Tuberculosis

Antimicrobial prescribing: NHS Lothian
NHS Lothian

For any cases of suspected TB, seek specialist advice from Infectious Diseases or Respiratory Medicine

Suspect pulmonary tuberculosis in any person who has risk factors (below), weight loss, fever, night sweats, anorexia, persistent productive cough (> 3 weeks), breathlessness or haemoptysis.  See NICE guidelines for further details

Required Investigations

How to send samples for Mycobacteria:

Obtaining multiple samples for TB culture is the gold standard for diagnosing TB.

  • Pulmonary TB – 3 x good quality, early morning sputum samples for mycobacterial investigations are required. Labels can be printed from TRAK. If unable to produce sputum, then induced sputum or bronchoscopy should be considered in discussion with a specialist.
  • Non-pulmonary TB – Tissue from the affected area should be sent for mycobacterial investigations (to Microbiology in saline or plain tube NOT in formulin) and histology (in formulin). Again seek advice from a specialist.

Further information about how to order these samples on TRAK can be found here on the Edinburgh and Lothians Laboratory Medicine website

Always offer HIV testing to patients with suspected or confirmed TB.

Notes

Local policies and guidelines for TB can be found here: Guidelines and Policies (scot.nhs.uk) (NB intranet only)

Contact details for the TB Nursing service:

For infection prevention and control see How to get advice

Risk Factors

Risk factors

for TB

History of untreated or inadequately treated active TB infection

Close contact of someone with active pulmonary TB

Born in or residence in a country where there is a high prevalence of TB

Co-morbid conditions:

e.g. HIV, diabetes mellitus, end-stage chronic kidney disease receiving renal replacement therapy, previous gastrectomy or jejunoileal bypass surgery, occupational lung disease (for example silicosis), haematological malignancy, history of solid organ transplantation, and malnutrition.

Immunosuppressive drugs:

e.g. High-dose corticosteroids, chemotherapy, anti TNF treatments.

Under-served groups:

e.g. People using homeless hostels, shelters, and day centres, and people living in prison or detention centres.

History of excessive alcohol, injecting drug users, and smokers