Complications of Tuberculosis1|journal=RadioGraphics|volume=21|issue=4|year=2001|pages=839–858|issn=0271-5333|doi=10.1148/radiographics.21.4.g01jl06839}}</ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866 }} </ref>
*Unilateral [[pleural effusion]] may be observed and it is commonly related to complicated primary tuberculosis.

===Secondary Tuberculosis===

*The most common location of secondary tuberculosis is in the upper lobes, especially in the apical and posterior segments. However, lesions may appear anywhere in the [[lungs]].
*The X-ray findings in secondary or reactivated tuberculosis include:<ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>

:*Patchy consolidation is poorly defined.
:*[[Cavitation]], which is the most important finding in secondary tuberculosis
::*Appears as a lesion with irregular margins and thick walls.
::*It may be observed in almost 50% of patients.
::*It is most commonly seen in the upper lung.
::*Cavities in the lower lung can be found in [[diabetes]] and [[HIV]] infection.<ref name="PatelRami2011">{{cite journal|last1=Patel|first1=AnandK|last2=Rami|first2=KiranC|last3=Ghanchi|first3=FerozD|title=Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus|journal=Lung India|volume=28|issue=1|year=2011|pages=70|issn=0970-2113|doi=10.4103/0970-2113.76308}}</ref><ref name="PadyanaBhat2012">{{cite journal|last1=Padyana|first1=Mahesha|last2=Bhat|first2=RaghavendraV|last3=Dinesha|first3=M|last4=Nawaz|first4=Alam|title=HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count|journal=North American Journal of Medical Sciences|volume=4|issue=5|year=2012|pages=221|issn=1947-2714|doi=10.4103/1947-2714.95904}}</ref>
::*Although it is rare, cavities can become superinfected and an air-fluid level is seen inside the cavity.
:*[[Pneumothorax]] is rare but may be seen in 5% of patients.
:*[[Lymphadenopathy]] is also uncommon in secondary tuberculosis.
:*Small [[pleural effusion]] may occur in 18% of patients.

*In the majority of cases the consolidation involves more than one lobe.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

=====Chest X-Ray Images in Pulmonary Tuberculosis=====
<gallery>
File: Pulmonary Tuberculosis X-ray.jpg|Pulmonary Tuberculosis
File: Pulmonary Tuberculosis X-ray2.jpg|Pulmonary Tuberculosis
File: Pulmonary Tuberculosis X-ray3.jpg|Pulmonary Tuberculosis
File: Pulmonary Tuberculosis X-ray4.jpg|Bilateral Pulmonary Tuberculosis
File: TB CXR.jpg|Pulmonary Tuberculosis
</gallery>

===Common Findings of Miliary Tuberculosis on Chest X-Ray===

*Fine, pinpoint approximately 1-2mm in size, discrete, uniform distribution, soft mottlings.
*Commonly found throughout both lungs.
{{further|'''[[Miliary tuberculosis chest x ray|Miliary tuberculosis]]'''}}

=====Chest X-Ray Images in Miliary Tuberculosis=====
<gallery>
File:Miliary Tuberculosis.jpg|Miliary Tuberculosis
File:Disseminated-TB-001.jpg|Miliary Tuberculosis
File:Disseminated-TB-002.jpg|Miliary Tuberculosis
</gallery>

==CDC Guidelines for Evaluating Chest X-Ray<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref>==
A medical examination is compulsory for all refugees coming to the U.S. and all applicants outside the U.S. applying for an immigrant visa. The purpose of the medical examination is to identify applicants with inadmissible health-related conditions such as active tuberculosis. Outside the U.S., medical examinations are performed by approximately 400 physicians (panel physicians) selected by United States Department of State consular officials. In the U.S., medical examinations are performed by approximately 3,000 physicians (civil surgeons) designated by district directors of the U.S. Citizenship and Immigration Services. Guidelines were developed by the [[Centers for Disease Control and Prevention]] (CDC).

The [[chest X-ray]] and classification system is designed to group findings into categories based on their likelihood of being related to TB or non-TB conditions needing medical follow-up (either at the time of the [[chest X-ray]] or after resettlement).

===Abnormal Findings===

====Chest X-Ray Findings that Can Suggest Active TB====

This category comprises all findings typically associated with active pulmonary TB. An applicant with any of the following findings must undergo [[sputum]] specimens for examination.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Infiltrate or consolidation
| style="padding: 5px 5px; background: #F5F5F5;" |Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Any cavitary lesion
| style="padding: 5px 5px; background: #F5F5F5;" |Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Nodule with poorly defined margins
| style="padding: 5px 5px; background: #F5F5F5;" |Round density within the lung parenchyma, also called a tuberculoma. Nodules included in this category are those with margins that are indistinct or poorly defined. The surrounding haziness can be either subtle or readily apparent and suggests coexisting airspace consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural effusion
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of a significant amount of fluid within the pleural space. This finding must be distinguished from blunting of the costophrenic angle, which may or may not represent a small amount of fluid within the pleural space (except in children when even minor blunting must be considered a finding that can suggest active TB).
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Hilar or mediastinal lymphadenopathy ([[bihilar lymphadenopathy]])
| style="padding: 5px 5px; background: #F5F5F5;" |Enlargement of lymph nodes in one or both hila or within the [[mediastinum]], with or without associated atelectasis or consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Linear, interstitial disease (in children only)
| style="padding: 5px 5px; background: #F5F5F5;" |Prominence of linear, interstitial (septal) markings.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of active TB, such as [[miliary TB]]. Miliary findings are nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Chest X-Ray Findings that Can Suggest Inactive TB====

This includes findings that are suggestive of prior TB, that is inactive. It must be remembered that active TB cannot be diagnosed on the basis of a single radiograph alone. If there is any question of active TB, sputum smears must be obtained. Furthermore, if there are any signs or symptoms of TB, [[sputum]] smears must be obtained then as well. Therefore, any applicant might have findings grouped in this category, but still have active TB as suggested by:

*The presence of signs or symptoms of TB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B1]]).
*[[Sputum]] smears positive for AFB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class A]]).

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar or linear opacity
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a fibrocalcific scar.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) without calcification
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and without any surrounding airspace opacification. Nodules are generally round or have rounded edges. These features allow them to be distinguished from infiltrates or airspace opacities. To be included here, these nodules must be noncalcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear densities with reduction in the space occupied by the upper lobe. Associated signs include upward deviation of the fissure or hilum on the corresponding side with asymmetry of the volumes of the two thoracic cavities.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and no surrounding airspace opacification with reduction in the space occupied by the upper lobe. Nodules are generally round or have rounded edges.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of prior TB, such as upper lobe bronchiectasis. Bronchiectasis is bronchial dilation with bronchial wall thickening.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

===Other Chest X-Ray Findings===
====Follow-up====
This category includes findings that suggest the need for a follow-up evaluation for non-TB conditions either at the time of the chest X-ray or after resettlement of the applicant in the United States.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Musculoskeletal abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |New bony fractures or radiographically apparent bony abnormalities that need follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cardiac abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Cardiac enlargement or anomalies, vascular abnormalities, or any other radiographically apparent cardiovascular abnormality of significant nature to require follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Pulmonary finding of a non-TB nature, such as a mass, that needs follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding that the panel physician believes needs follow-up, but is not one of the above.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Follow-up Not Required====

This includes findings that are minor and not suggestive of TB disease. This does not require follow-up evaluation after the resettlement of the applicant.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural thickening
| style="padding: 5px 5px; background: #F5F5F5;" |Irregularity or abnormal prominence of the pleural margin, including apical capping (thickening of the pleura in the apical region). Pleural thickening can be calcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Diaphragmatic tenting

| style="padding: 5px 5px; background: #F5F5F5;" |A localized accentuation of the normal convexity of the hemidiaphragm as if 'pulled upwards by a string'.

|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Blunting of [[costophrenic angle]] (in adults)
| style="padding: 5px 5px; background: #F5F5F5;" |Loss of sharpness of one or both [[costophrenic angle]]s. Blunting can be related to a small amount of fluid in the pleural space or to pleural thickening and, by itself, is a non-specific finding (except in children, when even minor blunting may suggest active TB). In contrast a large pleural effusion, or the presence of a significant amount of fluid in the pleural space, may be a sign of active TB at any age.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Solitary calcified nodules or [[granuloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete calcified nodule or [[granuloma]], or calcified [[lymph node]]. The calcified nodule can be within the lung, hilium, or mediastinum. The borders must be sharp, distinct, and well defined. This was considered a [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] TB in the past; however, [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] has been omitted from the classification scheme because it has not been found to be associated with active TB.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

==X-Ray Findings in Complications of Tuberculosis==
{| style="border: 0px; font-size: 90%; margin: 3px; width:700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|X-Ray Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cicatrization<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Upper lobe [[atelectasis]]
*Compensatory hyperinflation of the lower lobe
*[[Hilar]] retraction
*[[Mediastinal]] shift
*Parenchymal bands
*Fibrotic cavities
*Fibrotic nodules
*Traction [[bronchiectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Thin-walled cavity
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present in active and inactive forms of the disease
*May regress with treatment
*Air-filled [[cysts]] may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
*Maybe misidentified as an [[Emphysema|emphysematous]] bulla or pneumatocelle.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Aspergilloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mobile mass ringed by an air shadow.
*Calcifications
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Broncholithiasis<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Calcified material within the tracheobronchial lumen, originated on a calcified [[lymph node]]
*[[Airway]] obstruction
*[[Atelectasis]]
*[[Air trapping]] on the expiration
*Frequent change in position of the calcified material
*Mucoid impaction
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Fibrosing [[mediastinitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Mediastinal]] widening
*Localized mass
*[[Hilar]] or [[mediastinal]] mass
*Calcification
*Pulmonary infiltrates
*[[Atelectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous spondylitis ([[Pott's disease]])
| style="padding: 5px 5px; background: #F5F5F5;" |
*Vertebral endplate irregularities
*Reduction of the intervertebral disk space
*Adjacent bone sclerosis
*In later stages of the disease, [[kyphosis]], due to anterior compression of the [[vertebral bodies]], and paravertebral [[abscess]]es may occur
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Malignancy]]<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Bone destruction around the region of the [[empyema]]
*Increased [[thoracic cavity]] opacity
*Medial deviation of the affected [[pleura]]
*Swelling of the soft-tissue
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis CT

2021-01-24T07:26:45Z

Mashal Awais: /* Overview */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{AL}}

==Overview==
Mostly patients with pulmonary tuberculosis will have abnormal findings in a chest [[CT]], which include micronodules, interlobular septal thickening, [[cavitation]] and consolidation. CT scans are more sensitive than an [[X-ray]] to detect [[lymphadenopathy|lymphadenopathies]].

==Computed Tomography==
===Pulmonary Tuberculosis===

*Chest CT abnormalities are seen in the majority of patients with active pulmonary tuberculosis.
*CT findings include:<ref>{{Cite journal
| author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]]
| title = Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging
| journal = [[Chest]]
| year = 2014
| month = June
| doi = 10.1378/chest.14-0196
| pmid = 25086249
}}</ref>

:*Micronodules
::*Most commonly found in the subpleural region and peribronchovascular interstitium.
::*CT scan allows early and accurate detection of micronodules.
:*Interlobular septal thickening
:*Cavitation is the most important finding in secondary tuberculosis
::*Appears as a lesion with thick walls and irregular margins.
::*It may be observed in almost 50% of patients.
::*It is most commonly seen in the upper lung.
::*Cavities in the lower lung can be found in [[diabetes]] and [[HIV]] infection.<ref name="PatelRami2011">{{cite journal|last1=Patel|first1=AnandK|last2=Rami|first2=KiranC|last3=Ghanchi|first3=FerozD|title=Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus|journal=Lung India|volume=28|issue=1|year=2011|pages=70|issn=0970-2113|doi=10.4103/0970-2113.76308}}</ref><ref name="PadyanaBhat2012">{{cite journal|last1=Padyana|first1=Mahesha|last2=Bhat|first2=RaghavendraV|last3=Dinesha|first3=M|last4=Nawaz|first4=Alam|title=HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count|journal=North American Journal of Medical Sciences|volume=4|issue=5|year=2012|pages=221|issn=1947-2714|doi=10.4103/1947-2714.95904}}</ref>
::*Although it is rare, cavities may become superinfected and an air-fluid level is seen inside the cavity.
::*After the active infection is treated and resolved, small cavities with thin walls may remain as a residual finding.
:*Homogeneous and dense consolidation

*CT is more sensitive to detect hilar lymphadenopathy.
*The "tree-in-bud" sign is a CT finding that may be seen in [[pulmonary tuberculosis]] and it is caused by mucus or pus [[impaction]] into the small airways that accentuates the branching course of peripheral airways.<ref name="Eisenhuber2002">{{cite journal|last1=Eisenhuber|first1=Edith|title=The Tree-in-Bud Sign1|journal=Radiology|volume=222|issue=3|year=2002|pages=771–772|issn=0033-8419|doi=10.1148/radiol.2223991980}}</ref>

{|
|[[File:Pulmonary Tuberculosis CT.jpg|thumb|280px|left|Pulmonary Tuberculosis Image courtesy of Dr Natalie Yang, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pulmonary-tuberculosis-6 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[File:Pulmonary Tuberculosis CT 2.jpg|thumb|280px|left|Pulmonary Tuberculosis Image courtesy of Dr Natalie Yang, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/pulmonary-tuberculosis-6 here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[File:Cavitary tuberculosis - CT scan.jpg|thumb|320px|Chest CT showing a tuberculous cavity in the left lung. Image courtesy of Wikimedia Commons.]]
|}

===Extrapulmonary Tuberculosis===
====Cardiac Tuberculosis====

*Pericardial thickening may be seen on a CT scan, specially if it is more than 3 mm.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>
*Lymph node enlargement is also a common CT finding in cardiac tuberculosis.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>
*Pericardial effusion is rare and is seen in less than 20% of patients.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

====Miliary Tuberculosis====
CT findings include multiple pulmonary nodules with a diameter of 1-2mm, distributed in a random pattern sometimes presenting with [[pleural effusion]] as well.
{|
|[[Image:Miliary Tuberculosis CT.jpg|thumb|300px|left|Miliary Tuberculosis Image courtesy of Dr Frank Gaillard, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/miliary-tuberculosis-ct here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|[[Image:Miliary Tuberculosis CT 2.jpg|thumb|300px|left|Miliary Tuberculosis Image courtesy of Dr Frank Gaillard, [http://www.Radiopaedia.org Radiopedia]. (original file [http://radiopaedia.org/cases/miliary-tuberculosis-ct here)] [http://radiopaedia.org/licence Creative Commons BY-SA-NC]]]
|}

===Tuberculous Meningitis===

*Head CT findings in [[tuberculous meningitis]] include meningeal enhancement indicating meningeal [[inflammation]] and [[Choroid plexus|choroidal]] calcifications.<ref name="KomolafeSunmonu2008">{{cite journal|last1=Komolafe|first1=Morenikeji A|last2=Sunmonu|first2=Taofiki A|last3=Esan|first3=Olufunmi A|title=Tuberculous meningitis presenting with unusual clinical features in Nigerians: Two case reports|journal=Cases Journal|volume=1|issue=1|year=2008|pages=180|issn=1757-1626|doi=10.1186/1757-1626-1-180}}</ref>
*Areas of [[infarction and hemorrhage]] may also be seen in cases of miliary tuberculosis.
*Patients with late complications may show hydrocephalus.

[[Image:Tuberculous meningitis.jpg|thumb|none|350px|Image courtesy of Wikimedia Commons.]]

====Abdominal Tuberculosis====

*CT findings in a pancreatic and spleen infection with tuberculosis may mimic a [[pancreatic cancer]].<ref name="RongLou2008">{{cite journal|last1=Rong|first1=YF|last2=Lou|first2=WH|last3=Jin|first3=DY|title=Pancreatic tuberculosis with splenic tuberculosis mimicking advanced [[pancreatic cancer]] with [[splenic]] metastasizes: a case report|journal=Cases Journal|volume=1|issue=1|year=2008|pages=84|issn=1757-1626|doi=10.1186/1757-1626-1-84}}</ref>
*Shown below there is a CT scan of the [[pancreas]] demonstrating a mass in the pancreatic tail and metastasizes in the [[spleen]].

{|
|[[Image:Pancreas_and_spleen-tuberculosis.jpg|thumb|none|350px|Image courtesy of Wikimedia Commons.]]
|[[Image:Pancreas_and_spleen-tuberculosis2.jpg |thumb|none|350px|Image courtesy of Wikimedia Commons.]]
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category: Pulmonology]]
[[Category: Needs overview]]
[[Category: Needs content]]
[[Category:Bacterial diseases]]

Tuberculosis chest x ray

2021-01-24T07:20:37Z

Mashal Awais: /* Chest X-Ray Findings that Can Suggest Inactive TB */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{AL}}

==Overview==
An X-ray is very important in diagnosing pulmonary tuberculosis. Chest X-ray findings may present with parenchymal infiltrates, hilar [[adenopathy]], cavitation, [[nodules]] and [[pleural effusion]]. Pulmonary tuberculosis is most commonly located in the upper lobes.

==Chest X-Ray==
An anteroposterior chest X-ray is one of the most important tests to be performed in a patient with tuberculosis or suspected tuberculosis.<ref>{{Cite journal
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]]
| title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review
| journal = [[The Journal of rheumatology. Supplement]]
| volume = 91
| pages = 32–40
| year = 2014
| month = May
| doi = 10.3899/jrheum.140100
| pmid = 24788998
}}</ref>

===Primary Tuberculosis===

*The 3 main X-ray findings in primary tuberculosis include parenchymal infiltrates, hilar [[adenopathy]], and [[pleural effusion]].
*Primary tuberculosis may appear at any location in the lung.
*Hilar [[lymphadenopathy]] is commonly seen in children, and maybe present in up to 95% of children with active tuberculosis.
*Less than half of adults with primary tuberculosis present with [[lymphadenopathy]]. <ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>
*Tuberculomas, which are opacities similar to a lung mass, may be observed in 5% of patients and can be almost 4 cm in size.<ref name="KimSong2001">{{cite journal|last1=Kim|first1=Hyae Young|last2=Song|first2=Koun-Sik|last3=Goo|first3=Jin Mo|last4=Lee|first4=Jin Seong|last5=Lee|first5=Kyoung Soo|last6=Lim|first6=Tae-Hwan|title=Thoracic Sequelae and Complications of Tuberculosis1|journal=RadioGraphics|volume=21|issue=4|year=2001|pages=839–858|issn=0271-5333|doi=10.1148/radiographics.21.4.g01jl06839}}</ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866 }} </ref>
*Unilateral [[pleural effusion]] may be observed and it is commonly related to complicated primary tuberculosis.

===Secondary Tuberculosis===

*The most common location of secondary tuberculosis is in the upper lobes, especially in the apical and posterior segments. However, lesions may appear anywhere in the [[lungs]].
*The X-ray findings in secondary or reactivated tuberculosis include:<ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>

:*Patchy consolidation is poorly defined.
:*[[Cavitation]], which is the most important finding in secondary tuberculosis
::*Appears as a lesion with irregular margins and thick walls.
::*It may be observed in almost 50% of patients.
::*It is most commonly seen in the upper lung.
::*Cavities in the lower lung can be found in [[diabetes]] and [[HIV]] infection.<ref name="PatelRami2011">{{cite journal|last1=Patel|first1=AnandK|last2=Rami|first2=KiranC|last3=Ghanchi|first3=FerozD|title=Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus|journal=Lung India|volume=28|issue=1|year=2011|pages=70|issn=0970-2113|doi=10.4103/0970-2113.76308}}</ref><ref name="PadyanaBhat2012">{{cite journal|last1=Padyana|first1=Mahesha|last2=Bhat|first2=RaghavendraV|last3=Dinesha|first3=M|last4=Nawaz|first4=Alam|title=HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count|journal=North American Journal of Medical Sciences|volume=4|issue=5|year=2012|pages=221|issn=1947-2714|doi=10.4103/1947-2714.95904}}</ref>
::*Although it is rare, cavities can become superinfected and an air-fluid level is seen inside the cavity.
:*[[Pneumothorax]] is rare but may be seen in 5% of patients.
:*[[Lymphadenopathy]] is also uncommon in secondary tuberculosis.
:*Small [[pleural effusion]] may occur in 18% of patients.

*In the majority of cases the consolidation involves more than one lobe.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

=====Chest X-Ray Images in Pulmonary Tuberculosis=====
<gallery>
File:Pulmonary Tuberculosis X-ray.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray2.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray3.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray4.jpg|Bilateral Pulmonary Tuberculosis
File:TB CXR.jpg|Pulmonary Tuberculosis
</gallery>

===Common Findings of Miliary Tuberculosis on Chest X-Ray===

*Fine, pin point approximately 1-2mm in size, discrete, uniform distribution, soft mottlings.
*Commonly found throughout both lungs.
{{further|'''[[Miliary tuberculosis chest x ray|Miliary tuberculosis]]'''}}

=====Chest X-Ray Images in Miliary Tuberculosis=====
<gallery>
File:Miliary Tuberculosis.jpg|Miliary Tuberculosis
File:Disseminated-TB-001.jpg|Miliary Tuberculosis
File:Disseminated-TB-002.jpg|Miliary Tuberculosis
</gallery>

==CDC Guidelines for Evaluating Chest X-Ray<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref>==
A medical examination is compulsory for all refugees coming to the U.S. and all applicants outside the U.S. applying for an immigrant visa. The purpose of the medical examination is to identify applicants with inadmissible health-related conditions such as active tuberculosis. Outside the U.S., medical examinations are performed by approximately 400 physicians (panel physicians) selected by United States Department of State consular officials. In the U.S., medical examinations are performed by approximately 3,000 physicians (civil surgeons) designated by district directors of the U.S. Citizenship and Immigration Services. Guidelines were developed by the [[Centers for Disease Control and Prevention]] (CDC).

The [[chest X-ray]] and classification system is designed to group findings into categories based on their likelihood of being related to TB or non-TB conditions needing medical follow-up (either at the time of the [[chest X-ray]] or after resettlement).

===Abnormal Findings===

====Chest X-Ray Findings that Can Suggest Active TB====

This category comprises all findings typically associated with active pulmonary TB. An applicant with any of the following findings must undergo [[sputum]] specimens for examination.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Infiltrate or consolidation
| style="padding: 5px 5px; background: #F5F5F5;" |Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Any cavitary lesion
| style="padding: 5px 5px; background: #F5F5F5;" |Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Nodule with poorly defined margins
| style="padding: 5px 5px; background: #F5F5F5;" |Round density within the lung parenchyma, also called a tuberculoma. Nodules included in this category are those with margins that are indistinct or poorly defined. The surrounding haziness can be either subtle or readily apparent and suggests coexisting airspace consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural effusion
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of a significant amount of fluid within the pleural space. This finding must be distinguished from blunting of the costophrenic angle, which may or may not represent a small amount of fluid within the pleural space (except in children when even minor blunting must be considered a finding that can suggest active TB).
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Hilar or mediastinal lymphadenopathy ([[bihilar lymphadenopathy]])
| style="padding: 5px 5px; background: #F5F5F5;" |Enlargement of lymph nodes in one or both hila or within the [[mediastinum]], with or without associated atelectasis or consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Linear, interstitial disease (in children only)
| style="padding: 5px 5px; background: #F5F5F5;" |Prominence of linear, interstitial (septal) markings.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of active TB, such as [[miliary TB]]. Miliary findings are nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Chest X-Ray Findings that Can Suggest Inactive TB====

This includes findings that are suggestive of prior TB, that is inactive. It must be remembered that active TB cannot be diagnosed on the basis of a single radiograph alone. If there is any question of active TB, sputum smears must be obtained. Furthermore, if there are any signs or symptoms of TB, [[sputum]] smears must be obtained then as well. Therefore, any applicant might have findings grouped in this category, but still have active TB as suggested by:

*The presence of signs or symptoms of TB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B1]]).
*[[Sputum]] smears positive for AFB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class A]]).

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar or linear opacity
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a fibrocalcific scar.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) without calcification
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and without any surrounding airspace opacification. Nodules are generally round or have rounded edges. These features allow them to be distinguished from infiltrates or airspace opacities. To be included here, these nodules must be noncalcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear densities with reduction in the space occupied by the upper lobe. Associated signs include upward deviation of the fissure or hilum on the corresponding side with asymmetry of the volumes of the two thoracic cavities.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and no surrounding airspace opacification with reduction in the space occupied by the upper lobe. Nodules are generally round or have rounded edges.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of prior TB, such as upper lobe bronchiectasis. Bronchiectasis is bronchial dilation with bronchial wall thickening.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

===Other Chest X-Ray Findings===
====Follow-up====
This category includes findings that suggest the need for a follow-up evaluation for non-TB conditions either at the time of the chest X-ray or after resettlement of the applicant in the United States.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Musculoskeletal abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |New bony fractures or radiographically apparent bony abnormalities that need follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cardiac abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Cardiac enlargement or anomalies, vascular abnormalities, or any other radiographically apparent cardiovascular abnormality of significant nature to require follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Pulmonary finding of a non-TB nature, such as a mass, that needs follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding that the panel physician believes needs follow-up, but is not one of the above.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Follow-up Not Required====

This includes findings that are minor and not suggestive of TB disease. This does not require follow-up evaluation after the resettlement of the applicant.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural thickening
| style="padding: 5px 5px; background: #F5F5F5;" |Irregularity or abnormal prominence of the pleural margin, including apical capping (thickening of the pleura in the apical region). Pleural thickening can be calcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Diaphragmatic tenting

| style="padding: 5px 5px; background: #F5F5F5;" |A localized accentuation of the normal convexity of the hemidiaphragm as if 'pulled upwards by a string'.

|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Blunting of [[costophrenic angle]] (in adults)
| style="padding: 5px 5px; background: #F5F5F5;" |Loss of sharpness of one or both [[costophrenic angle]]s. Blunting can be related to a small amount of fluid in the pleural space or to pleural thickening and, by itself, is a non-specific finding (except in children, when even minor blunting may suggest active TB). In contrast a large pleural effusion, or the presence of a significant amount of fluid in the pleural space, may be a sign of active TB at any age.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Solitary calcified nodules or [[granuloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete calcified nodule or [[granuloma]], or calcified [[lymph node]]. The calcified nodule can be within the lung, hilium, or mediastinum. The borders must be sharp, distinct, and well defined. This was considered a [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] TB in the past; however, [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] has been omitted from the classification scheme because it has not been found to be associated with active TB.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

==X-Ray Findings in Complications of Tuberculosis==
{| style="border: 0px; font-size: 90%; margin: 3px; width:700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|X-Ray Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cicatrization<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Upper lobe [[atelectasis]]
*Compensatory hyperinflation of the lower lobe
*[[Hilar]] retraction
*[[Mediastinal]] shift
*Parenchymal bands
*Fibrotic cavities
*Fibrotic nodules
*Traction [[bronchiectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Thin-walled cavity
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present in active and inactive forms of the disease
*May regress with treatment
*Air-filled [[cysts]] may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
*Maybe misidentified as an [[Emphysema|emphysematous]] bulla or pneumatocelle.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Aspergilloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mobile mass ringed by an air shadow.
*Calcifications
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Broncholithiasis<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Calcified material within the tracheobronchial lumen, originated on a calcified [[lymph node]]
*[[Airway]] obstruction
*[[Atelectasis]]
*[[Air trapping]] on the expiration
*Frequent change in position of the calcified material
*Mucoid impaction
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Fibrosing [[mediastinitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Mediastinal]] widening
*Localized mass
*[[Hilar]] or [[mediastinal]] mass
*Calcification
*Pulmonary infiltrates
*[[Atelectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous spondylitis ([[Pott's disease]])
| style="padding: 5px 5px; background: #F5F5F5;" |
*Vertebral endplate irregularities
*Reduction of the intervertebral disk space
*Adjacent bone sclerosis
*In later stages of the disease, [[kyphosis]], due to anterior compression of the [[vertebral bodies]], and paravertebral [[abscess]]es may occur
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Malignancy]]<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Bone destruction around the region of the [[empyema]]
*Increased [[thoracic cavity]] opacity
*Medial deviation of the affected [[pleura]]
*Swelling of the soft-tissue
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis chest x ray

2021-01-24T07:16:55Z

Mashal Awais: /* CDC Guidelines for Evaluating Chest X-Ray[8] */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{AL}}

==Overview==
An X-ray is very important in diagnosing pulmonary tuberculosis. Chest X-ray findings may present with parenchymal infiltrates, hilar [[adenopathy]], cavitation, [[nodules]] and [[pleural effusion]]. Pulmonary tuberculosis is most commonly located in the upper lobes.

==Chest X-Ray==
An anteroposterior chest X-ray is one of the most important tests to be performed in a patient with tuberculosis or suspected tuberculosis.<ref>{{Cite journal
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]]
| title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review
| journal = [[The Journal of rheumatology. Supplement]]
| volume = 91
| pages = 32–40
| year = 2014
| month = May
| doi = 10.3899/jrheum.140100
| pmid = 24788998
}}</ref>

===Primary Tuberculosis===

*The 3 main X-ray findings in primary tuberculosis include parenchymal infiltrates, hilar [[adenopathy]], and [[pleural effusion]].
*Primary tuberculosis may appear at any location in the lung.
*Hilar [[lymphadenopathy]] is commonly seen in children, and maybe present in up to 95% of children with active tuberculosis.
*Less than half of adults with primary tuberculosis present with [[lymphadenopathy]]. <ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>
*Tuberculomas, which are opacities similar to a lung mass, may be observed in 5% of patients and can be almost 4 cm in size.<ref name="KimSong2001">{{cite journal|last1=Kim|first1=Hyae Young|last2=Song|first2=Koun-Sik|last3=Goo|first3=Jin Mo|last4=Lee|first4=Jin Seong|last5=Lee|first5=Kyoung Soo|last6=Lim|first6=Tae-Hwan|title=Thoracic Sequelae and Complications of Tuberculosis1|journal=RadioGraphics|volume=21|issue=4|year=2001|pages=839–858|issn=0271-5333|doi=10.1148/radiographics.21.4.g01jl06839}}</ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866 }} </ref>
*Unilateral [[pleural effusion]] may be observed and it is commonly related to complicated primary tuberculosis.

===Secondary Tuberculosis===

*The most common location of secondary tuberculosis is in the upper lobes, especially in the apical and posterior segments. However, lesions may appear anywhere in the [[lungs]].
*The X-ray findings in secondary or reactivated tuberculosis include:<ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>

:*Patchy consolidation is poorly defined.
:*[[Cavitation]], which is the most important finding in secondary tuberculosis
::*Appears as a lesion with irregular margins and thick walls.
::*It may be observed in almost 50% of patients.
::*It is most commonly seen in the upper lung.
::*Cavities in the lower lung can be found in [[diabetes]] and [[HIV]] infection.<ref name="PatelRami2011">{{cite journal|last1=Patel|first1=AnandK|last2=Rami|first2=KiranC|last3=Ghanchi|first3=FerozD|title=Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus|journal=Lung India|volume=28|issue=1|year=2011|pages=70|issn=0970-2113|doi=10.4103/0970-2113.76308}}</ref><ref name="PadyanaBhat2012">{{cite journal|last1=Padyana|first1=Mahesha|last2=Bhat|first2=RaghavendraV|last3=Dinesha|first3=M|last4=Nawaz|first4=Alam|title=HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count|journal=North American Journal of Medical Sciences|volume=4|issue=5|year=2012|pages=221|issn=1947-2714|doi=10.4103/1947-2714.95904}}</ref>
::*Although it is rare, cavities can become superinfected and an air-fluid level is seen inside the cavity.
:*[[Pneumothorax]] is rare but may be seen in 5% of patients.
:*[[Lymphadenopathy]] is also uncommon in secondary tuberculosis.
:*Small [[pleural effusion]] may occur in 18% of patients.

*In the majority of cases the consolidation involves more than one lobe.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

=====Chest X-Ray Images in Pulmonary Tuberculosis=====
<gallery>
File:Pulmonary Tuberculosis X-ray.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray2.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray3.jpg|Pulmonary Tuberculosis
File:Pulmonary Tuberculosis X-ray4.jpg|Bilateral Pulmonary Tuberculosis
File:TB CXR.jpg|Pulmonary Tuberculosis
</gallery>

===Common Findings of Miliary Tuberculosis on Chest X-Ray===

*Fine, pin point approximately 1-2mm in size, discrete, uniform distribution, soft mottlings.
*Commonly found throughout both lungs.
{{further|'''[[Miliary tuberculosis chest x ray|Miliary tuberculosis]]'''}}

=====Chest X-Ray Images in Miliary Tuberculosis=====
<gallery>
File:Miliary Tuberculosis.jpg|Miliary Tuberculosis
File:Disseminated-TB-001.jpg|Miliary Tuberculosis
File:Disseminated-TB-002.jpg|Miliary Tuberculosis
</gallery>

==CDC Guidelines for Evaluating Chest X-Ray<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref>==
A medical examination is compulsory for all refugees coming to the U.S. and all applicants outside the U.S. applying for an immigrant visa. The purpose of the medical examination is to identify applicants with inadmissible health-related conditions such as active tuberculosis. Outside the U.S., medical examinations are performed by approximately 400 physicians (panel physicians) selected by United States Department of State consular officials. In the U.S., medical examinations are performed by approximately 3,000 physicians (civil surgeons) designated by district directors of the U.S. Citizenship and Immigration Services. Guidelines were developed by the [[Centers for Disease Control and Prevention]] (CDC).

The [[chest X-ray]] and classification system is designed to group findings into categories based on their likelihood of being related to TB or non-TB conditions needing medical follow-up (either at the time of the [[chest X-ray]] or after resettlement).

===Abnormal Findings===

====Chest X-Ray Findings that Can Suggest Active TB====

This category comprises all findings typically associated with active pulmonary TB. An applicant with any of the following findings must undergo [[sputum]] specimens for examination.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Infiltrate or consolidation
| style="padding: 5px 5px; background: #F5F5F5;" |Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Any cavitary lesion
| style="padding: 5px 5px; background: #F5F5F5;" |Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Nodule with poorly defined margins
| style="padding: 5px 5px; background: #F5F5F5;" |Round density within the lung parenchyma, also called a tuberculoma. Nodules included in this category are those with margins that are indistinct or poorly defined. The surrounding haziness can be either subtle or readily apparent and suggests coexisting airspace consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural effusion
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of a significant amount of fluid within the pleural space. This finding must be distinguished from blunting of the costophrenic angle, which may or may not represent a small amount of fluid within the pleural space (except in children when even minor blunting must be considered a finding that can suggest active TB).
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Hilar or mediastinal lymphadenopathy ([[bihilar lymphadenopathy]])
| style="padding: 5px 5px; background: #F5F5F5;" |Enlargement of lymph nodes in one or both hila or within the [[mediastinum]], with or without associated atelectasis or consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Linear, interstitial disease (in children only)
| style="padding: 5px 5px; background: #F5F5F5;" |Prominence of linear, interstitial (septal) markings.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of active TB, such as [[miliary TB]]. Miliary findings are nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Chest X-Ray Findings that Can Suggest Inactive TB====

This category includes findings that are suggestive of prior TB, that is inactive. It must be remembered that assessments of the activity of TB cannot be made accurately on the basis of a single radiograph alone. If there is any question of active TB, sputum smears must be obtained. Furthermore, if the applicant has any signs or symptoms of TB, [[sputum]] smears must be obtained. Obtaining sputum smears is necessary if there is any question of active TB. Therefore, any applicant might have findings grouped in this category, but still have active TB as suggested by:

*The presence of signs or symptoms of TB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B1]]).
*[[Sputum]] smears positive for AFB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class A]]).

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar or linear opacity
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a fibrocalcific scar.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) without calcification
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and without any surrounding airspace opacification. Nodules are generally round or have rounded edges. These features allow them to be distinguished from infiltrates or airspace opacities. To be included here, these nodules must be noncalcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear densities with reduction in the space occupied by the upper lobe. Associated signs include upward deviation of the fissure or hilum on the corresponding side with asymmetry of the volumes of the two thoracic cavities.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and no surrounding airspace opacification with reduction in the space occupied by the upper lobe. Nodules are generally round or have rounded edges.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of prior TB, such as upper lobe bronchiectasis. Bronchiectasis is bronchial dilation with bronchial wall thickening.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

===Other Chest X-Ray Findings===
====Follow-up====
This category includes findings that suggest the need for a follow-up evaluation for non-TB conditions either at the time of the chest X-ray or after resettlement of the applicant in the United States.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Musculoskeletal abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |New bony fractures or radiographically apparent bony abnormalities that need follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cardiac abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Cardiac enlargement or anomalies, vascular abnormalities, or any other radiographically apparent cardiovascular abnormality of significant nature to require follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Pulmonary finding of a non-TB nature, such as a mass, that needs follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding that the panel physician believes needs follow-up, but is not one of the above.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Follow-up Not Required====

This category includes findings that are minor and not suggestive of TB disease. These findings require no follow-up evaluation after the resettlement of the applicant.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural thickening
| style="padding: 5px 5px; background: #F5F5F5;" |Irregularity or abnormal prominence of the pleural margin, including apical capping (thickening of the pleura in the apical region). Pleural thickening can be calcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Diaphragmatic tenting

| style="padding: 5px 5px; background: #F5F5F5;" |A localized accentuation of the normal convexity of the hemidiaphragm as if 'pulled upwards by a string'.

|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Blunting of [[costophrenic angle]] (in adults)
| style="padding: 5px 5px; background: #F5F5F5;" |Loss of sharpness of one or both [[costophrenic angle]]s. Blunting can be related to a small amount of fluid in the pleural space or to pleural thickening and, by itself, is a non-specific finding (except in children, when even minor blunting may suggest active TB). In contrast a large pleural effusion, or the presence of a significant amount of fluid in the pleural space, may be a sign of active TB at any age.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Solitary calcified nodules or [[granuloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete calcified nodule or [[granuloma]], or calcified [[lymph node]]. The calcified nodule can be within the lung, hilium, or mediastinum. The borders must be sharp, distinct, and well defined. This was considered a [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] TB in the past; however, [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] has been omitted from the classification scheme because it has not been found to be associated with active TB.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

==X-Ray Findings in Complications of Tuberculosis==
{| style="border: 0px; font-size: 90%; margin: 3px; width:700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|X-Ray Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cicatrization<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Upper lobe [[atelectasis]]
*Compensatory hyperinflation of the lower lobe
*[[Hilar]] retraction
*[[Mediastinal]] shift
*Parenchymal bands
*Fibrotic cavities
*Fibrotic nodules
*Traction [[bronchiectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Thin-walled cavity
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present in active and inactive forms of the disease
*May regress with treatment
*Air-filled [[cysts]] may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
*Maybe misidentified as an [[Emphysema|emphysematous]] bulla or pneumatocelle.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Aspergilloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mobile mass ringed by an air shadow.
*Calcifications
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Broncholithiasis<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Calcified material within the tracheobronchial lumen, originated on a calcified [[lymph node]]
*[[Airway]] obstruction
*[[Atelectasis]]
*[[Air trapping]] on the expiration
*Frequent change in position of the calcified material
*Mucoid impaction
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Fibrosing [[mediastinitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Mediastinal]] widening
*Localized mass
*[[Hilar]] or [[mediastinal]] mass
*Calcification
*Pulmonary infiltrates
*[[Atelectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous spondylitis ([[Pott's disease]])
| style="padding: 5px 5px; background: #F5F5F5;" |
*Vertebral endplate irregularities
*Reduction of the intervertebral disk space
*Adjacent bone sclerosis
*In later stages of the disease, [[kyphosis]], due to anterior compression of the [[vertebral bodies]], and paravertebral [[abscess]]es may occur
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Malignancy]]<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Bone destruction around the region of the [[empyema]]
*Increased [[thoracic cavity]] opacity
*Medial deviation of the affected [[pleura]]
*Swelling of the soft-tissue
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Bacterial diseases]]

Tuberculosis chest x ray

2021-01-24T07:11:14Z

Mashal Awais: /* Secondary Tuberculosis */

__NOTOC__
{{Tuberculosis}}
{{CMG}}; {{AE}} {{AL}}

==Overview==
An X-ray is very important in diagnosing pulmonary tuberculosis. Chest X-ray findings may present with parenchymal infiltrates, hilar [[adenopathy]], cavitation, [[nodules]] and [[pleural effusion]]. Pulmonary tuberculosis is most commonly located in the upper lobes.

==Chest X-Ray==
An anteroposterior chest X-ray is one of the most important tests to be performed in a patient with tuberculosis or suspected tuberculosis.<ref>{{Cite journal
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]]
| title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review
| journal = [[The Journal of rheumatology. Supplement]]
| volume = 91
| pages = 32–40
| year = 2014
| month = May
| doi = 10.3899/jrheum.140100
| pmid = 24788998
}}</ref>

===Primary Tuberculosis===

*The 3 main X-ray findings in primary tuberculosis include parenchymal infiltrates, hilar [[adenopathy]], and [[pleural effusion]].
*Primary tuberculosis may appear at any location in the lung.
*Hilar [[lymphadenopathy]] is commonly seen in children, and maybe present in up to 95% of children with active tuberculosis.
*Less than half of adults with primary tuberculosis present with [[lymphadenopathy]]. <ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>
*Tuberculomas, which are opacities similar to a lung mass, may be observed in 5% of patients and can be almost 4 cm in size.<ref name="KimSong2001">{{cite journal|last1=Kim|first1=Hyae Young|last2=Song|first2=Koun-Sik|last3=Goo|first3=Jin Mo|last4=Lee|first4=Jin Seong|last5=Lee|first5=Kyoung Soo|last6=Lim|first6=Tae-Hwan|title=Thoracic Sequelae and Complications of Tuberculosis1|journal=RadioGraphics|volume=21|issue=4|year=2001|pages=839–858|issn=0271-5333|doi=10.1148/radiographics.21.4.g01jl06839}}</ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866 }} </ref>
*Unilateral [[pleural effusion]] may be observed and it is commonly related to complicated primary tuberculosis.

===Secondary Tuberculosis===

*The most common location of secondary tuberculosis is in the upper lobes, especially in the apical and posterior segments. However, lesions may appear anywhere in the [[lungs]].
*The X-ray findings in secondary or reactivated tuberculosis include:<ref name="CardinaleParlatano2014">{{cite journal|last1=Cardinale|first1=L.|last2=Parlatano|first2=D.|last3=Boccuzzi|first3=F.|last4=Onoscuri|first4=M.|last5=Volpicelli|first5=G.|last6=Veltri|first6=A.|title=The imaging spectrum of pulmonary tuberculosis|journal=Acta Radiologica|year=2014|issn=0284-1851|doi=10.1177/0284185114533247}}</ref>

:*Patchy consolidation is poorly defined.
:*[[Cavitation]], which is the most important finding in secondary tuberculosis
::*Appears as a lesion with irregular margins and thick walls.
::*It may be observed in almost 50% of patients.
::*It is most commonly seen in the upper lung.
::*Cavities in the lower lung can be found in [[diabetes]] and [[HIV]] infection.<ref name="PatelRami2011">{{cite journal|last1=Patel|first1=AnandK|last2=Rami|first2=KiranC|last3=Ghanchi|first3=FerozD|title=Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus|journal=Lung India|volume=28|issue=1|year=2011|pages=70|issn=0970-2113|doi=10.4103/0970-2113.76308}}</ref><ref name="PadyanaBhat2012">{{cite journal|last1=Padyana|first1=Mahesha|last2=Bhat|first2=RaghavendraV|last3=Dinesha|first3=M|last4=Nawaz|first4=Alam|title=HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count|journal=North American Journal of Medical Sciences|volume=4|issue=5|year=2012|pages=221|issn=1947-2714|doi=10.4103/1947-2714.95904}}</ref>
::*Although it is rare, cavities can become superinfected and an air-fluid level is seen inside the cavity.
:*[[Pneumothorax]] is rare but may be seen in 5% of patients.
:*[[Lymphadenopathy]] is also uncommon in secondary tuberculosis.
:*Small [[pleural effusion]] may occur in 18% of patients.

*In the majority of cases the consolidation involves more than one lobe.<ref name="BurrillWilliams2007">{{cite journal|last1=Burrill|first1=Joshua|last2=Williams|first2=Christopher J.|last3=Bain|first3=Gillian|last4=Conder|first4=Gabriel|last5=Hine|first5=Andrew L.|last6=Misra|first6=Rakesh R.|title=Tuberculosis: A Radiologic Review1|journal=RadioGraphics|volume=27|issue=5|year=2007|pages=1255–1273|issn=0271-5333|doi=10.1148/rg.275065176}}</ref>

=====Chest X-Ray Images in Pulmonary Tuberculosis=====
<gallery>
File: Pulmonary Tuberculosis X-ray.jpg|Pulmonary Tuberculosis
File: Pulmonary Tuberculosis X-ray2.jpg|Pulmonary Tuberculosis
File: Pulmonary Tuberculosis X-ray3.jpg|Pulmonary Tuberculosis
File: Pulmonary Tuberculosis X-ray4.jpg|Bilateral Pulmonary Tuberculosis
File: TB CXR.jpg|Pulmonary Tuberculosis
</gallery>

===Common Findings of Miliary Tuberculosis on Chest X-Ray===

*Fine, pin point approximately 1-2mm in size, discrete, uniform distribution, soft mottlings.
*Commonly found throughout both lungs.
{{further|'''[[Miliary tuberculosis chest x ray|Miliary tuberculosis]]'''}}

=====Chest X-Ray Images in Miliary Tuberculosis=====
<gallery>
File:Miliary Tuberculosis.jpg|Miliary Tuberculosis
File:Disseminated-TB-001.jpg|Miliary Tuberculosis
File:Disseminated-TB-002.jpg|Miliary Tuberculosis
</gallery>

==CDC Guidelines for Evaluating Chest X-Ray<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref>==
A medical examination is mandatory for all refugees coming to the U.S. and all applicants outside the U.S. applying for an immigrant visa. The purpose of the medical examination is to identify applicants with inadmissible health-related conditions such as active tuberculosis. Outside the U.S., medical examinations are performed by approximately 400 physicians (panel physicians) selected by United States Department of State consular officials. In the U.S., medical examinations are performed by approximately 3,000 physicians (civil surgeons) designated by district directors of the U.S. Citizenship and Immigration Services. Guidelines were developed by the [[Centers for Disease Control and Prevention]] (CDC).

The [[chest X-ray]] and classification worksheet is designed to group findings into categories based on their likelihood of being related to TB or non-TB conditions needing medical follow-up (either at the time of the [[chest X-ray]] or after resettlement).

===Abnormal Findings===

====Chest X-Ray Findings that Can Suggest Active TB====

This category comprises all findings typically associated with active pulmonary TB. An applicant with any of the following findings must submit [[sputum]] specimens for examination.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Infiltrate or consolidation
| style="padding: 5px 5px; background: #F5F5F5;" |Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Any cavitary lesion
| style="padding: 5px 5px; background: #F5F5F5;" |Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Nodule with poorly defined margins
| style="padding: 5px 5px; background: #F5F5F5;" |Round density within the lung parenchyma, also called a tuberculoma. Nodules included in this category are those with margins that are indistinct or poorly defined. The surrounding haziness can be either subtle or readily apparent and suggests coexisting airspace consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural effusion
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of a significant amount of fluid within the pleural space. This finding must be distinguished from blunting of the costophrenic angle, which may or may not represent a small amount of fluid within the pleural space (except in children when even minor blunting must be considered a finding that can suggest active TB).
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Hilar or mediastinal lymphadenopathy ([[bihilar lymphadenopathy]])
| style="padding: 5px 5px; background: #F5F5F5;" |Enlargement of lymph nodes in one or both hila or within the [[mediastinum]], with or without associated atelectasis or consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Linear, interstitial disease (in children only)
| style="padding: 5px 5px; background: #F5F5F5;" |Prominence of linear, interstitial (septal) markings.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of active TB, such as [[miliary TB]]. Miliary findings are nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Chest X-Ray Findings that Can Suggest Inactive TB====

This category includes findings that are suggestive of prior TB, that is inactive. It must be remembered that assessments of the activity of TB cannot be made accurately on the basis of a single radiograph alone. If there is any question of active TB, sputum smears must be obtained. Furthermore, if the applicant has any signs or symptoms of TB, [[sputum]] smears must be obtained. Obtaining sputum smears is necessary if there is any question of active TB. Therefore, any applicant might have findings grouped in this category, but still have active TB as suggested by:

*The presence of signs or symptoms of TB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B1]]).
*[[Sputum]] smears positive for AFB ([[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class A]]).

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar or linear opacity
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear or reticular densities within the lung. The edges of these densities should be distinct and there should be no suggestion of airspace opacification or haziness between or surrounding these densities. Calcification can be present within the lesion and then the lesion is called a fibrocalcific scar.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) without calcification
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and without any surrounding airspace opacification. Nodules are generally round or have rounded edges. These features allow them to be distinguished from infiltrates or airspace opacities. To be included here, these nodules must be noncalcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete fibrotic scar with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete linear densities with reduction in the space occupied by the upper lobe. Associated signs include upward deviation of the fissure or hilum on the corresponding side with asymmetry of the volumes of the two thoracic cavities.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Discrete nodule(s) with volume loss or retraction
| style="padding: 5px 5px; background: #F5F5F5;" |One or more nodular densities with distinct borders and no surrounding airspace opacification with reduction in the space occupied by the upper lobe. Nodules are generally round or have rounded edges.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding suggestive of prior TB, such as upper lobe bronchiectasis. Bronchiectasis is bronchial dilation with bronchial wall thickening.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

===Other Chest X-Ray Findings===
====Follow-up====
This category includes findings that suggest the need for a follow-up evaluation for non-TB conditions either at the time of the chest X-ray or after resettlement of the applicant in the United States.
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Musculoskeletal abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |New bony fractures or radiographically apparent bony abnormalities that need follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cardiac abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Cardiac enlargement or anomalies, vascular abnormalities, or any other radiographically apparent cardiovascular abnormality of significant nature to require follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" |Pulmonary finding of a non-TB nature, such as a mass, that needs follow-up.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Other
| style="padding: 5px 5px; background: #F5F5F5;" |Any other finding that the panel physician believes needs follow-up, but is not one of the above.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

====Follow-up Not Required====

This category includes findings that are minor and not suggestive of TB disease. These findings require no follow-up evaluation after the resettlement of the applicant.

{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 225px;" |{{fontcolor|#FFF|Chest X-ray Findings}}
! style="background: #4479BA; width: 475px;" |{{fontcolor|#FFF|Description}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pleural thickening
| style="padding: 5px 5px; background: #F5F5F5;" |Irregularity or abnormal prominence of the pleural margin, including apical capping (thickening of the pleura in the apical region). Pleural thickening can be calcified.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Diaphragmatic tenting

| style="padding: 5px 5px; background: #F5F5F5;" |A localized accentuation of the normal convexity of the hemidiaphragm as if 'pulled upwards by a string'.

|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Blunting of [[costophrenic angle]] (in adults)
| style="padding: 5px 5px; background: #F5F5F5;" |Loss of sharpness of one or both [[costophrenic angle]]s. Blunting can be related to a small amount of fluid in the pleural space or to pleural thickening and, by itself, is a non-specific finding (except in children, when even minor blunting may suggest active TB). In contrast a large pleural effusion, or the presence of a significant amount of fluid in the pleural space, may be a sign of active TB at any age.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Solitary calcified nodules or [[granuloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |Discrete calcified nodule or [[granuloma]], or calcified [[lymph node]]. The calcified nodule can be within the lung, hilium, or mediastinum. The borders must be sharp, distinct, and well defined. This was considered a [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] TB in the past; however, [[Tuberculosis classification#CDC TB Classification for Immigrants and Refugees|Class B3]] has been omitted from the classification scheme because it has not been found to be associated with active TB.
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Adpated from CDC<ref name="CDC"> {{cite web| url=http://www.cdc.gov/immigrantrefugeehealth/exams/medical-examination.html| title= CDC Medical Examination of Immigrants and Refugees}}</ref> 
|}

==X-Ray Findings in Complications of Tuberculosis==
{| style="border: 0px; font-size: 90%; margin: 3px; width:700px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Complication}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|X-Ray Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Cicatrization<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Upper lobe [[atelectasis]]
*Compensatory hyperinflation of the lower lobe
*[[Hilar]] retraction
*[[Mediastinal]] shift
*Parenchymal bands
*Fibrotic cavities
*Fibrotic nodules
*Traction [[bronchiectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Thin-walled cavity
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present in active and inactive forms of the disease
*May regress with treatment
*Air-filled [[cysts]] may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
*Maybe misidentified as an [[Emphysema|emphysematous]] bulla or pneumatocelle.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Aspergilloma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mobile mass ringed by an air shadow.
*Calcifications
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Broncholithiasis<ref name="pmid2371439">{{cite journal| author=Galdermans D, Verhaert J, Van Meerbeeck J, de Backer W, Vermeire P| title=Broncholithiasis: present clinical spectrum. | journal=Respir Med | year= 1990 | volume= 84 | issue= 2 | pages= 155-6 | pmid=2371439 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2371439 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Calcified material within the tracheobronchial lumen, originated on a calcified [[lymph node]]
*[[Airway]] obstruction
*[[Atelectasis]]
*[[Air trapping]] on the expiration
*Frequent change in position of the calcified material
*Mucoid impaction
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Fibrosing [[mediastinitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Mediastinal]] widening
*Localized mass
*[[Hilar]] or [[mediastinal]] mass
*Calcification
*Pulmonary infiltrates
*[[Atelectasis]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tuberculous spondylitis ([[Pott's disease]])
| style="padding: 5px 5px; background: #F5F5F5;" |
*Vertebral endplate irregularities
*Reduction of the intervertebral disk space
*Adjacent bone sclerosis
*In later stages of the disease, [[kyphosis]], due to anterior compression of the [[vertebral bodies]], and paravertebral [[abscess]]es may occur
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Malignancy]]<ref name="pmid1987602">{{cite journal| author=Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M et al.| title=Malignancy associated with chronic empyema: radiologic assessment. | journal=Radiology | year= 1991 | volume= 178 | issue= 2 | pages= 417-23 | pmid=1987602 | doi=10.1148/radiology.178.2.1987602 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1987602 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Bone destruction around the region of the [[empyema]]
*Increased [[thoracic cavity]] opacity
*Medial deviation of the affected [[pleura]]
*Swelling of the soft-tissue
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Bacterial diseases]]