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Published byStephen McDowell Modified over 5 years ago
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Procedures (Decision on Diagnosis based on Laboratory Results)
PRESUMPTIVE TB: Cough of at least 2 weeks in an adult (age >15 y/o) A child (<15 y/o) w/ any 3 out of 6 criteria for TB Signs/Symptoms Chest X-ray suggestive of tuberculosis Cough of any duration in a high risk individual or a close contact of an active TB case (adult/adolescent) Decision of MD or TBDC? For ages <15 y/o, decide based on the following diagnostic criteria (3/5): Clinical signs and symptoms (3/6) - Coughing/wheezing of > 2 weeks, esp. if unexplained Unexplained fever of > 2 weeks after common causes such as malaria or pneumonia have been excluded Loss of weight/failure to gain weight/weight faltering/loss of appetite Failure to respond to 2 weeks of appropriate antibiotic therapy for LRTI Failure to regain previous state of health 2 weeks after a viral infection or exanthema (e.g., measles) Fatigue, reduced playfulness, or lethargy (child has lost his/her normal energy) Exposure to an active TB case (adult/adolescent) Positive Tuberculin Skin Test Chest X-ray suggestive of TB Other laboratory findings No or not done DSSM positive? Age <15 y/o? No Yes No or not done Yes Chest x-ray findings suggestive of TB? Yes With access to Xpert MTB/Rif? No Bacteriologically confirmed PTB, New History of previous treatment? Bacteriologically confirmed PTB No Yes Yes Not TB or investigate further/refer to specialist Bacteriologically confirmed PTB, Retreatment Not TB or investigate further/refer to specialist MTB positive, Rif-sensitive MTB negative Refer to PMDT services for evaluation MTB positive, Rif-resistant Xpert MTB/Rif result? Clinically diagnosed TB, Retreatment (PTB if CXR+ or with cough) Yes Category II Treatment (for Rif-sensitive) Clinically diagnosed TB (PTB if CXR+ or with cough) History of previous treatment? Clinically diagnosed TB, New (PTB if CXR+ or with cough) Category I Treatment No COLOR LEGEND Classification Disposition Treatment Diagnosis Xpert Result Question Diagnostic Test
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Procedures (Household Contacts of Drug-susceptible TB)
Asymptomatic household contacts Age <5 y/o? Age >5, <15 y/o? Bacteriologically confirmed PTB Classification of Index Case? Clinically diagnosed PTB Tuberculin Skin Test positive? No Give Isoniazid Preventive Therapy Yes Tuberculin Skin Test positive? Yes No No With access to CXR and findings are suggestive of TB? Other lab findings suggestive of TB? Child to be re- evaluated once with signs or symptoms suggestive of TB No Yes Yes Clinically diagnosed PTB Classification Disposition Treatment Question Diagnostic Test COLOR LEGEND Refer to previous Figure No. 5 (previous algorithm)
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