Tuberculosis — Uganda (General Adult population)
Pulmonary TB Symptoms
Chronic cough >2 weeks (in HIV, cough of ANY duration), fevers especially evening, excessive night sweats, weight loss, chest pain, purulent or blood-stained sputum.
Extrapulmonary TB Symptoms
Lymph node: Localized enlargement. Abdominal: ascites/abdominal pain. Meningitis: headache, altered consciousness. Bone/Joint: swelling/deformity. Pleural/pericardial effusion.
TB Screening and Investigations
All presumed TB patients should be screened. Obtain sputum for Xpert MTB/RIF (recommended diagnostic test and detects Rifampicin resistance). If not available, do Sputum smear microscopy for AAFBs (ZN stain) but send sample for Xpert. ALL TB patients MUST be offered an HIV test.
Sputum Culture and DST
Confirmatory test. Do for: Rifampicin resistance on GeneXpert, patients on 1st line remaining positive at 2 months, patients suspected failing 1st line.
Drug Resistant (DR-TB) Definitions
RR-TB: Rifampicin resistant. MDR-TB: Resistant to Rifampicin + Isoniazid. XDR-TB: MDR-TB + any fluoroquinolone + bedaquiline/linezolid. INH mono-resistant: Resistant to INH only.
Post-TB Lung Disease
Patient successfully treated but has persistent respiratory symptoms. Re-do standard evaluation (GeneXpert/CXR). If negative, do NOT retreat. Give supportive treatment (pulmonary rehabilitation).
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