Clinical findings relate both to complications of disease and its treatment
Symptoms:
Fever, night sweats, weight loss
Cough (productive)
Haemoptysis
SOB
Pleuritic chest pain
Signs:
On inspection:
Cachexia
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
Investigations:
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
Imaging:
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
Plombage
Thoracoplasty
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