TB SCREENING

For >15 years old

1. Ask about the cardinal signs and symptoms for >2 weeks
a. Cough
b. Unexplained fever
c. Unexplained weight loss
d. Night sweats

***if any of the above signs/symptoms are present for 2 weeks à Presumptive TB
***for those signs/symptoms present for <2 weeks, offer chest xray PA view
For <15 years old

1. Ask about the cardinal signs and symptoms for >2 weeks

a. coughing/wheezing of 2 weeks or more, especially if unexplained (e.g. not responding

to antibiotic or bronchodilator treatment);
b. unexplained fever of 2 weeks or more after common causes such as malaria or
pneumonia have been excluded; and
c. unexplained weight loss or failure to thrive not responding to nutrition therapy.

***If the child has at least 1 of the 3 main signs and symptoms à Presumptive TB

2. If the child is a close contact (exposure within 3 months) of a known TB case, ask for:

a. Presence of fatigue
b. Reduced playfulness
c. Decreased activity
d. Not eating well or anorexia

***if the close contact child experiences these symptoms à Presumptive TB

3. Chest xray is not advisable for TB Screening for <5 years old

4. Ask about history of treatment and exposure to TB case to determine risk for DR-TB
For Presumptive EPTB

1. Note any of the following:

a. gibbus deformity, especially of recent onset (resulting from vertebral TB);

b. non-painful enlarged cervical lymphadenopathy with or without fistula formation;
c. neck stiffness (or nuchal rigidity) and/or drowsiness suggestive of meningitis, with a
sub-acute onset or raised intracranial pressure;
d. pleural effusion;
e. pericardial effusion;
f. distended abdomen (i.e. big liver and spleen) with ascites;
g. non-painful enlarged joint; and
h. signs of tuberculin hypersensitivity
DIAGNOSIS OF TB

Once a presumptive TB case is identified, diagnosis through bacteriologic confirmation must be

conducted. This requires collection of the necessary specimens for testing, performing the test (Xpert,
SM or TB LAMP), and making a diagnosis based on the results.

1. Collect sputum specimen (only contraindication for collecting sputum is massive

hemoptysis)
a. Prepare sputum cup or 50ml conical tube
b. Instruct patient on how to expectorate
- Clean mouth by rinsing with water
- Breathe deeply, hold breath for 2 seconds, and then exhale slowly. Repeat
sequence 2 more times
- Cough strongly after inhaling deeply for the third time and try to bring up
sputum from deep within the lungs
- Expectorate sputum
§ 1ml for Xpert MTB/RIF and TB LAMP
§ 3 to 5ml for smear microscopy
c. If unable to expectorate (<5 years old), do nasopharyngeal aspirate or gastric lavage
d. Label specimen correctly
***For smear microscopy, instruct to collect a second sample one hour later or an early-
morning sputum sample.

***Blood, urine, and stool are not accepted for Xpert testing

2. If sputum or non-sputum specimen tested by Xpert MTB/RIF, SM or TB LAMP shows

MTB detected or positive result à bacteriologically confirmed PTB or EPTB (BC-TB, BC-
EPTB)

a. For patients who are at least 15 years old with negative Xpert MTB/RIF, SM, TB LAMP
results (or not done)
- Do chest xray if not done
- If chest xray shows shadows in the lung fields consistent with lung disease, may
give a course of broad spectrum antibiotics

§ Markedly enlarged unequal hilar lymph gland (i.e. > 2 cm in size) with or
without opacification
§ Miliary mottling
§ Large pleural effusion (≥ 1/3 of pleural cavity, usually common in children >
5 years old)
§ Apical opacification with cavitation (rare in younger children, common in
adolescents.

- If signs/symptoms are not resolved despite the antibiotic treatment, do clinical

judgement to decide whether to treat for active TB à clinically diagnosed PTB or
EPTB (CD-TB; CD-EPTB)
LABORATORY RESULT INTERPRETATION
TREATMENT
ADVERSE REACTIONS
FOLLOW-UP

1. Always weigh the patient and adjust the dose every follow-up.

Xpert MTB/RIF test is not used for follow-up examination to monitor treatment because current-
generation PCR-based tests are unable to determine MTB viability and may test positive even
with nonviable or dead bacilli.
***Treatment for Drug-Resistant TB in children is usually managed by TB-MAC; referral to the
committee is required
Tuberculosis Preventive Treatment (TPT)