Tuberculosis: a focused review for the emergency medicine clinician

Brit Long, Stephen Y. Liang, Alex Koyfman, Michael Gottlieb

Research output: Contribution to journalReview article

1 Scopus citations

Abstract

Introduction: Tuberculosis (TB) is a common disease worldwide, affecting nearly one-third of the world's population. While TB has decreased in frequency in the United States, it remains an important infection to diagnose and treat. Objective: This narrative review discusses the evaluation and management of tuberculosis, with an emphasis on those factors most relevant for the emergency clinician. Discussion: TB is caused by Mycobacterium tuberculosis and is highly communicable through aerosolized particles. A minority of patients will develop symptomatic, primary disease. Most patients will overcome the initial infection or develop a latent infection, which can reactivate. Immunocompromised states increase the risk of primary and reactivation TB. Symptoms include fever, prolonged cough, weight loss, and hemoptysis. Initial diagnosis often includes a chest X-ray, followed by serial sputum cultures. If the patient has a normal immune system and a normal X-ray, active TB can be excluded. Newer tests, including nucleic acid amplification testing, can rapidly diagnose active TB with high sensitivity. Treatment for primary and reactivation TB differs from latent TB. Extrapulmonary forms can occur in a significant proportion of patients and involve a range of different organ systems. Patients with human immunodeficiency virus are high-risk and require specific considerations. Conclusions: TB is a disease associated with significant morbidity and mortality. The emergency clinician must consider TB in the appropriate setting, based on history and examination. Accurate diagnosis and rapid therapy can improve patient outcomes and reduce the spread of this communicable disease.

Original languageEnglish (US)
Pages (from-to)1014-1022
Number of pages9
JournalAmerican Journal of Emergency Medicine
Volume38
Issue number5
DOIs
StatePublished - May 2020

Keywords

  • Extrapulmonary
  • Infectious disease
  • Latent
  • Pulmonary
  • Sputum
  • Tuberculosis

ASJC Scopus subject areas

  • Emergency Medicine

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