Chronic granulomatous infection by Mycobacterium tuberculosis, primarily affecting lungs.
History taking
- • Cough >2 weeks, evening rise of temperature, night sweats, weight loss
- • Haemoptysis, anorexia, chest pain
- • TB contact, HIV status, prior TB treatment (RIPE)
- • Diabetes, steroids, alcohol, smoking
Examination
- • Cachexia, clubbing, lymphadenopathy
- • Chest: bronchial breathing, crackles in upper zones; signs of effusion/fibrosis
Red flags
- • Massive haemoptysis, respiratory failure
- • Meningitis, miliary TB, spinal TB (Pott's) with cord compression
- • MDR/XDR TB
Differential diagnosis
- • Bacterial pneumonia, lung abscess, fungal infections
- • Lung malignancy, sarcoidosis, bronchiectasis
Recommended investigations
- • Sputum CBNAAT (GeneXpert) — first test (also detects rifampicin resistance)
- • Sputum AFB smear x2, MGIT culture & DST
- • Chest X-ray (upper-lobe cavities, fibrosis)
- • HIV test, blood sugar, LFT, RFT before therapy
Diagnosis
- • Microbiological confirmation preferred (CBNAAT or culture)
- • Clinically diagnosed TB allowed if strong evidence + initiate therapy
Initial treatment / management
- • Standard regimen: 2 months HRZE + 4 months HR (DS-TB)
- • Weight-banded fixed-dose combinations per NTEP
- • Pyridoxine 10 mg OD with INH
- • Notify under NIKSHAY; nutritional support
Prescription examples
- • Tab HRZE (FDC, weight-band) PO OD empty stomach x 2 months (intensive phase)
- • Tab HR (FDC) PO OD x 4 months (continuation)
- • Tab Pyridoxine 10 mg PO OD throughout therapy
Follow-up advice
- • Symptom & weight review monthly; sputum AFB at end of 2 months and 5 months
- • Baseline + monthly LFT (especially if alcohol/HBV)
- • Vision/colour vision check during ethambutol use
Patient counselling
- • Adherence is curative; cough hygiene; isolation until sputum-negative
- • Family screening (contacts <6 y get IPT)
- • Avoid alcohol; nutrition support; HIV testing
Referral criteria
- • Drug resistance (Rif-R on CBNAAT), MDR/XDR
- • Extrapulmonary TB (CNS, spine, miliary)
- • Severe hepatotoxicity, paradoxical reaction
Clinical pearls
- • Three negative smears do not exclude TB — always do CBNAAT in suspects
- • Always test for HIV in TB patients
- • Hepatitis on RIPE: stop all, restart sequentially after LFT normalises
References
- • WHO Consolidated Guidelines on TB 2023
- • NTEP Technical and Operational Guidelines 2023 (India)
Educational outpatient guide — verify against local guidelines before clinical use.
