Tuberculosis -- Printable Tables

TITLE:	TUBERCULOSIS
AUTHORS:	OCTAVIAN IOACHIMESCU, MD -- Department of Pulmonary, Allergy, & Critical Care Medicine
	J. WALTON TOMFORD, MD -- Department of Infectious Diseases
PUBLISHED:	SEPTEMBER 2, 2004

Table 1:
CDC Case Definition of Tuberculosis
Laboratory Criteria	Clinical Elements*
Isolation of M. Tuberculosis from a clinical specimen OR (when culture not obtained) Demonstration of acid-fast bacilli in a clinical specimen	A positive skin tuberculin test Signs and symptoms compatible with TB or an abnormal chest radiograph Treatment with 2 or more antituberculous drugs A complete diagnostic evaluation with exclusion of other, alternative diagnoses
* All needed when no laboratory confirmation is performed

Table 2:
First Line Drugs Used In Chemotherapy of Tuberculosis: Dosages and Main Side Effects
Drug (Side Effects)	Daily Regimen	Twice or Three Times Weekly
INH (Hepatitis, peripheral neuropathy, lupus-like syndrome, drug interactions)	5 mg/kg (max 300 mg)	15 mg/kg (max 900 mg)
RIF (Drug interactions, orange discoloration of body fluids, GI upset, hepatitis, fever, hypersensitivity, acute renal failure, hemolytic anemia)	10 mg/kg (max 600 mg)	10 mg/kg (max 600 mg)
PZA (Hyperuricemia, gouty arthritis, rarely hepatitis)	15-30 mg/kg (max 2 g)	50-70 mg/kg (max 4 g)
ETB (optic neuritis, exfolliative rash)	15-25 mg/kg	25-30 mg/kg
SM (cochleo- and vestibulo-toxicity, nephrotoxicity)	15 mg/kg	25-30 mg/kg
AK (Amikacin) (same as SM)	7.5-10 mg/kg

Table 3:
Threshold for PPD Skin Reaction Positivity by Host or Setting
Reaction ƒ5 mm	Reaction ƒ10 mm	Reaction ƒ15 mm
HIV-positive individuals Recent contacts of TB cases Fibrotic changes on chest radiograph suggesting old TB Patients with organ transplants and other immunosuppressed patients (receiving the equivalent of >15 mg/day of prednisone for 1 month or longer, or anti-TNF drugs)	Recent immigrants (within last 5 years) from endemic countries Injection drug users Residents and employees of the following high-risk congregate settings: prisons, jails, nursing homes, other long-term facilities, residential facilities for patients with AIDS, homeless shelters Microbiology laboratory personnel Patients with the following clinical conditions that place them at risk: silicosis, diabetes mellitus, chronic renal failure, leukemia, lymphoma, other malignancies (eg, carcinoma of the head and lung), weight loss of ƒ10% of ideal body weight, gastrectomy, and jejunoileal bypass Children younger than 4 years of age Children, infants or adolescents exposed to adults at high-risk	Persons with no risk factors for TB

Table 4:
Approach to a Patient with LTBI
Clinical Evaluation -- Cough, chest pain, hemoptysis, fever, chills, night sweats, anorexia, weight loss, fatigue Past Medical History -- TB treatment or exposure Social History -- Demographic factors increasing the risk of acquiring TB or resistant strainsHIV status (voluntary testing and counseling should be offered routinely)) Chest Radiograph -- postero-anterior and lateral Sputum (3 specimens) -- For: patients with symptoms (even if chest radiograph is normal), or patients with radiologic abnormalities (images compatible with old, fibrotic changes) Obtain baseline laboratory testing (for: HIV-infected patients, pregnant and post-partum women, those with liver disease, and those who use alcohol regurlaly) Those without clinical, radiologic, or microbiologic evidence of active disease: LTBI therapy (those with abnormal liver function tests at baseline require continuous monitoring)

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