Tuberculosis resident survival guide: Difference between revisions

Revision as of 00:59, 31 August 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Moises Romo M.D.

Synonyms and keywords:

Overview

Tuberculosis (abbreviated as TB for 'Tubercle bacillus' or Tuberculosis is a common infectious disease caused by Mycobacterium tuberculosis. Tuberculosis most commonly involves the lungs as the organism thrives in high oxygen environments, but it can also cause disease in the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin.^[1] Over one-third of the world's population has been exposed to M. tuberculosis, and new infections occur at a rate of one per second.^[2] Not all individuals exposed to the bacterium develop clinically overt tuberculosis infection; in fact, asymptomatic, latent TB infection discovered by screening is more common. Approximately, one in ten latent infections progresses to active (symptomatic) TB disease, which, if left untreated, carries mortality rates of up to 50%. Symptoms include shortness of breath, hemoptysis, fever, chills, night sweats, and weight loss. Several treatment regimens are available for the latent and active forms of TB. Classically, a prolonged course of 6-9 months of a single agent (rifampin or isoniazid) is administered to patients with latent TB, while a more aggressive course that consists of 4 major antituberculous agents (rifampin, isoniazid, ethambutol, pyrazinamide) is reserved for patients with active disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Tuberculosis according the the Association of chest physicians guidelines.

Presumptive TB

Sputum examination + Chest X-ray

Sputum positive for TB, Chest X-ray suggestive of TB

Sputum positive for TB, Chest X-ray not suggestive of TB

Sputum negative for TB, Chest X-ray suggestive of TB

Sputum negative for TB, Chest X-ray not suggestive of TB

High clinical suspicion for TB

Cartridge-Based Nucleic Acid Amplification Test

Mycobacterium tuberculosis detected

Mycobacterium tuberculosis not detected or Cartridge-Based Nucleic Acid Amplification Test result not available

Considere alternate diagnosis

Rifampicin sensitive

Rifampicin indeterminate

Rifampicin resistant

Clinically diagnosed TB

Alternate diagnosis

Microbiologically confirmed TB

Repeat Cartridge-Based Nucleic Acid Amplification Test on 2nd sample

Refer to management of Rifampicin resistance

Indeterminate of 2nd sample, collect fresh sample of liquid culture/ Line Probe Assay

Do's

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Don'ts

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References

↑ Raviglione MC, O'Brien RJ (2004). "Tuberculosis". In Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, eds. Harrison's Principles of Internal Medicine (16th ed. ed.). McGraw-Hill Professional. pp. 953–66. doi:10.1036/0071402357. ISBN 0071402357.
↑ World Health Organization (WHO). Tuberculosis Fact sheet N°104 - Global and regional incidence. March 2006, Retrieved on 6 October 2006.

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Treatment

Shown below is an algorithm summarizing the treatment of disease name according the the [...] guidelines.

Do's The content in this section is in bullet points. Don'ts The content in this section is in bullet points. References