- Cough > 3 weeks duration (if not starting to improve, & no alternative Dx) warrants CXR
- CXR sooner for hemoptysis, fever, weight loss, night sweats
- PPD / IGRA OK but not useful (20% false-neg; Pos. non-specific)
- 3 Sputum specimens (different days) for AFB
- Order PCR on 1st specimen if high index of suspicion
- Begin 4-drug Tx (by DOT) if high index of suspicion
- Isolation if high index of suspicion (confine to home)
- If high index of suspicion: all Dx & Tx should be managed by Dept. Public Health TB Control
- Click link for examples of active TB on x-ray
- AFB smears ready in 24 hrs.
- Smear-Positive = presumptive TB → Tx!
- Smear-Negative may get empiric Tx pending cultures (judgment call)
- Cultures take 1-2 weeks by radiometric technology
- If negative, must wait full 60 days for no-growth on conventional media to say “Negative”
- If pos., Susceptibility Results take another 1-2 wks.
- Presents with weight loss, night sweats, &/or fevers
- Specific Sx depend on involved organ
- Dx by FNA / Biopsy (“urine for AFB” for renal TB; CSF for TB meningitis)
- “Caseating Granulomas” on histology = TB
- Smear for AFB gives poor yield; must await Cultures (long wait)
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