Pulmonary tuberculosis - Revision history

Aidan at 17:19, 27 September 2024

2024-09-27T17:19:32Z

← Older revision		Revision as of 17:19, 27 September 2024
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	=== Adjunctive Therapies ===		=== Adjunctive Therapies ===

			* The addition of [[metformin]] to the induction regimen has been shown to speed resolution of radiographic findings, such as cavitations[[CiteRef::padmapriydarsini2021ra]]
	* The addition of [[metformin]] to the induction regimen has been shown to speed resolution of radiographic findings, such as cavitations<ref>Chandrasekaran Padmapriydarsini, Megha Mamulwar, Anant Mohan, Prema Shanmugam, N S Gomathy, Aarti Mane, Urvashi B Singh, Nathella Pavankumar, Abhijeet Kadam, Hemanth Kumar, Chandra Suresh, Devaraju Reddy, Poornaganga Devi, P M Ramesh, Lakshmanan Sekar, Shaheed Jawahar, R K Shandil, Manjula Singh, Jaykumar Menon, Randeep Guleria, the METRIF Team, Randomized Trial of Metformin With Anti-Tuberculosis Drugs for Early Sputum Conversion in Adults With Pulmonary Tuberculosis, ''Clinical Infectious Diseases'', Volume 75, Issue 3, 1 August 2022, Pages 425–434, https://doi.org/10.1093/cid/ciab964</ref>
	** [[Metformin]] 500 mg p.o. daily for 1 week then 1000 mg p.o. daily for 7 weeks		** [[Metformin]] 500 mg p.o. daily for 1 week then 1000 mg p.o. daily for 7 weeks
	** No difference in conversion of sputum culture		** No difference in conversion of sputum culture

Aidan: /* Investigations */

2023-03-06T15:48:52Z

Investigations

← Older revision		Revision as of 15:48, 6 March 2023
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	* May transiently improve with partially-active antibiotics such as [[fluoroquinolones]]		* May transiently improve with partially-active antibiotics such as [[fluoroquinolones]]

	== ~~Investigations~~ ==		== Diagnosis ==
			* '''At least three consecutive sputum specimens''', collected q8-24h, with at least one being an early morning specimen
	* Spontaneous sputum, induced sputum, or bronchoalveolar lavage specimens ~~should be sent for~~		* Spontaneous sputum, induced sputum, or bronchoalveolar lavage specimens
	** Acid-fast staining of a smear
			* Can be sent for either acid-fast staining of a smear and culture, or for PCR (e.g. GeneXpert)
	** Culture
	** PCR
	* Chest x-ray may show signs of prior tuberculosis, including dense pulmonary nodules (with or without calcification) which can be hilar or upper lobe; small nodules with or without scarring/fibrosis in the upper lobes; upper lobe volume loss or bronchiectasis; pleural scarring		* Chest x-ray may show signs of prior tuberculosis, including dense pulmonary nodules (with or without calcification) which can be hilar or upper lobe; small nodules with or without scarring/fibrosis in the upper lobes; upper lobe volume loss or bronchiectasis; pleural scarring

Aidan: /* Investigations */

2023-01-27T15:30:58Z

Investigations

← Older revision		Revision as of 15:30, 27 January 2023
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	** Culture		** Culture
	** PCR		** PCR
			* Chest x-ray may show signs of prior tuberculosis, including dense pulmonary nodules (with or without calcification) which can be hilar or upper lobe; small nodules with or without scarring/fibrosis in the upper lobes; upper lobe volume loss or bronchiectasis; pleural scarring

	== Management ==		== Management ==

Aidan at 01:30, 4 September 2022

2022-09-04T01:30:57Z

← Older revision		Revision as of 01:30, 4 September 2022
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	** Recommend a fluoroquinolone, [[ethambutol]], and [[amikacin]] for 2 months followed by fluroquinolone and ethambutol for 18 months		** Recommend a fluoroquinolone, [[ethambutol]], and [[amikacin]] for 2 months followed by fluroquinolone and ethambutol for 18 months
	** Can consider adding [[rifampin]] if they are monitored closely		** Can consider adding [[rifampin]] if they are monitored closely

			=== Adjunctive Therapies ===

			* The addition of [[metformin]] to the induction regimen has been shown to speed resolution of radiographic findings, such as cavitations<ref>Chandrasekaran Padmapriydarsini, Megha Mamulwar, Anant Mohan, Prema Shanmugam, N S Gomathy, Aarti Mane, Urvashi B Singh, Nathella Pavankumar, Abhijeet Kadam, Hemanth Kumar, Chandra Suresh, Devaraju Reddy, Poornaganga Devi, P M Ramesh, Lakshmanan Sekar, Shaheed Jawahar, R K Shandil, Manjula Singh, Jaykumar Menon, Randeep Guleria, the METRIF Team, Randomized Trial of Metformin With Anti-Tuberculosis Drugs for Early Sputum Conversion in Adults With Pulmonary Tuberculosis, ''Clinical Infectious Diseases'', Volume 75, Issue 3, 1 August 2022, Pages 425–434, https://doi.org/10.1093/cid/ciab964</ref>
			** [[Metformin]] 500 mg p.o. daily for 1 week then 1000 mg p.o. daily for 7 weeks
			** No difference in conversion of sputum culture

	=== Infection Control ===		=== Infection Control ===

Aidan at 14:35, 7 April 2022

2022-04-07T14:35:58Z

← Older revision		Revision as of 14:35, 7 April 2022
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	** [[Is treated by::Pyrazinamide]] 25mg/kg/d, max 2g daily		** [[Is treated by::Pyrazinamide]] 25mg/kg/d, max 2g daily
	** [[Is treated by::Ethambutol]] 20mg/kg/d, max 1.2g daily, which can be dropped once susceptibility testing shows that it is pan-susceptible		** [[Is treated by::Ethambutol]] 20mg/kg/d, max 1.2g daily, which can be dropped once susceptibility testing shows that it is pan-susceptible
	* Standard duration for uncomplicated disease is 6 months total, though it is extended if high risk of relapse (see below)		* Standard duration for uncomplicated disease is 6 months total, though it is extended if high risk of relapse (see Special Populations, below)
	* Treatment for multidrug-resistant tuberculosis is discussed [[Drug-resistant tuberculosis#Management\|separately]]		* Treatment for multidrug-resistant tuberculosis is discussed [[Drug-resistant tuberculosis#Management\|separately]]

	=== Special ~~populations~~ ===		=== Special Populations ===
	* For the '''elderly''', or those at elevated '''risk of hepatotoxicity''': can do induction phase ''without'' [[pyrazinamide]] and extend continuation phase to 7 months (from 4)		* For the '''elderly''', or those at elevated '''risk of hepatotoxicity''': can do induction phase ''without'' [[pyrazinamide]] and extend continuation phase to 7 months (from 4)
	* For '''pregnant women''': can consider dropping [[pyrazinamide]] and extending the course by 3 months, but if there is severe disease then likely should follow standard treatment		* For '''pregnant women''': can consider dropping [[pyrazinamide]] and extending the course by 3 months, but if there is severe disease then likely should follow standard treatment
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	** Can consider adding [[rifampin]] if they are monitored closely		** Can consider adding [[rifampin]] if they are monitored closely

	=== Infection ~~control~~ ===		=== Infection Control ===
	* Airborne precautions until:		* Airborne precautions until:
	** Treated for at least 2 weeks and symptoms are clearly improving		** Treated for at least 2 weeks and symptoms are clearly improving

Aidan at 19:55, 20 August 2020

2020-08-20T19:55:42Z

← Older revision		Revision as of 19:55, 20 August 2020
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	[[Category:Respiratory infections]]		[[Category:Respiratory infections]]
	[[Category:Tuberculosis]]		[[Category:Tuberculosis]]
	[[Category:Mycobacteria]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-19T13:43:56Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 13:43, 19 July 2020
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	* See [[Mycobacterium tuberculosis]]		* See [[Mycobacterium tuberculosis]]

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Presents as reactivation of latent infection months or years after [[Mycobacterium tuberculosis#Primary tuberculosis\|primary tuberculosis]]		* Presents as reactivation of latent infection months or years after [[Mycobacterium tuberculosis#Primary tuberculosis\|primary tuberculosis]]
	* Subacute or [[chronic cough]] (at least 2 to 3 weeks) eventually becoming productive and occasionally involving [[hemoptysis]]		* Subacute or [[chronic cough]] (at least 2 to 3 weeks) eventually becoming productive and occasionally involving [[hemoptysis]]

Aidan: Text replacement - "Category:TB" to "Category:Tuberculosis"

2020-06-01T16:56:11Z

Text replacement - "Category:TB" to "Category:Tuberculosis"

← Older revision		Revision as of 16:56, 1 June 2020
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	[[Category:Respiratory infections]]		[[Category:Respiratory infections]]
	[[Category:TB]]		[[Category:Tuberculosis]]
	[[Category:Mycobacteria]]		[[Category:Mycobacteria]]

Aidan: /* Management */ tidied section

2019-11-15T01:08:03Z

Management: tidied section

← Older revision		Revision as of 01:08, 15 November 2019
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	== Management ==		== Management ==
	* ~~Standard~~ ~~HREZ~~ x2mo then HR x4mo		* Empiric treatment for suspected drug-susceptible tuberculosis is RIPE x2mo then RI x4mo
	** [[Is treated by::Isoniazid]] 5mg/kg/d, max 300mg daily, with pyridoxine 25 mg po daily		** [[Is treated by::Isoniazid]] 5mg/kg/d, max 300mg daily, with pyridoxine 25 mg po daily
	** [[Is treated by::Rifampin]] 10mg/kg/d		** [[Is treated by::Rifampin]] 10mg/kg/d
	** [[Is treated by::Pyrazinamide]] 25mg/kg/d, max 2g daily		** [[Is treated by::Pyrazinamide]] 25mg/kg/d, max 2g daily
	** [[Is treated by::Ethambutol]] 20mg/kg/d, max 1.2g daily, which can be dropped once susceptibility testing shows that it is pan-susceptible		** [[Is treated by::Ethambutol]] 20mg/kg/d, max 1.2g daily, which can be dropped once susceptibility testing shows that it is pan-susceptible
	* Standard duration for uncomplicated disease is 6 months total		* Standard duration for uncomplicated disease is 6 months total, though it is extended if high risk of relapse (see below)
			* Treatment for multidrug-resistant tuberculosis is discussed [[Drug-resistant tuberculosis#Management\|separately]]

	=== Special populations ===		=== Special populations ===

Aidan: /* Infection control */

2019-11-14T15:03:14Z

Infection control

← Older revision		Revision as of 15:03, 14 November 2019
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	=== Infection control ===		=== Infection control ===
	* Airborne precautions until:		* Airborne precautions until:
	** Treated for at least 2 weeks and clearly improving		** Treated for at least 2 weeks and symptoms are clearly improving
	** 3x negative sputum smears~~, which can be collected hourly, but ideally at 8- to 24-hour intervals, including one early morning collection~~		** 3x negative sputum smears
			** They can be discharged home when clinical improvement, drug-resistant TB is not suspected and there is no contraindication for home isolation
	** Improvement in symptoms

	[[Category:Respiratory infections]]		[[Category:Respiratory infections]]