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Diagnosis of pulmonary tuberculosis in HIV-uninfected patients

John Bernardo, MD
Section Editors
Sheldon L Kaplan, MD
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Initiation of a diagnostic evaluation for tuberculosis (TB) is usually based on suspicion for TB on epidemiologic, clinical, and radiographic grounds (table 1) [1,2]. Consideration of TB as part of the differential diagnosis of selected patients with respiratory infections is important to avoid delays in diagnosis and inappropriate antibiotic therapy; prompt diagnosis facilitates timely therapeutic intervention and minimizes community transmission.

Diagnostic evaluation for TB may be initiated in outpatient settings [3,4]. For situations in which clinical circumstances preclude outpatient management or in which there is public health risk for transmission, hospitalization with airborne infection isolation (AII) is appropriate [3-7]. Consultation and expert assistance is available at any point during the patient evaluation from state health departments and from United States Centers for Disease Control and Prevention (CDC)-supported Regional Training and Medical Consultation Centers [8].

The diagnosis of tuberculosis will be reviewed here. The microbiology, epidemiology, clinical manifestations, and treatment of TB are discussed separately. (See "Epidemiology of tuberculosis" and "Clinical manifestations and complications of pulmonary tuberculosis" and "Treatment of pulmonary tuberculosis in HIV-uninfected adults".)


In general, establishing a clinical diagnosis of tuberculosis (TB) includes assessing the following factors (table 1):

Clinical manifestations, physical findings (cough generally >2 to 3 weeks duration, lymphadenopathy, fevers, night sweats, weight loss). In general, specific symptoms localize to site(s) of disease.


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