Revised guidelines for diagnosis of smear-negative and extrapulmonary TB.The World Health Organization (WHO) have released revised guidelines for the diagnosis of smear-negative and extrapulmonary TB extrapulmonary TB Infectious disease Clinical TB outside the lungs–eg, lymph nodes, pleura, brain, kidneys, or bones in areas of high HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. prevalence. The new guidelines revise previously used algorithms in an effort to speed up the diagnosis of smear-negative pulmonary and extrapulmonary TB in resource-limited settings wherever HIV is prevalent. The diagnosis of TB in someone who is HIV-positive can be problematic, particularly as the usual methods of smear culture smear culture n. A culture made by spreading material presumed to be infected on the surface of a solidified medium. and chest X-ray chest x-ray, n an examination of the chest using x-rays. Routinely performed in patients complaining of chest pain to rule out respiratory or heart disease. chest X-ray Chest film, see there often don't work. Smears may be negative and chest X-rays may not be typical of pulmonary TB pulmonary TB Pulmonary tuberculosis, see there . Extrapulmonary TB is also more common in co-infection with HIV. The new guidelines suggest only two sputum sputum /spu·tum/ (spu´tum) [L.] expectoration; matter ejected from the trachea, bronchi, and lungs through the mouth. sputum cruen´tum bloody sputum. specimens for smear microscopy from someone who is HIV-infected or when there is strong clinical evidence of HIV infection. This will reduce the time, and the number of visits the patient has to make to the clinic, required to make a diagnosis. If one of the specimens is positive, a diagnosis of pulmonary TB can be made. If both the specimens are smear negative, but a chest X-ray suggests TB, the suggetion is to treat for TB, monitor, and make the diagnosis on a positive response to treatment. In addition, a diagnosis of smear-negative TB can be reached once a specimen sent for culture comes back positive for Mycobacterium tuberculosis. Any patient with a temperature higher than 39[degrees]C, a pulse rate of over 120 per minute and a respiratory rate of over 30 per minute should be treated with a broad-spectrum intravenous antibiotic and, depending on the CD4 count or the clinical setting, treatment for Pneumocystis pneumonia (PCP PCP abbr. 1. phencyclidine 2. primary care physician Pneumocystis carinii pneumonia (PCP) , also known as Pneumocystis Pneumocystis /Pneu·mo·cys·tis/ (-sis´tis) a genus of yeastlike fungi. P. cari´nii is the causative agent of interstitial plasma cell pneumonia. pneu·mo·cys·tis n. jirovecii pneumonia) should be considered as well. The patient should, if possible, be transferred to a high-level centre for further treatment. The recommendation is not to wait for diagnostic evidence of TB or HIV. The revised definition of extrapulmonary TB requires obtaining a positive result, by smear microscopy or culture, on at least one biological specimen from the site of infection. Or, a diagnosis may be made if there is histological or strong clinical evidence consistent with extrapulmonary TB in a person with (or strongly suspected of having) HIV, and a decision to treat with a full course of anti-TB treatment. The full guidelines can be seen online: http://www.who.int/entity/tb/publications/2006/tbhiv_recommendations.pdf |
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