see also: [[Meningitis#Mycobacterial tuberculosis|TB meningitis]] > [!Key Points] > - Approximately one-third of the world’s human population is infected by Mycobacterium tuberculosis, making it a major worldwide public health concern. > - kills ~1.4 million worldwide each year # symptoms Tuberculosis can be asymptomatic but may also produce non-specific symptoms including fever, night sweats, anorexia and cachexia. The most common presentation is pulmonary tuberculosis, which causes a productive cough, haemoptysis, chest pain and dyspnoea. An exudative pleural effusion may occur. Chronic complications include bronchiectasis and pulmonary fibrosis. Non-pulmonary tuberculosis can occur in virtually any part of the body, including lymph nodes, bones, meninges, pericardium, abdomen and genitourinary tract. Miliary tuberculosis is an aggressive form of haematogenously disseminated tuberculosis that occurs in infants and immunocompromised patients. Latent tuberculosis occurs when mycobacteria persist intracellularly; patients are asymptomatic and not infectious. The disease can reactivate later—for example, when the patient becomes immunocompromised. # screening and prevention - For screening purposes, the Mantoux (tuberculin) skin test and interferon-gamma release assays (IGRAs) are commonly used. When positive, these tests indicate prior exposure to tuberculosis but do not prove active disease. False-negative and false-positive test results are a concern. The Bacillus Calmette-Guérin (BCG) vaccination offers some protection to people at high risk of contracting tuberculosis; it may cause a false-positive Mantoux test. # diagnosis > [!danger]- Key CXR findings in pulmonary TB > - Consolidation > - Hilar lymphadenopathy > - Ghon focus (calcified nodule that remains after resolution of initial consolidation) > - Cavitating lesions Fibrosis (dominant in upper lobes) > - Calcifications > - Miliary pattern (small nodules throughout lungs) > - Tuberculoma (well-defined tuberculosis mass) Pulmonary tuberculosis may be suggested by chest x-ray appearance. Mycobacteria can be demonstrated on acid-fast (Ziehl-Neelsen) staining of sputum or broncho-alveolar lavage fluid. Culture confirms the diagnosis by identifying the species of mycobacteria; it also enables drug susceptibility testing. For non-pulmonary tuberculosis, samples appropriate to the site should be obtained and tested # management - patients suspected to have infective tuberculosis should be held in a negative pressure room - staff and visitors should wear appropriate N95 face masks (aerosol precautions). - medications: - rifampin - [[Isoniazid]] - give [[Pyridoxine]] with INH - pyrazinamide - ethambutol - Public health reporting with appropriate contact tracing is essential. - A 6-month treatment regimen with four drugs initially (‘RIPE’, i.e. rifampicin, isoniazid, pyrazinamide, ethambutol) is often used to treat uncomplicated tuberculosis. - Emerging multi-drug resistance is of increasing concern worldwide.