A complete medical evaluation for tuberculosis (TB) must includes a medical history, a physical examination and a chest X-ray. It may include a tuberculin skin test, other scans and X-rays, surgical biopsy, microbiologic smears and cultures. It has been suggested that Antituberculant be merged into this article or section. ... 48-h PPD test induration being measured. ...

Medical history

The medical history includes obtaining the symptoms of pulmonary TB: productive, prolonged cough of three or more weeks, chest pain, and hemoptysis. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, and easy fatigability. Other parts of the medical history include prior TB exposure, infection or disease; past TB treatment; demographic risk factors for TB; and medical conditions that increase risk for TB disease such as HIV infection. Hemoptysis is the expectoration of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e. ...

Tuberculosis should be suspected when a persistent respiratory illness in an otherwise healthy individual does not respond to regular antibiotics.

Physical examination

A physical examination is done to assess the patient's general health and find other factors which may affect the TB treatment plan. It cannot be used to confirm or rule out TB. In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ...

Chest X-ray

Tuberculosis creates cavities visible in x-rays like this one in the patient's right upper lobe.

In active pulmonary TB, infiltrates or consolidations and/or cavities are often seen in the upper lungs with or without mediastinal or hilar lymphadenopathy or pleural effusions ( tuberculous pleurisy). However, lesions may appear anywhere in the lungs. In disseminated TB a pattern of many tiny nodules throughout the lung fields is common - the so called milliary TB. In HIV and other immunosuppressed persons, any abnormality may indicate TB or the chest X-ray may even appear entirely normal. Tuberculosis Chest X-ray with TB cavity right upper lobe Figure 1. ... Tuberculosis Chest X-ray with TB cavity right upper lobe Figure 1. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... The human lungs are the human organs of respiration. ... Immunosuppression is the medical suppression of the immune system. ...

Abnormalities on chest radiographs may be suggestive of, but are never diagnostic of, TB. However, chest radiographs may be used to rule out the possibility of pulmonary TB in a person who has a positive reaction to the tuberculin skin test and no symptoms of disease.

See Tuberculosis radiology for more information.

Main article: Tuberculosis Radiology is used in the diagnosis of tuberculosis. ...

Abreugraphy

Main article: Abreugraphy

A variant of the chest X-Ray, abreugraphy (from the name of its inventor, Dr. Manuel Dias de Abreu) was a small radiographic image, also called miniature mass radiography (MMR) or miniature chest radiograph. Though its resolution is limited (it doesn't allow the diagnosis of lung cancer, for example) it is sufficiently accurate for diagnosis of tuberculosis. Chest radiography showing advanced bilateral pulmonary tuberculosis. ... Chest radiography showing advanced bilateral pulmonary tuberculosis. ... Manuel Dias de Abreu Manuel Dias de Abreu (b. ... Lung cancer is a cancer of the lungs characterized by the presence of malignant tumours. ...

Much less expensive than traditional X-Ray, MMR was quickly adopted and extensively utilized in some countries, in the 1950s. For example, in Brazil and in Japan, tuberculosis prevention laws went into effect, obligating ca. 60% of the population to undergo MMR screening.

The procedure went out of favor, as the incidence of tuberculosis dramatically decreased, but is still used in certain situations, such as the screening of prisioners and immigration applicants.. Dorchester Penitentiary in New Brunswick, Canada is an institution that is part of the Correctional Service of Canada. ...

Laboratory

Mycobacterium tuberculosis produces the antigens early secretory antigen target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10). These antigens are not present in non-tuberculous mycobacteria, nor in BCG vaccine. An antigen is a substance that stimulates an immune response, especially the production of antibodies. ...

The blood tests QuantiFERON-TB Gold and T-SPOT.TB use these antigens to detect people with tuberculosis. Lymphocytes from the patient's blood are cultured with the antigens. If the patient has been exposed to tuberculosis before, T lymphocytes produce interferon γ in response. The test then uses ELISA to detect the interferon γ. A lymphocyte is a type of white blood cell involved in the human bodys immune system. ... T cells are a subset of lymphocytes that play a large role in the immune response. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Pearl Days Elisa Toffoli, or Elisa, is an Italian singer. ...

QuantiFERON-TB Gold quantifies the amount of interferon γ when whole blood is exposed to the antigens. T-SPOT.TB counts the number of activated T lymphocytes. These tests are called interferon γ tests and are not equivalent.^[1]

Guidelines for the use of the FDA approved QuantiFERON-TB Gold were released by the CDC in December 2005.

The enzyme linked immunospot (ELISPOT) blood test is another blood test available in the UK that may replace the skin test for diagnosis. PMID 14586040

Microbiological studies

Distinctive clusters of colorless Mycobacterium tuberculosis form in this culture.

Sputum smears and cultures should be done for acid-fast bacilli if the patient is producing sputum. If no sputum is being produced,examination of gastric juice, a laryngeal swab, bronchoscopy or fine needle aspiration should be considered. Other mycobacteria are also acid-fast. Even if sputum smear is negative, tuberculosis must be considered and is only excluded after negative cultures. Further PCR or gene probe tests can distinguish M. tuberculosis from other mycobacteria. If this is not available, a culture of the AFB can distinguish the various forms of mycobacteria, although results from this may take four to eight weeks for a conclusive answer. This is a close-up of a Mycobacterium tuberculosis culture revealing this organism’s colonial morphology. ... This is a close-up of a Mycobacterium tuberculosis culture revealing this organism’s colonial morphology. ... Binomial name Mycobacterium tuberculosis Zopf 1883 Mycobacterium tuberculosis is the bacterium that causes most cases of tuberculosis[1]. It was first described on March 24, 1882 by Robert Koch, who subsequently received the Nobel Prize in physiology or medicine for this discovery in 1905. ... A microbiological culture is a way to determine the cause of infectious disease by letting the agent multiply (reproduce) in predetermined media. ... In medicine, bronchoscopy is the visualization of the lower airways using a flexible or rigid endoscope. ... Wikipedia does not yet have an article with this exact name. ...

Full blood count

Although a full blood count is never diagnostic, normocytic anemia and lymphopenia are common. Neutrophilia is rarely found. A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... This article discusses the medical condition. ... Lymphopenia is the condition in which there exists an abnormally low number of lymphocytes in the blood. ... Neutrophilia (or neutrophil leukocytosis) is a condition where a person has a high number of neutrophil granulocytes in their blood. ...

Urea and electrolytes are usually normal, although hypocalcemia and hyponatremia are possible in tuberculous meningoencephalitis due to SIADHS. In advanced disease, hypoalbuminemia and hyperglobulinemia may be present. Urea is an organic compound of carbon, nitrogen, oxygen and hydrogen, with the formula CON2H4 or (NH2)2CO. Urea is also known as carbamide, especially in the recommended International Non-proprietary Names (rINN) in use in Europe. ... An electrolyte is a substance that dissociates into free ions when dissolved (or molten), to produce an electrically conductive medium. ... In medicine, hypocalcaemia is the presence of less than a total calcium of 2. ... The electrolyte disturbance hyponatremia or hyponatraemia exists in humans when the sodium level in the plasma falls below 135 mmol/l. ... The syndrome of inappropriate antidiuretic hormone (SIADH) is a condition commonly found in the hospital population, especially in patients being hospitalized for central nervous system (CNS) injury. ... This article is in need of attention. ...

Erythrocyte sedimentation rate is usually raised. The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ...

Tuberculin skin test

Two tests are available: the Mantoux and Heaf tests.

Mantoux skin test

Injecting a Mantoux skin test

The Mantoux test for TB involves intradermally injecting PPD tuberculin and measuring the size of induration 48-72 hours later.

The Mantoux skin test is used in the United States and is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). Image File history File links Mantoux_tuberculin_skin_test. ... Image File history File links Mantoux_tuberculin_skin_test. ... The Mantoux test for tuberculosis diagnosis. ... The Mantoux test for tuberculosis diagnosis. ... The Mantoux test is a skin test of tuberculosis infection used in the United States and is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). ... CDC is an abbreviation which can mean any of the following: Centers for Disease Control and Prevention Community of Democratic Choice, a group of nine Eastern-European states Change data capture, in data warehousing Clock Domain Crossing, or simply clock-crossing in computing. ...

See: Mantoux test for further information

If a person has had a history of a positive tuberculin skin test, another skin test is not needed.

The Mantoux test is a skin test of tuberculosis infection used in the United States and is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). ...

Heaf test

The Heaf test was used in the United Kingdom until 2005. The Mantoux test is now used. The Heaf test is a diagnostic skin test performed in order to determine whether or not a child has been exposed to tuberculosis. ... The Mantoux test is a skin test of tuberculosis infection used in the United States and is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). ...

The equivalent Mantoux test positive levels done with 10 TU (0.1 ml 100 TU/ml, 1:1000) are

• 0-4 mm induration (Heaf 0-1)
• 5-14 mm induration (Heaf 2)
• >15 mm induration (Heaf 3-4)

Classification of tuberculin reaction

An induration (palpable raised hardened area of skin) of more than 5-15 mm (depending upon the person's risk factors) to 10 Mantoux units is considered a positive result, indicating TB infection.

• 5 mm or more is positive in
  • HIV-positive person
  • Recent contacts of TB case
  • Persons with nodular or fibrotic changes on CXR consistent with old healed TB
  • Patients with organ transplants and other immunosuppressed patients

• 10 mm or more is positive in
  • Recent arrivals (less than 5 years) from high-prevalent countries
  • Injection drug users
  • Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
  • Mycobacteriology lab personnel
  • Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc)
  • Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories

• 15 mm or more is positive in
  • Persons with no known risk factors for TB
  • (Note: Targeted skin testing programs should only be conducted among high-risk groups)

A tuberculin test conversion is defined as an increase of 10 mm or more within a 2-year period, regardless of age. This article is about the disease that features high blood sugar. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Leukemia or leukaemia (see spelling differences) is a cancer of the blood or bone marrow characterized by an abnormal proliferation of blood cells, usually white blood cells (leukocytes). ... Renal failure is the condition where the kidneys fail to function properly. ... Malabsorption is the state of impaired absorption of nutrients in the small intestine. ...

BCG vaccine and tuberculin skin test

There is disagreement on the use of the Mantoux test on people who have been imunised. The US recommendation is that the tuberculin test is not conterindicated while the UK recommendation is that the interferon-γ test shoul be used to help interpret positive tuberculin tests and that serial tuberculin skin testing must not be done on people who have had BCG innoculations. In their guidelines on the use of Quantiferon Gold the US Centers for Disease Control and Prevention state that whereas Quantiferon Gold is not affected by BCG innoculation tuberculin tests can be affected. In general the US approach is likely to result in more false positives and more unnecessary treatment with potentially toxic drugs.

Under the US recommendation latent TB infection (LTBI) diagnosis and treatment for LTBI is considered for any BCG-vaccinated person whose skin test is 10 mm or greater, if any of these circumstances are present:

• Was contact of another person with infectious TB
• Was born or has resided in a high TB prevalence country
• Is continually exposed to populations where TB prevalence is high.

Contact screening

When someone is diagnosed with tuberculosis, all their close contacts should be screened for TB with a tuberculin skin test or a chest x-ray or both. In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz...

Tuberculosis classification system

The current clinical classification system for TB (Class 0 to 5) is based on the pathogenesis of the disease.

The U.S. Citizenship and Immigration Services has an additional TB classification (Class A, B1, or B2) for immigrants and refugees developed by the Centers for Disease Control and Prevention (CDC). The (Class) B notification program is an important screening strategy to identify new arrivals who have a high risk for TB. U.S. Citizenship and Immigration Services (USCIS) is a part of the U.S. Department of Homeland Security (DHS), and performs some of the functions formerly carried out by the United States Immigration and Naturalization Service, which was part of the Department of Justice. ... Immigration is the act of moving to or settling in another country or region, temporarily or permanently. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...

See Tuberculosis classification for more details.

Main article: Tuberculosis Tuberculosis classification system The current clinical classification system for tuberculosis (TB) is based on the pathogenesis of the disease. ...

References

• Medical Examination of Aliens (Refugees and Immigrants) - Division of Global Migration and Quarantine, CDC (website).
• Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection 2000 ATS/CDC (fulltext,PDF format) (Updates 2001-2003).
• Lalvani A. ELISPOT Spotting latent infection: the path to better tuberculosis control. Thorax. 2003 Nov;58(11):916-8. Editorial. PMID 14586040