1. 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

2. 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)