Screening for Mycobacterium tuberculosis infection in risk groups, diagnosis of active disease, and planning of long-term combination antibiotic therapy.
Indication
- Cough lasting more than two weeks, blood-streaked sputum, night sweats, and weight loss
- Close contact with a patient with active tuberculosis
- High-risk conditions such as HIV, chronic kidney failure, cancer, and immunosuppressive therapy
- Screening of healthcare workers, prison staff, and migrant populations
- Latent infection assessment before anti-TNF therapy
- Evaluation of contact risk in children after BCG vaccination
Preparation
- Detailed history, physical examination, and risk assessment
- Tuberculin skin test (PPD) or interferon-gamma release assay (IGRA)
- Chest X-ray and, if needed, thorax computed tomography
- AFB and TB-PCR with culture and antibiogram on three separate morning sputum samples
- Liver function tests and baseline vision/hearing assessment
How it's performed
- In screen-positive but asymptomatic patients, latent TB therapy is planned (commonly 9 months of isoniazid or 3 months of rifapentine-isoniazid)
- In patients diagnosed with active TB, an initial 2-month intensive phase: isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE)
- A 4-7 month continuation phase with isoniazid and rifampicin; total treatment 6-9 months
- Adherence is monitored using directly observed therapy (DOT)
- In multidrug-resistant (MDR-TB) cases, treatment may be extended to 18-24 months and require different combinations
- Contacts are screened and preventive treatment is started for those who need it
Post-procedure
- Monthly clinical follow-up, sputum monitoring, and liver function testing
- Report side effects such as visual problems (ethambutol) or numbness (isoniazid) to the physician
- Avoid smoking, alcohol, and drugs harmful to the liver during treatment
- Clinical and radiological cure assessment at the end of therapy
- Public health notification and follow-up of contacts
Risks
- Drug-induced liver toxicity (especially with isoniazid and rifampicin)
- Changes in visual fields (ethambutol) and decreased visual acuity
- Peripheral neuropathy due to isoniazid (vitamin B6 supplementation reduces the risk)
- Allergic rashes and joint pain (pyrazinamide)
- Development of resistant (MDR/XDR) tuberculosis with poor adherence
FAQ
Will my PPD be positive if I had a BCG vaccine?
Some individuals can have temporary positivity after vaccination; in uncertain cases, the IGRA test is preferred.
Can I continue working during treatment?
Once sputum smears become negative (usually within the first 2-3 weeks), infectiousness is greatly reduced; you can return to work with your physician's approval.
What happens if I stop the medication early?
Stopping early increases the risk of relapse and the development of resistant (MDR) tuberculosis; full adherence to the treatment plan is very important.
Can tuberculosis be fully cured?
With appropriate, full-course treatment, the great majority of patients recover; however, no guarantee of complete cure can be made without ongoing physician follow-up.
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