Register / Log in

Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image

amboss

Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Tuberculosis

Last updated: January 13, 2021

Summarytoggle arrow icon

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis, which typically affects the lungs. It is a common infectious cause of morbidity and mortality worldwide. Primary infection, transmitted via airborne aerosol droplet nuclei, is often initially asymptomatic. M. tuberculosis infection is typically dormant (latent TB infection; LTBI) because of intact innate and cellular immune responses. If the immune system is compromised, however, reactivation of the infection may occur. Patients with active disease characteristically present with fever, weight loss, night sweats, and a productive cough (with or without hemoptysis) that does not respond to conventional antibiotic therapy. The infection may spread hematologically to any organ, causing extrapulmonary TB. However, disseminated disease is rare, occurring in severely immunocompromised individuals. Patients with suspected LTBI should be tested using the tuberculin skin test (TST) or interferon-γ release assay (IGRA) and then treated accordingly. Treatment of LTBI reduces the risk of active infection in up to 90% of cases and, therefore, plays a crucial role in the prevention of active TB. If active TB infection is suspected, imaging should be obtained as well as microscopy, cultures, and/or polymerase chain reaction (PCR) to identify M. tuberculosis. The treatment of tuberculosis is prolonged due to the slow growth of M. tuberculosis, its concealment in macrophages, and the inability of drugs to easily penetrate its cell wall. Standard empirical treatment includes combination therapy with rifampin, isoniazid, ethambutol, and pyrazinamide for two months, followed by rifampin and isoniazid for an additional four months. The incidence of multidrug-resistant TB is steadily increasing.

Types of tuberculosis
Primary tuberculosis (primary infection) Reactivation tuberculosis (secondary infection) [1]
Latent tuberculosis infection (LTBI) [2] Active primary tuberculosis [3]
Definition
Features
  • Asymptomatic
  • Not contagious
  • The risk of reactivation is 5–10% during the course of a lifetime. [4]
  • Symptomatic
  • Contagious
  • Progressive primary tuberculosis is a severe form of disease seen in individuals with impaired immune systems (e.g., HIV, malnutrition) or immature immune systems (e.g., young children). [1]
  • Symptomatic
  • Contagious
Diagnostics
Treatment
  • Drug-resistant tuberculosis [5]
    • Definition: a form of TB that is resistant to one or more antitubercular agents
    • Types
    • Causes
      • Incorrect drug combination therapy
      • Inadequate duration or dosage of drug therapy
      • Poor treatment adherence
      • Poor quality of drugs
      • Close contact with an individual with drug-resistant TB

  • United States [6]
    • The incidence of TB infection in the US has been slowly declining.
    • The incidence rate for 2018 was 2.8 cases per 100,000 population.
    • Two-thirds of new TB cases reported in the US in 2019 were in individuals born outside the US.
  • Worldwide [7]
    • A leading cause of death from a single infectious agent
    • The overall incidence and prevalence have been declining.
    • The incidence rate for 2018 was 132 cases per 100,000 population.
    • One-fourth of the world's population has latent TB.
    • The sex ratio varies across countries and communities and largely depends on social and cultural factors. [8]
    • Countries with the highest incidence of TB: India, Indonesia, China, the Philippines, Bangladesh, Nigeria, Pakistan, and South Africa
    • The incidence of multidrug-resistant TB is steadily rising.

Epidemiological data refers to the US, unless otherwise specified.

Mycobacteria

Species

Mycobacterium species that cause tuberculosis are collectively known as the Mycobacterium tuberculosis complex, which includes:

  • Mycobacterium tuberculosis
    • Mode of transmission: spread via aerosol droplet nuclei
    • Reservoir: predominantly humans
    • Disease: all forms of tuberculosis
  • Mycobacterium bovis
    • Mode of transmission: predominantly via ingestion of contaminated cow's milk
    • Reservoir: predominantly cattle
    • Disease: gastrointestinal tuberculosis in humans
  • Mycobacterium africanum: common cause of tuberculosis in West, Central, and East Africa [1]

Features of Mycobacterium tuberculosis

Risk factors for tuberculosis

Risk factors for TB exposure [15]

  • Working in the health care industry
  • Migration from countries with a high TB incidence (≥ 100 cases per 100,000 population) [16]
  • Frequent travel to countries with a high TB burden
  • Close contact with a patient with active TB infection
  • Crowded living conditions (e.g., prisons)
  • Homelessness

Risk factors for reactivation of latent TB [17]

M. tuberculosis remains dormant within the host and may be reactivated once the immune system becomes compromised (e.g., by high doses of glucocorticoids or chemotherapeutic agents, HIV infection).

Tuberculosis case definitions and management [31][32]
Class Classification Description Notifiable Treatment
0 No TB exposure, not infected
  • No history of exposure
  • Negative TST
  • No
  • None
1 TB exposure, no evidence of infection
  • History of exposure
  • Negative TST
  • No
  • For patients with HIV and children < 15 years of age with significant exposure in the last 3 months, start treatment for latent TB and follow up with TST results after 10 weeks of exposure to decide further continuation of therapy.
  • For other individuals with significant exposure within 3 months, treatment is initiated based on TST results after 10 weeks of exposure.
2 Latent TB infection, no disease
  • Yes
  • Consider chemoprophylaxis in certain patients in this group (see “Latent TB infection” under “Treatment”).
3

Clinically active TB
  • Positive TST
  • Clinical, bacteriological, or radiographic evidence of active TB disease
  • Yes
  • Yes (see “Treatment” below)
4 TB, not clinically active
  • No clinical or radiological evidence of current disease in individuals with:
    • Previous history of TB
    • Abnormal but stable radiological changes (in patients with a positive TST and negative bacteriological studies)
  • Treatment status (one of the following):
    • Never received treatment
    • Currently receiving treatment for latent TB
    • Completed course of treatment
  • No
  • Complete treatment and monitor the course of disease.
  • If an individual has never received treatment and active TB has not been ruled out, reclassify as class 5.
5

TB is suspected (diagnosis pending)
  • Clinical suspicion of TB
  • Diagnostic tests have not been completed
  • Patients should not remain in this classification for longer than 3 months.
  • Yes
  • Initiated based on the results of diagnostic tests

Primary tuberculosis [1][33][34]

Innate immune response

Cellular immune response

Secondary tuberculosis [34]

Pulmonary tuberculosis

Clinical features

Patients with primary TB are typically asymptomatic. Symptomatic patients present with the following features: [40]

Clinical examination findings

Findings are nonspecific.

  • General
  • Chest examination
    • Percussion
      • Dullness over areas of consolidation
      • Hyperresonance over areas of cavitation
    • Auscultation

Depending on the degree of immunosuppression, TB in HIV-positive individuals may progress atypically or more rapidly.

Always consider TB as a differential diagnosis in a young individual with hemoptysis.

Complications [42]

Extrapulmonary tuberculosis

TB lymphadenitis [43]

Tuberculous hilar lymphadenopathy [1][45]

Tuberculous pleurisy [46]

Miliary TB [40]

Tuberculous meningitis

Pericardial TB [49][50]

Adrenal TB [51]

Rifampin can precipitate an acute adrenal crisis in patients with undetected adrenal insufficiency due to tuberculosis.

Cutaneous TB [40][52]

  • Classification: based on pathogenesis, morphology of the lesion, and histopathological features
Types of cutaneous TB
Type Pathophysiology Clinical features Histopathology features
Exogenous source of TB
Primary inoculation TB (tuberculous chancre)
Postprimary inoculation TB (tuberculosis verrucosa cutis)
Endogenous source of TB
Scrofuloderma
  • Firm nodule or swelling that ulcerates to form a discharging sinus tract
Autoinoculation
Hematogenous source of TB
Lupus vulgaris
  • Individuals previously sensitized to TB with a high degree of sensitivity
  • Nonspecific features
Tuberculosis miliaris cutis disseminata
  • Site: trunk, thighs, buttocks, genitalia
  • Widespread papules and crusted vesicles
Tuberculous gumma (metastatic tuberculous abscess)
  • Multiple skin nodules that may ulcerate to form discharging sinus tract
Tuberculid
Variable forms
  • Unknown
  • Papules or nodules with ulceration and scarring

Gastrointestinal TB [53][54]

  • Pathophysiology
    • Ingestion of infected milk or sputum
    • Hematogenous spread resulting from primary pulmonary TB
    • Contiguous spread via affected lymph nodes
  • Sites of involvement: See “Types of gastrointestinal TB” below.
Types of gastrointestinal TB
Site of involvement Clinical features Diagnostics Differential diagnosis
Peritoneum
Esophagus
Stomach

Jejunum and ileocecal region
Colorectal
  • Abdominal pain
  • Weight loss
  • Loss of appetite
  • Altered bowel habits

Genitourinary TB [40][55]

Renal and urologic TB

Male genital tract TB

Female genital tract TB [56]

Pott disease [40]

Active TB [40][57]

Individuals with a history and physical examination findings that suggest TB must undergo bacteriological and/or radiological testing to confirm active TB infection.

Diagnosis of active TB
Test Characteristics Advantages Disadvantages
Bacteriological confirmation
Acid-fast bacilli smear microscopy
  • Rapid detection
  • Inexpensive
PCR
  • High sensitivity
  • Rapid diagnosis [57]
  • Rapid detection of drug-resistant strains [57]
  • Species identification
  • Expensive
  • Cannot be used in resource-limited settings.
Culture
  • Gold standard diagnostic test
  • Used for drug susceptibility testing
  • High sensitivity
  • Species identification
  • Identification of drug resistance
  • Long time for positive cultures to develop [57]
  • Delays the initiation of treatment, especially drug-resistant TB
Radiological confirmation
Chest x-ray [58]
  • Inexpensive
  • Low specificity
  • Variability in interpretation
  • Indications for drug susceptibility testing [57]
    • Previous history of treated tuberculosis
    • Patient has had contact with individuals with MDR-TB
    • HIV infection
    • Patients born or living (for at least one year) in countries with high TB burden (≥ 20 cases per 100,000 population) or high prevalence of primary MDR-TB (≥ 2%) [57]
  • Testing in HIV infection: Urine lipoarabinomannan assay can be used in patients with a CD4 count < 100 cells/mm3. [59]

Latent TB [57][60]

  • Testing objective: to identify individuals who will benefit from treatment
  • Indications
    • High risk of TB exposure
      • Close contact with individuals who have TB
      • Individuals born in or who frequently travel to countries with a high TB burden (> 20 cases per 100,000 population) [57]
      • Individuals living or working in high-risk settings (e.g., homeless shelters, prisons)
      • Health care workers who come into contact with individuals who have TB
    • High risk of TB reactivation
      • HIV infection
      • Children < 5 years of age
      • Recent TB infection (within 2 years of treatment)
      • Intravenous drug users
      • Diabetes mellitus
      • CKD
      • Individuals taking immunosuppressant drugs
      • Silicosis
      • Individuals with cancer of the head and neck
      • Individuals with gastrectomy or jejunoileal bypass
  • Tests: See “Diagnosis of latent TB.”
Diagnosis of latent TB
Tuberculin skin test (purified protein derivative test, Mantoux test) Interferon-γ release assay (IGRA)
Mechanism
Procedure
  • Step 1: 0.1 mL (or 5 units) of PPD injected intradermally on the volar surface of forearm resulting in wheal formation
  • Step 2: transverse diameter of palpable induration checked 48–72 hours later
Interpretation
  • Positive TST indicates active TB or latent TB
  • ≥ 5 mm is considered positive in:
    • Close contacts of patients with TB
    • HIV infection
    • Individuals with clinical or radiographic evidence of active or prior TB
    • Individuals with organ transplants or receiving immunosuppressive therapy
  • ≥ 10 mm is considered positive in:
    • Individuals who have moved within the last 5 years from a high TB burden country (> 20 cases per 100,000 population) [57]
    • Individuals living or working in high-risk settings (e.g., homeless shelters, prisons)
    • Intravenous drug users
    • Mycobacteriology laboratory workers
    • Individuals with illnesses such as diabetes and CKD
    • Children < 5 years of age
    • Children who have had contact with adults in high-risk categories
  • ≥ 15 mm is considered positive in all other individuals.
Benefits
  • Inexpensive
  • Preferred test in children < 5 years of age
  • Only requires a single office visit
  • Preferred test in individuals with prior BCG vaccination
  • Results are available within 24 hours. [60]
Limitations
  • No differentiation between active and latent TB
  • Expensive
  • Requires phlebotomy
  • Errors in collecting and transporting blood can decrease accuracy.
  • Approach
    • Selection of test: based on cost, availability, and history of BCG vaccination
    • Positive IGRA or TST
    • Negative IGRA or TST
      • Consider a second test (TST or IGRA) to increase sensitivity.
      • Two-step TST: baseline test for individuals who are tested periodically (except when IGRA is the baseline test) [60]
        • If repeat TST after 1–3 weeks is negative, no further management is required.
        • If repeat TST after 1–3 weeks is positive, it is a boosted reaction and no treatment is needed.
      • Health care workers with a prior negative TST or IGRA must be retested immediately and again after 8–10 weeks of last known TB exposure. [61]

A healthy individual without any risk factors for TB infection who has an induration smaller than 15 mm is considered negative for TB.

Gross pathology [33]

Histopathology [33]

Caseating tuberculous granulomas are pathognomonic of reactivation (secondary) tuberculosis.

Although caseating tuberculous granulomas are a sign of a functioning immune system in TB infection, they do not necessarily indicate TB infection because other mycobacteria (including tuberculoid leprosy) and tertiary syphilis manifest similarly.

Histopathology of other types of tuberculosis

  • Acinar nodular tuberculosis: merging of multiple epithelioid granulomas into macroscopically visible areas of necrosis
  • Miliary tuberculosis: single, small, and nodular foci without central necrosis
  • Urogenital tuberculosis [62]
    • Step-like progression with an initial singular focus of tuberculosis
    • Gradually increasing destruction of the renal calyces
    • During the end stage, the kidney appears to have homogeneous, sac-like collections of calcified caseous material on plain abdominal x-ray (known as “putty kidney").

The differential diagnoses listed here are not exhaustive.

Active TB [63]

General measures

First-line drugs [40][65]

First-line drugs for tuberculosis
Duration of treatment Common side effects
Rifampin
  • 6 months
Isoniazid
  • 6 months
Pyrazinamide
  • 2 months
Ethambutol
  • 2 months

"RIPE": Rifampin, Isoniazid, Pyrazinamide, and EthambutolRifampin and isoniazid alter the efficacy of drugs metabolized by cytochrome P450 (especially protease inhibitors, NNRTIs, OCPs, warfarin, sulfonylureas).

Second-line drugs

These drugs are typically indicated in drug-resistant TB.

Latent TB infection [68]

  • Case notification: mandatory reporting to local health department [32]
  • Indication: positive IGRA or TST
  • Pretreatment evaluation
    • No clinical or radiological evidence of TB
    • Comorbid conditions and medication history
  • Therapy monitoring
Treatment of latent TB
Drug(s) Frequency Duration of therapy
Preferred regimens

Isoniazid PLUS rifapentine
  • Once weekly
  • 3 months
Rifampin (OR rifabutin)
  • Daily
  • 4 months
Isoniazid PLUS rifampin
  • Daily
  • 3 months
Alternative regimen
Isoniazid
  • Daily or twice weekly
  • 6 months
  • 9 months

Bacillus Calmette-Guérin vaccine (BCG) [69]

Postexposure management [72]

  • Risk assessment
    • Individuals with the following characteristics are highly contagious:
      • Pulmonary or laryngeal TB
      • Positive sputum smear microscopy
      • Cavitary lesions on chest x-ray
      • Untreated or inadequately treated TB
    • Type of exposure: frequency and duration
    • People with the following characteristics and who have had contact with individuals with TB have a high risk of developing severe disease:
  • Clinical assessment
  • Baseline test: All individuals should be offered HIV testing if HIV status is unknown.
  • Treatment
    • Positive TST or IGRA: See “Latent TB infection” under “Treatment” above.
    • Negative TST or IGRA
      • If HIV positive and < 5 years of age: Start treatment for latent TB until TST or IGRA is repeated 8–10 weeks following exposure.
      • Other patients: no treatment
  • Follow up test: TST or IGRA repeated 8–10 weeks following exposure
    • Positive TST or IGRA: See “Latent TB infection” under “Treatment” above.
    • Negative TST or IGRA
      • Children < 5 years and patients with HIV infection: Discontinue treatment for latent TB.
      • Other patients: no treatment

Disinfectants active against M. tuberculosis [73]

One-Minute Telegram 4-2020-3/3: Rifampin vs. isoniazid for latent TB infection: better care at a lower cost

Interested in the newest medical research, distilled down to just one minute? Sign up for the One-Minute Telegram in “Tips and links” below.

  1. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2). McGraw-Hill Education / Medical ; 2018
  2. Latent TB Infection : Updated and consolidated guidelines for programmatic management. https://www.who.int/tb/publications/2018/latent-tuberculosis-infection/en/. Updated: January 1, 2018. Accessed: September 18, 2020.
  3. Kumar V, Abbas AK, Aster JC. Robbins & Cotran Pathologic Basis of Disease. Elsevier Saunders ; 2014
  4. Fact Sheets: The Difference Between Latent TB Infection and TB Disease. https://www.cdc.gov/tb/publications/factsheets/general/ltbiandactivetb.htm. Updated: November 21, 2014. Accessed: March 25, 2017.
  5. WHO - TB drug resistance types. https://www.who.int/tb/areas-of-work/drug-resistant-tb/types/en/. . Accessed: September 21, 2020.
  6. Fact Sheet: Trends in Tuberculosis, 2018. https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm. Updated: October 29, 2019. Accessed: September 17, 2020.
  7. Global Tuberculosis Report 2019.
  8. Mason PH, Snow K, et al. Tuberculosis and gender in the Asia-Pacific region. Aust N Z J Public Health. 2017; 41 (3): p.227-229. doi: 10.1111/1753-6405.12619 . | Open in Read by QxMD
  9. Hinson JM Jr, Bradsher RW, Bodner SJ. Gram-stain neutrality of Mycobacterium tuberculosis.. Am Rev Respir Dis. 1981; 123 (4 Pt 1): p.365-366. doi: 10.1164/arrd.1981.123.4.365 . | Open in Read by QxMD
  10. Meena LS, Rajni. Survival mechanisms of pathogenic Mycobacterium tuberculosis H37Rv. FEBS J. 2010; 277 (11): p.2416-2427. doi: 10.1111/j.1742-4658.2010.07666.x . | Open in Read by QxMD
  11. Willey JM, Sherwood L, Woolverton CJ. Prescott's Principles of Microbiology. McGraw-Hill ; 2008
  12. Annam V, Kulkarni MH, et al. Comparison of the modified fluorescent method and conventional Ziehl–Neelsen method in the detection of acidfast bacilli in lymphnode aspirates. Cytojournal. 2009; 6 (13). doi: 10.4103/1742-6413.53887 . | Open in Read by QxMD
  13. Martinez L, Verma R, Croda J, et al. Detection, survival and infectious potential of Mycobacterium tuberculosis in the environment: a review of the evidence and epidemiological implications. European Respiratory Journal. 2019; 53 (6): p.1802302. doi: 10.1183/13993003.02302-2018 . | Open in Read by QxMD
  14. Vandal OH, Nathan CF, et al. Acid Resistance in Mycobacterium tuberculosis. J Bacteriol. 2009; 191 (15): p.4714-21. doi: 10.1128/jb.00305-09 . | Open in Read by QxMD
  15. Kumar, Clark. Kumar and Clark's Clinical Medicine, 9th edition. Elsevier ; 2016
  16. WHO - Latent TB Infection : Updated and consolidated guidelines for programmatic management 2018. https://www.who.int/tb/publications/2018/latent-tuberculosis-infection/en/. Updated: January 1, 2018. Accessed: September 21, 2020.
  17. Ai J-W, Ruan Q-L, et al. Updates on the risk factors for latent tuberculosis reactivation and their managements. Emerging Microbes & Infections. 2016; 5 (2): p.e10. doi: 10.1038/emi.2016.10 . | Open in Read by QxMD
  18. Podlekareva DN, Panteleev AM, Grint D, et al. Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe. European Respiratory Journal. 2013; 43 (1): p.166-177. doi: 10.1183/09031936.00138712 . | Open in Read by QxMD
  19. Geldmacher C, Schuetz A, et al. Early Depletion of Mycobacterium tuberculosis–Specific T Helper 1 Cell Responses after HIV‐1 Infection. J Infect Dis. 2008; 198 (11): p.1590-1598. doi: 10.1086/593017 . | Open in Read by QxMD
  20. Bumbacea D, Arend SM, et al. The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement. European Respiratory Journal. 2012; 40 (4): p.990-1013. doi: 10.1183/09031936.00000712 . | Open in Read by QxMD
  21. Romanowski K, Clark EG, Levin A, Cook VJ, Johnston JC. Tuberculosis and chronic kidney disease: an emerging global syndemic. Kidney Int. 2016; 90 (1): p.34-40. doi: 10.1016/j.kint.2016.01.034 . | Open in Read by QxMD
  22. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009; 9 (12): p.737-746. doi: 10.1016/s1473-3099(09)70282-8 . | Open in Read by QxMD
  23. Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection.
  24. Jick SS, Lieberman ES, et al. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis & Rheumatism. 2006; 55 (1): p.19-26. doi: 10.1002/art.21705 . | Open in Read by QxMD
  25. Koo S, Marty FM, Baden LR. Infectious Complications Associated with Immunomodulating Biologic Agents. Infect Dis Clin North Am. 2010; 24 (2): p.285-306. doi: 10.1016/j.idc.2010.01.006 . | Open in Read by QxMD
  26. Hochberg NS, Horsburgh CR. Prevention of Tuberculosis in Older Adults in the United States: Obstacles and Opportunities. Clinical Infectious Diseases. 2013; 56 (9): p.1240-1247. doi: 10.1093/cid/cit027 . | Open in Read by QxMD
  27. Arcavi L, Benowitz NL. Cigarette Smoking and Infection. Arch Intern Med. 2004; 164 (20): p.2206-2216. doi: 10.1001/archinte.164.20.2206 . | Open in Read by QxMD
  28. Szabo G. Alcohol's contribution to compromised immunity.. Alcohol Health Res World. 1997; 21 (1): p.30-41.
  29. Chandrasekaran P, Saravanan N, et al. Malnutrition: Modulator of Immune Responses in Tuberculosis. Frontiers in Immunology. 2017 . doi: 10.3389/fimmu.2017.01316 . | Open in Read by QxMD
  30. Inghammar M, Ekbom A, et al. COPD and the Risk of Tuberculosis - A Population-Based Cohort Study. PLoS ONE. 2010; 5 (4): p.e10138. doi: 10.1371/journal.pone.0010138 . | Open in Read by QxMD
  31. Diagnostic Standards and Classification of Tuberculosis in Adults and Children.
  32. Menu of Suggested Provisions For State Tuberculosis Prevention and Control Laws. https://www.cdc.gov/tb/programs/laws/menu/caseid.htm. Updated: September 1, 2012. Accessed: March 28, 2017.
  33. Kumar V, Abbas AK, Aster JC. Robbins & Cotran Pathologic Basis of Disease. Elsevier Saunders ; 2015
  34. Ahmad S. Pathogenesis, Immunology, and Diagnosis of LatentMycobacterium tuberculosisInfection. Clinical and Developmental Immunology. 2010; 2011 : p.1-17. doi: 10.1155/2011/814943 . | Open in Read by QxMD
  35. Kinchen JM, Ravichandran KS. Phagosome maturation: going through the acid test. Nature Reviews Molecular Cell Biology. 2008; 9 (10): p.781-795. doi: 10.1038/nrm2515 . | Open in Read by QxMD
  36. Malik ZA, Iyer SS, Kusner DJ. Mycobacterium tuberculosisPhagosomes Exhibit Altered Calmodulin-Dependent Signal Transduction: Contribution to Inhibition of Phagosome-Lysosome Fusion and Intracellular Survival in Human Macrophages. The Journal of Immunology. 2001; 166 (5): p.3392-3401. doi: 10.4049/jimmunol.166.5.3392 . | Open in Read by QxMD
  37. Lang R. Recognition of the mycobacterial cord factor by Mincle: relevance for granuloma formation and resistance to tuberculosis. Frontiers in Immunology. 2013; 4 . doi: 10.3389/fimmu.2013.00005 . | Open in Read by QxMD
  38. Engele M, Stöβel E, et al. Induction of TNF in Human Alveolar Macrophages As a Potential Evasion Mechanism of Virulent Mycobacterium tuberculosis. The Journal of Immunology. 2002; 168 (3): p.1328-1337. doi: 10.4049/jimmunol.168.3.1328 . | Open in Read by QxMD
  39. Goren MB. Phagocyte Lysosomes: Interactions with Infectious Agents, Phagosomes, and Experimental Perturbations in Function. Annu Rev Microbiol. 1977; 31 (1): p.507-533. doi: 10.1146/annurev.mi.31.100177.002451 . | Open in Read by QxMD
  40. Schlossberg D. Tuberculosis and Nontuberculous Mycobacterial Infections Seventh Edition. ASM Press ; 2017
  41. Luies L, du Preez I. The Echo of Pulmonary Tuberculosis: Mechanisms of Clinical Symptoms and Other Disease-Induced Systemic Complications. Clin Microbiol Rev. 2020; 33 (4): p.1-19. doi: 10.1128/cmr.00036-20 . | Open in Read by QxMD
  42. Kim HY, Song K-S, at al. Thoracic Sequelae and Complications of Tuberculosis. RadioGraphics. 2001; 21 (4): p.839-858. doi: 10.1148/radiographics.21.4.g01jl06839 . | Open in Read by QxMD
  43. Fontanilla JM, Barnes A, et al. Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis. Clinical Infectious Diseases. 2011; 53 (6): p.555-562. doi: 10.1093/cid/cir454 . | Open in Read by QxMD
  44. Mohapatra PR, Janmeja AK. Tuberculous lymphadenitis. J Assoc Physicians India. 2009; 57 : p.585-90.
  45. Leung AN, Müller NL, et al. Primary tuberculosis in childhood: radiographic manifestations.. Radiology. 1992; 182 (1): p.87-91. doi: 10.1148/radiology.182.1.1727316 . | Open in Read by QxMD
  46. Udwadia ZF, Sen T. Pleural tuberculosis: an update. Curr Opin Pulm Med. 2010; 16 (4): p.399-406. doi: 10.1097/mcp.0b013e328339cf6e . | Open in Read by QxMD
  47. Sahn SA. The Value of Pleural Fluid Analysis. Am J Med Sci. 2008; 335 (1): p.7-15. doi: 10.1097/maj.0b013e31815d25e6 . | Open in Read by QxMD
  48. Sharma SK, Mohan A, Sharma A. Miliary tuberculosis: A new look at an old foe. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2016; 3 : p.13-27. doi: 10.1016/j.jctube.2016.03.003 . | Open in Read by QxMD
  49. Mayosi BM, Burgess LJ, Doubell AF. Tuberculous Pericarditis. Circulation. 2005; 112 (23): p.3608-3616. doi: 10.1161/circulationaha.105.543066 . | Open in Read by QxMD
  50. Isiguzo G, Du Bruyn E, et al. Diagnosis and Management of Tuberculous Pericarditis: What Is New?. Curr Cardiol Rep. 2020; 22 (1): p.1-8. doi: 10.1007/s11886-020-1254-1 . | Open in Read by QxMD
  51. Kelestimur F. The endocrinology of adrenal tuberculosis: The effects of tuberculosis on the hypothalamo-pituitary-adrenal axis and adrenocortical function. J Endocrinol Invest. 2004; 27 (4): p.380-386. doi: 10.1007/bf03351067 . | Open in Read by QxMD
  52. VanZyl L, DuPlessis J, Viljoen J. Cutaneous tuberculosis overview and current treatment regimens. Tuberculosis. 2015; 95 (6): p.629-638. doi: 10.1016/j.tube.2014.12.006 . | Open in Read by QxMD
  53. Debi U, Ravisankar V, et al. Abdominal tuberculosis of the gastrointestinal tract: Revisited. World Journal of Gastroenterology. 2014; 20 (40): p.14831-14840. doi: 10.3748/wjg.v20.i40.14831 . | Open in Read by QxMD
  54. Rasheed S, Zinicola R, et al. Intra-abdominal and gastrointestinal tuberculosis. Colorectal Disease. 2007; 9 (9): p.773-783. doi: 10.1111/j.1463-1318.2007.01337.x . | Open in Read by QxMD
  55. Abbara A, Davidson RN. Etiology and management of genitourinary tuberculosis. Nature Reviews Urology. 2011; 8 (12): p.678-688. doi: 10.1038/nrurol.2011.172 . | Open in Read by QxMD
  56. Gatongi DK, Gitau G, et al. Female genital tuberculosis. The Obstetrician & Gynaecologist. 2005; 7 (2): p.75-79. doi: 10.1576/toag.7.2.075.27000 . | Open in Read by QxMD
  57. Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clinical Infectious Diseases. 2016; 64 (2): p.e1-e33. doi: 10.1093/cid/ciw694 . | Open in Read by QxMD
  58. Nachiappan AC, Rahbar K, et al. Pulmonary Tuberculosis: Role of Radiology in Diagnosis and Management. RadioGraphics. 2017; 37 (1): p.52-72. doi: 10.1148/rg.2017160032 . | Open in Read by QxMD
  59. The use of lateral flow urine lipoarabinomannan assay (LF-LAM) for the diagnosis and screening of active tuberculosis in people living with HIV Policy update. https://www.who.int/tb/publications/use-of-lf-lam-tb-hiv/en/. Updated: January 1, 2015. Accessed: November 17, 2020.
  60. Latent Tuberculosis Infection: A Guide for Primary Health Care Providers. https://www.cdc.gov/tb/publications/ltbi/default.htm. Updated: January 1, 2020. Accessed: November 13, 2020.
  61. Sosa LE, Njie GJ, et al. Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. MMWR Morb Mortal Wkly Rep. 2019; 68 (19): p.439-443. doi: 10.15585/mmwr.mm6819a3 . | Open in Read by QxMD
  62. Merchant S, Bharati A, et al. Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part I. Indian Journal of Radiology and Imaging. 2013; 23 (1): p.46-63. doi: 10.4103/0971-3026.113615 . | Open in Read by QxMD
  63. Nahid P, Dorman SE, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clinical Infectious Diseases. 2016; 63 (7): p.e147-e195. doi: 10.1093/cid/ciw376 . | Open in Read by QxMD
  64. CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005.. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 2005; 54 (RR-17): p.1-141.
  65. Katzung BG, Trevor AJ. Basic and Clinical Pharmacology 14E. McGraw-Hill Education / Medical ; 2017
  66. Brahm NC, Yeager LL, et al. Commonly prescribed medications and potential false-positive urine drug screens. American Journal of Health-System Pharmacy. 2010; 67 (16): p.1344-1350. doi: 10.2146/ajhp090477 . | Open in Read by QxMD
  67. Ben Salem C, Slim R, et al. Drug-induced hyperuricaemia and gout. Rheumatology. 2016; 56 (5): p.679-688. doi: 10.1093/rheumatology/kew293 . | Open in Read by QxMD
  68. Sterling TR, Njie G, et al. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR. Recommendations and Reports. 2020; 69 (1): p.1-11. doi: 10.15585/mmwr.rr6901a1 . | Open in Read by QxMD
  69. The role of BCG vaccine in the prevention and control of tuberculosis in the United States. A joint statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices.. https://www.ncbi.nlm.nih.gov/pubmed/8602127. Updated: April 26, 1996. Accessed: November 15, 2020.
  70. WHO. Implementing the WHO Stop TB Strategy. World Health Organization ; 2008
  71. Mangtani P, Abubakar I, et al. Protection by BCG Vaccine Against Tuberculosis: A Systematic Review of Randomized Controlled Trials. Clinical Infectious Diseases. 2014; 58 (4): p.470-480. doi: 10.1093/cid/cit790 . | Open in Read by QxMD
  72. National Tuberculosis Controllers Association, Centers for Disease Control and Prevention (CDC).. Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC.. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 2005; 54 (RR-15): p.1-47.
  73. Guideline for Disinfection and Sterilization in Healthcare Facilities (2008). https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html#Chlorine. Updated: January 1, 2008. Accessed: November 15, 2020.
  74. Herold G. Internal Medicine. Herold G ; 2014
  75. Kasper DL, Fauci AS, Hauser S, Longo D, Jameson LJ, Loscalzo J . Harrisons Principles of Internal Medicine . McGraw-Hill Medical Publishing Division ; 2016
  76. Klein K, Yang Z. Comparison of ambient air survival of Mycobacterium tuberculosis clinical strains associated with different epidemiological phenotypes. Int J Mycobacteriol. 2014; 3 (3): p.211-213. doi: 10.1016/j.ijmyco.2014.04.002 . | Open in Read by QxMD
  77. Anergy. http://medical-dictionary.thefreedictionary.com/anergy. Updated: March 28, 2017. Accessed: March 28, 2017.
  78. Questions and Answers About TB: Testing and Treatment. https://www.cdc.gov/tb/publications/faqs/qa_latenttbinf.htm. Updated: September 18, 2014. Accessed: March 28, 2017.
  79. Tuberculosis.
  80. C Robert Horsburgh, Jr, MD, MUS. Epidemiology of tuberculosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/epidemiology-of-tuberculosis.. Accessed: February 9, 2019.
  81. Dick Menzies, MD, MSc. Approach to diagnosis of latent tuberculosis infection (tuberculosis screening) in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/approach-to-diagnosis-of-latent-tuberculosis-infection-tuberculosis-screening-in-adults.. Accessed: February 10, 2019.
  82. Anton Pozniak, MD, FRCP. Clinical manifestations and complications of pulmonary tuberculosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-complications-of-pulmonary-tuberculosis.. Accessed: February 17, 2019.
  83. C Robert Horsburgh, Jr, MD, MUS. Treatment of latent tuberculosis infection in HIV-uninfected nonpregnant adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/treatment-of-latent-tuberculosis-infection-in-hiv-uninfected-nonpregnant-adults.. Accessed: February 17, 2019.
  84. Neil W Schluger, MDScott K Heysell, MD, MPHGerald Friedland, MD. Treatment of drug-resistant pulmonary tuberculosis in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/treatment-of-drug-resistant-pulmonary-tuberculosis-in-adults.. Accessed: February 17, 2019.
  85. Tuberculosis in Women. https://www.who.int/tb/publications/tb_women_factsheet.pdf?ua=1. . Accessed: February 24, 2019.
  86. Fact Sheet: Trends in Tuberculosis, 2017. https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm. Updated: October 15, 2017. Accessed: March 27, 2019.
  87. Global Tuberculosis Report 2018.
  88. Flynn, Chan. Tuberculosis: Latency and Reactivation. Infection and Immunity. 2001 . doi: 10.1128/IAI.69.7.4195-4201.2001 . | Open in Read by QxMD
  89. Cutaneous manifestations of tuberculosis. https://www.uptodate.com/contents/cutaneous-manifestations-of-tuberculosis. Updated: March 30, 2018. Accessed: March 29, 2019.
  90. Use of interferon-gamma release assays for diagnosis of latent tuberculosis infection (tuberculosis screening) in adults. https://www.uptodate.com/contents/use-of-interferon-gamma-release-assays-for-diagnosis-of-latent-tuberculosis-infection-tuberculosis-screening-in-adults. Updated: October 25, 2018. Accessed: March 29, 2019.
  91. Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. International Journal of Infectious Diseases. 2015; 32 : p.87-93. doi: 10.1016/j.ijid.2014.12.007 . | Open in Read by QxMD