I(x) Active TBRoutine;

FBE•↑ WCC (Infection)•↓ Hb (Anaemic of chronic disease)U&E’s •(baseline)LFT’s •(baseline)ESR/CRP •(inflammation/infection)

I(x) Active PTBDiagnostic

Chest X-Ray• Abnormal CXR often found with no symptoms but reverse extremely rare• PTB is unlikely in absence of radiographic abnormalities • Exception is miliary TB or non-respiratory TBFindings• Patchy or nodular shadows in the upper zones• Loss of volume and fibrosis (with or without cavitation)• Calcification may be presentSimilar CXR findings• Histoplasmosis, fungal infections (cryptococcosis, coccidiomycosis,

blastomycosis, aspergillosis), bronchial carcinoma, cavitating pulmonary Infarcts

EVERY EFFORT MUST BE MADE TO OBTAIN MICROBIOLOGICAL EVIDENCE

A cavity is a walled hollow structure within the lungs. Diagnosis is aided by noting:wall thickness

wall outline changes in the surrounding lung

I(x) Active TB

Culture Clinical Samples

• sputum, pleura & pleural fluid, urine, pus, ascites, bone marrow, CSF

• Induce if non-productive (bronchoscopy & lavage)

• Prolonged culture – 12wks

AFB – acid fast bacilli

• Ziehl-Neelsen stain

• Acid fast bacilli are stained bright red and stand out against a blue background

• Resistant to de-colouring when

washed with acid

I(x) Active TB

Other• Imaging for non-respiratory TB (CT, XR etc)• PCR – rapid identification of sensitivity/resistance

(rifampicin)• Biopsies – pleura, lymph nodes, solid lesions etc