Mycobacterium tuberculosis - Revision history

Aidan: /* Extra-Pulmonary Tuberculosis */

2026-02-04T20:29:19Z

Extra-Pulmonary Tuberculosis

← Older revision		Revision as of 20:29, 4 February 2026
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	===Extra-Pulmonary Tuberculosis===		===Extra-Pulmonary Tuberculosis===

	*Pleural tuberculosis is most common extrapulmonary site		*[[Pleural tuberculosis]] is most common extrapulmonary site
	*[[Scrofula]] (cervical lymph node infection) next-most common		*[[Scrofula]] (cervical lymph node infection) next-most common
	*[[Tuberculous meningitis]]		*[[Tuberculous meningitis]]

Aidan: /* Background */

2025-11-10T16:46:29Z

Background

← Older revision		Revision as of 16:46, 10 November 2025
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	== Background ==		== Background ==
	*''Mycobacterium tuberculosis'' causes '''tuberculosis'''		*''Mycobacterium tuberculosis'' causes '''tuberculosis'''
	*Most commonly '''pulmonary TB''' but extrapulmonary tuberculosis is possible (including adenitis, gastrointestinal TB, pericarditis, meningitis)		*Most commonly '''pulmonary TB''' but extrapulmonary tuberculosis is possible (including [[Tuberculous adenitis\|adenitis]], gastrointestinal TB, pericarditis, [[Tuberculous meningitis\|meningitis]])
	*Standard treatment for susceptible TB is '''RIPE x2mo then RI x4mo'''		*Standard treatment for susceptible TB is '''RIPE x2mo then RI x4mo'''

Aidan: /* Clinical Manifestations */

2025-07-29T15:53:23Z

Clinical Manifestations

← Older revision		Revision as of 15:53, 29 July 2025
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	*Primary vs. reactivation vs. reinfection		*Primary vs. reactivation vs. reinfection
	*Latent vs. active		*[[Latent tuberculosis infection\|Latent]] vs. active

	===Primary Tuberculosis===		===Primary Tuberculosis===
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	** [[Tuberculous meningitis#Management\|Management of tuberculous meningitis]]		** [[Tuberculous meningitis#Management\|Management of tuberculous meningitis]]
	** [[Drug-resistant tuberculosis#Management\|Management of drug-resistant tuberculosis]]		** [[Drug-resistant tuberculosis#Management\|Management of drug-resistant tuberculosis]]
			* Fevers usually resolve within 8 to 10 days (range 5 to 21 days), though in rare cases can last longer
			** Persistent fever should be assessed for superimposed infection, drug fever, other complication of TB, hypersensitivity reaction to TB, and drug resistance[[CiteRef::tewoldemedhin2024pe]]

	===Antibiotics===		===Antibiotics===

Aidan: /* Drug-Induced Liver Injury (DILI) */

2023-06-13T15:12:02Z

Drug-Induced Liver Injury (DILI)

← Older revision		Revision as of 15:12, 13 June 2023
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	*Most patients can have the same TB drugs reintroduced without recurrence of DILI, though recurrence can be delayed		*Most patients can have the same TB drugs reintroduced without recurrence of DILI, though recurrence can be delayed
	*Procedure		*Procedure
	**Hold if ALT >120 and symptoms, if ALT >200 even without symptoms, or bili >2x ULN		**Hold all medications if ALT >120 (3x ULN) and symptoms, if ALT >200 (5x ULN) even without symptoms, or bili >2x ULN
			**If severe disease and patient needs to continue treatment, immediately start two second-line agents (e.g. a fluoroquinolone and an injectable)
	**Switch to second-line meds
			**Once AST & ALT are less than twice the upper limit of normal, reintroduce the original drugs every 3 to 5 days, trending enzymes
	**Reintroduce the original drugs once AST & ALT are <2x ULN
	**Only rechallenge with pyrazinamide if it was a mild case		**Only rechallenge with pyrazinamide if it was a mild case

Aidan at 15:12, 17 May 2023

2023-05-17T15:12:28Z

← Older revision		Revision as of 15:12, 17 May 2023
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	\|-		\|-
	! colspan="3" \|First-Line Medications		! colspan="3" \|First-Line Medications
⚫	\|-
⚫	\|[[Is treated by::Isoniazid]]
⚫	\|5 mg/kg daily, max 300 mg daily, with pyridoxine 25 mg po daily
⚫	\|Rash, hepatitis, neuropathy, CNS toxicity, anemia
	\|-		\|-
	\|[[Is treated by::Rifampin]]		\|[[Is treated by::Rifampin]]
	\|10 mg/kg daily, no max		\|10 mg/kg daily, no max
	\|Drug interactions, rash, hepatitis, flu-like illness, neutropenia, thrombocytopenia		\|Drug interactions, rash, hepatitis, flu-like illness, neutropenia, thrombocytopenia
		⚫	\|-
		⚫	\|[[Is treated by::Isoniazid]]
		⚫	\|5 mg/kg daily, max 300 mg daily, with pyridoxine 25 mg po daily
		⚫	\|Rash, hepatitis, neuropathy, CNS toxicity, anemia
	\|-		\|-
	\|[[Is treated by::Pyrazinamide]]		\|[[Is treated by::Pyrazinamide]]
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	{\| class="wikitable"		{\| class="wikitable"
	! rowspan="2" \|Drug		! rowspan="2" \|Drug
			! rowspan="2" \|Dose
			! rowspan="2" \|Tabs
	! colspan="5" \|Weight (kg)		! colspan="5" \|Weight (kg)
	\|-		\|-
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	!>70		!>70
	\|-		\|-
			! colspan="8" \|First-Line Medications
⚫	\|[[isoniazid]]
⚫	\|150 mg
⚫	\|200 mg
⚫	\| colspan="3" \|300 mg
	\|-		\|-
	\|[[rifampin]]		\|[[rifampin]]
			\|10 mg/kg
			\|150 & 300 mg
	\|300 mg		\|300 mg
	\| colspan="2" \|450 mg		\| colspan="2" \|450 mg
	\| colspan="2" \|600 mg		\| colspan="2" \|600 mg
			\|-
		⚫	\|[[isoniazid]]
			\|5 mg/kg
			\|100 & 300 mg
		⚫	\|150 mg
		⚫	\|200 mg
		⚫	\| colspan="3" \|300 mg
	\|-		\|-
	\|[[pyrazinamide]]		\|[[pyrazinamide]]
	\|~~800~~ mg		\|25 mg/kg
			\|500 mg
			\|750 mg
	\|1000 mg		\|1000 mg
	\|~~1200~~ mg		\|1250 mg
	\|~~1600~~ mg		\|1500 mg
	\|2000 mg		\|1750-2000 mg
	\|-		\|-
	\|[[ethambutol]]		\|[[ethambutol]]
			\|15 mg/kg
			\|100 & 400 mg
	\|600 mg		\|600 mg
	\|800 mg		\|800 mg
	\|1000 mg		\|1000 mg
	\| colspan="2" \|1200 mg		\| colspan="2" \|1200 mg
			\|-
			! colspan="8" \|Alternative Medications
	\|-		\|-
	\|[[rifabutin]]		\|[[rifabutin]]
			\|
			\|
	\| colspan="5" \|300 mg		\| colspan="5" \|300 mg
	\|-		\|-
	\|[[levofloxacin]]		\|[[levofloxacin]]
			\|
			\|
	\| colspan="2" \|750 mg		\| colspan="2" \|750 mg
	\| colspan="3" \|1000 mg		\| colspan="3" \|1000 mg
	\|-		\|-
	\|[[moxifloxacin]]		\|[[moxifloxacin]]
			\|
			\|
	\| colspan="5" \|400 mg		\| colspan="5" \|400 mg
	\|-		\|-
	\|[[ethionamide]]		\|[[ethionamide]]
			\|
			\|
	\| colspan="2" \|500 mg		\| colspan="2" \|500 mg
	\| colspan="2" \|750 mg		\| colspan="2" \|750 mg
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	\|-		\|-
	\|[[prothionamide]]		\|[[prothionamide]]
			\|
			\|
	\| colspan="2" \|500 mg		\| colspan="2" \|500 mg
	\| colspan="2" \|750 mg		\| colspan="2" \|750 mg
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	\|-		\|-
	\|[[cycloserine]]		\|[[cycloserine]]
			\|
			\|
	\| colspan="3" \|500 mg		\| colspan="3" \|500 mg
	\| colspan="2" \|750 mg		\| colspan="2" \|750 mg
	\|-		\|-
	\|[[p-aminosalicylic acid]]		\|[[p-aminosalicylic acid]]
			\|
			\|
	\| colspan="4" \|4 g bid		\| colspan="4" \|4 g bid
	\|4 g bid to tid		\|4 g bid to tid
	\|-		\|-
	\|[[bedaquiline]]		\|[[bedaquiline]]
			\|
			\|
	\| colspan="5" \|400 mg daily for 2 weeks then 200 mg 3 times per week		\| colspan="5" \|400 mg daily for 2 weeks then 200 mg 3 times per week
	\|-		\|-
	\|[[clofazimine]]		\|[[clofazimine]]
			\|
			\|
	\| colspan="5" \|200-300 mg for 2 months then 100 mg		\| colspan="5" \|200-300 mg for 2 months then 100 mg
	\|-		\|-
	\|[[linezolid]]		\|[[linezolid]]
			\|
			\|
	\| colspan="5" \|600 mg daily		\| colspan="5" \|600 mg daily
	\|}		\|}

Aidan at 12:46, 17 May 2023

2023-05-17T12:46:04Z

← Older revision		Revision as of 12:46, 17 May 2023
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	\|-		\|-
	\|[[Is treated by::Rifampin]]		\|[[Is treated by::Rifampin]]
	\|10 mg/kg daily		\|10 mg/kg daily, no max
	\|Drug interactions, rash, hepatitis, flu-like illness, neutropenia, thrombocytopenia		\|Drug interactions, rash, hepatitis, flu-like illness, neutropenia, thrombocytopenia
	\|-		\|-
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	\|-		\|-
	\|[[Is treated by::Ethambutol]]		\|[[Is treated by::Ethambutol]]
	\|20 mg/kg daily, max 1.2 g daily		\|15 mg/kg daily, max 1.6 g daily
	\|Optic/retrobulbar neuritis, rash		\|Optic/retrobulbar neuritis, rash
	\|-		\|-
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	\|-		\|-
	\|Corticosteroids for patients with [[tuberculous meningitis]] or [[tuberculous pericarditis]]		\|Corticosteroids for patients with [[tuberculous meningitis]] or [[tuberculous pericarditis]]
	\|Prednisone 40 to 80 mg po daily for 6 to 12 weeks		\|[[Prednisone]] 40 to 80 mg po daily for 6 to 12 weeks
	\|		\|
	\|}		\|}

Aidan at 01:50, 2 April 2023

2023-04-02T01:50:41Z

← Older revision		Revision as of 01:50, 2 April 2023
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	**Can be discharged home provided there is clinical improvement, drug-resistant TB is not suspected, and there is no contraindication for home isolation		**Can be discharged home provided there is clinical improvement, drug-resistant TB is not suspected, and there is no contraindication for home isolation
	*For patient with smear-positive, culture-positive, drug-susceptible respiratory TB:		*For patient with smear-positive, culture-positive, drug-susceptible respiratory TB:
	**Continue airborne precautions as ~~above,~~ ~~but~~ ~~additionally~~ ~~require~~ ~~three~~ ~~negative~~ ~~sputum~~ ~~''smears'' to be negative before they are~~ ~~taken~~ ~~out~~ of ~~airborne~~ ~~isolation~~		**Continue airborne precautions until clinical evidence of improvement and a minimum of 2 weeks of effective therapy
			**Can be stopped at 4 weeks, or earlier if there are 3 negative smears
	**Can be discharge home as above		**Can be discharge home as above
	*For patients with rifampin- or multidrug-resistant TB:		*For patients with rifampin- or multidrug-resistant TB:

Aidan at 01:30, 2 April 2023

2023-04-02T01:30:37Z

← Older revision		Revision as of 01:30, 2 April 2023
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			== Background ==
	*''Mycobacterium tuberculosis'' causes '''tuberculosis'''		*''Mycobacterium tuberculosis'' causes '''tuberculosis'''
	*Most commonly '''pulmonary TB''' but extrapulmonary tuberculosis is possible (including adenitis, gastrointestinal TB, pericarditis, meningitis)		*Most commonly '''pulmonary TB''' but extrapulmonary tuberculosis is possible (including adenitis, gastrointestinal TB, pericarditis, meningitis)
	*Standard treatment for susceptible TB is '''RIPE x2mo then RI x4mo'''		*Standard treatment for susceptible TB is '''RIPE x2mo then RI x4mo'''

	==~~Background~~==		==Microbiology==
	===Microbiology===

	*Fastidious, aerobic [[Stain::acid-fast]] [[Shape::bacillus]]		*Fastidious, aerobic [[Stain::acid-fast]] [[Shape::bacillus]]
	*Cell wall has high lipid content		*Cell wall has high lipid content
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	* Requires at least 2 effective drugs at all times, including at least 3 effective drugs during intensive phase		* Requires at least 2 effective drugs at all times, including at least 3 effective drugs during intensive phase
	** Consider rapid rifampin resistance testing (PCR) in all patients		** Consider rapid rifampin resistance testing (PCR) in all patients
	* Most patients are started on RIPE,		* Most patients are started on RIPE
			**In cases of increased risk for [[MDR-TB]], still use RIPE while awaiting rapid rifampin testing
	**Typical duration is intensive therapy for 2 months (with at least 3 drugs), then narrowed to at least 2 drugs for the remainder of treatment		**Typical duration is intensive therapy for 2 months (with at least 3 drugs), then narrowed to at least 2 drugs for the remainder of treatment
	**Rifampin is the most effective agent, and any regimen that excludes rifampin must be extended to 12-18 months		**Rifampin is the most effective agent, and any regimen that excludes rifampin must be extended to 12-18 months

Aidan at 01:26, 2 April 2023

2023-04-02T01:26:26Z

← Older revision		Revision as of 01:26, 2 April 2023
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	* Requires at least 2 effective drugs at all times, including at least 3 effective drugs during intensive phase		* Requires at least 2 effective drugs at all times, including at least 3 effective drugs during intensive phase
			** Consider rapid rifampin resistance testing (PCR) in all patients
	* Most patients are started on RIPE,		* Most patients are started on RIPE,
	**Typical duration is intensive therapy for 2 months (with at least 3 drugs), then narrowed to at least 2 drugs for the remainder of treatment		**Typical duration is intensive therapy for 2 months (with at least 3 drugs), then narrowed to at least 2 drugs for the remainder of treatment

Aidan at 15:49, 6 March 2023

2023-03-06T15:49:09Z

← Older revision		Revision as of 15:49, 6 March 2023
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	**Urine lipoarabinomannan antigen		**Urine lipoarabinomannan antigen
	*Microbiology		*Microbiology
	**Samples can include routine or induced sputum (x3) or bronchoscopy, or tissue sample		**Samples can include routine or induced sputum (x3 q8h including 1 early AM) or bronchoscopy, or tissue sample
	**Spontaneous sputum should include at least one morning sputum, ideally, but can be done all in a row at least one hour apart if needed		**Spontaneous sputum should include at least one morning sputum, ideally, but can be done all in a row at least one hour apart if needed
	**Acid-fast bacillus culture of sputum x3 is about 70% sensitive, and PCR (ANTB) x1 is about 75% sensitive		**Acid-fast bacillus culture of sputum x3 is about 70% sensitive, and PCR (ANTB) x1 is about 75% sensitive