Old TB

Clinical findings relate both to complications of disease and its treatment



Fever, night sweats, weight loss

Cough (productive)



Pleuritic chest pain




On inspection:
Chest deformity, rib resection
Scars: thoracotomy scar, phrenic nerve crush scar in supraclavicular fossa

Orange urine in catheter bag (rifampicin use)

Kyphosis (spinal TB)


On examination:

Scars eg. from chest drains
Tracheal deviation towards side of old TB in upper lobe, displaced apex beat
Reduced expansion
Dullness to percussion

Decreased breath sounds
Crepitations: fine end inspiratory over area of fibrosis or coarse inspiratory creps over area of bronchiectasis
Bronchial breathing




If TB is suspected:
Bloods: FBC (anaemia), CRP, LFTs (pre-treatment), HIV test, Hep B and C screen

Sputum for m,c,s, Ziehl Neelsen/auramine stain and TB culture: 3 sputum samples. If cough is non-productive, sputum can be induced with hypertonic saline or samples obtained at bronchoscopy
Early morning urine AFB- sterile pyuria
Mantoux test can be falsely negative if immunosuppressed eg. HIV and sarcoidosis
T-SPOT/quantiferon test- more sensitive especially in immunosuppressed


CXR: can be normal, hilar or paratracheal adenopathy, pulmonary infiltrates, pulmonary nodules and consolidation, cavitation and pleural effusion, pneumothorax, collapse
CT scan: changes of old TB including fibrosis (predominantly upper lobe), traction bronchiectasis and pleural scarring
Bronchoscopy: to obtain bronchoalveolar lavage samples and assess for end bronchial abnormalities
Biopsy of extrapulmonary site e.g. lymph node for culture

Treatment of TB:


Standard therapies available for treatment of TB include:


Rifampicin, isoniazid, pyrazinamide and ethambutol


Patients are treated with all four drugs for initial two months of therapy followed by rifampicin and isoniazid for subsequent 4 months. Treatment is complete in six months.
Multidrug resistant TB can occur and is resistant to at least rifampicin and isoniazid
Side effects of medication:
Drug induced hepatitis : rifampicin, isoniazid, pyrazinamide (check LFTS prior to starting)
Optic neuritis: ethambutol (pre-treatment visual acuity and ishihara plates)
Peripheral neuropathy: isoniazid (co-prescribe pyridoxine)


Notifiable disease


Past surgical treatments for TB:

Induced pneumothoraces
Phrenic nerve crush


Written by Dr Amna Shah

Edited by Dr Sarah Kennedy


Resources used to write this document are listed in the references section of this webpage