Assessment of the quality of health information on the Internet: evidence-based accuracy indicators for tuberculosis

Paolucci, Rodolfo; Pereira Neto, André; Nadanovsky, Paulo

doi:10.1590/0103-1104202213501I

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Saúde debate 46 (135) • Oct-Dec 2022 • https://doi.org/10.1590/0103-1104202213501I copy

Assessment of the quality of health information on the Internet: evidence-based accuracy indicators for tuberculosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Not long ago, someone had to buy a newspaper, a book, or a magazine or go to a library to obtain information. Today, the Internet quickly facilitates a myriad of information. However, the information provided may be obsolete, incomplete, incorrect, or deliberately false: fake news. In the health field, this information can affect well-being or harm individuals and society. Thus, professionals, researchers, and institutions have assessed the quality of information on health websites to address this issue. Evaluations often verify the accuracy of the information provided. However, the information accuracy indicators have yet to be constructed from Evidence-Based Medicine (EBM). This article aims to build indicators from EBM practices, analyzing the case of tuberculosis. This manuscript proposes 43 information accuracy indicators that evaluated the tuberculosis information available on the Brazilian Ministry of Health. The results indicate that much information needs to be included, and some data must be corrected. This evaluation reiterates the importance of building EBM accuracy indicators. This work intends to encourage new studies about assessing the quality of health information on the Internet.

KEYWORDS
Evidence-based medicine; Internet; Access to information; Indicators (statistics); Tuberculosis

Id	Indicators
Prevention and BCG Group dimension
23	[ Indicator ] The BCG vaccine should be given soon after birth in countries with a high prevalence of tuberculosis. It should also be applied if there is no information about the mother having HIV, as the benefits outweigh the risks. [ Evidence ] 1) BCG vaccination as soon as possible after birth in countries with a high tuberculosis (TB) prevalence revaccination not recommended. 2) benefits outweigh risks in infants born to women of unknown HIV status and should be immunized [ Reference ] 1) http://www.dynamed.com/topics/dmp~AN~T905489#Overview 2) http://www.dynamed.com/topics/dmp~AN~T905489#Overview
26	[ Indicator ] Babies should not be vaccinated with BCG in the following two cases: suspected HIV infection; or are born to women with HIV. [ Evidence ] Risks usually outweigh benefits for infants and should not be immunized if HIV infection is suspected or if born to woman with HIV infection [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview
29	[ Indicator ] In countries with a low prevalence of tuberculosis, the BCG vaccine should only be considered for children under the following conditions: negative skin test for tuberculosis; continuous exposure to tuberculosis; and cannot receive long-term primary preventive treatment. Besides these conditions, the vaccine should be considered if children cannot be separated from adults under the following conditions: ineffectively treated for tuberculosis; did not receive treatment; or have strains of tuberculosis resistant to isoniazid and rifampicin. [ Evidence ] Centers for Disease Control and Prevention (CDC) recommendations - consider BCG vaccination only in children - with negative TB skin test - with continual exposure - who cannot be separated from adults who - are ineffectively treated or untreated for TB and child cannot be given long-term primary preventive treatment for TB infection - have TB strains resistant to isoniazid and rifampicin [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview
41	[ Indicator ] Revaccination of the BCG vaccine as a booster is not recommended. Moreover, the vaccine is unreliable against pulmonary tuberculosis for adults and older children. [ Evidence ] 1) revaccination not recommended 2) BCG is unreliable against adult forms of pulmonary tuberculosis. - efficacy variable (0% to > 80%) in older children and adults, with some reports of net harm ( JAMA 2004 May 5;291(17):2127) [ Reference ] 1) http://www.dynamed.com/topics/dmp~AN~T905489#Overview 2) http://www.dynamed.com/topics/dmp~AN~T905489#Efficacy
Prevention and HIV Group dimension
20	[ Indicator ] HIV patients traveling or working in TB endemic regions should be counseled about the risks of the disease and the need to be tested for latent TB infection. [ Evidence ] Counsel patients with HIV who travel or work in tuberculosis (TB)-endemic regions about the risks of TB and need for testing for latent TB infection (LTBI) upon return. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening
21	[ Indicator ] Patients with HIV and latent tuberculosis infection, with no previous treatment, should receive preventive therapy with isoniazid. [ Evidence ] Patients with HIV and LTBI, no evidence of active TB, and no previous treatment for active or latent TB should receive isoniazid preventative therapy (IPT) (CDC/NIH/IDSA Grade A-I) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening
22	[ Indicator ] Antiretroviral therapy can reduce the incidence of tuberculosis in patients with HIV infection. [ Evidence ] Antiretroviral therapy may reduce incidence of tuberculosis in patients with HIV infection regardless of baseline CD4 T-cell count (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening
102	[ Indicator ] Preventive therapy with isoniazid for children with HIV infection is associated with reduced mortality and incidence of tuberculosis, but only if they do not receive antiretroviral therapy. However, if babies were immunized with the BCG vaccine, this preventive therapy may not improve TB-free survival, whether or not they have HIV. [ Evidence ] Efficacy of IPT in children with HIV infection IPT may not reduce mortality or active TB in children with HIV infection receiving ART (level 2 [mid-level] evidence) IPT in children with HIV infection not receiving ART associated with reduced mortality and incidence of TB (level 2 [mid-level] evidence) IPT may not improve TB-disease-free survival in infants with or without HIV infection immunized with Bacille Calmette–Guérin (BCG) vaccine (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Isoniazid-preventative-therapy-IPT
Prevention and Child Guardian Group dimension
28	[ Indicator ] If the mother has a positive sputum smear (sputum test) for tuberculosis, the baby should receive 6 months of preventive therapy with isoniazid, followed by immunization with the BCG vaccine. An alternative is to perform a tuberculin skin test after 3 months of isoniazid. If the test is negative, isoniazid should be stopped and the BCG vaccine given. If positive, isoniazid should be continued for another 3 months before the BCG vaccine. [ Evidence ] Breastfeeding infant - has high risk of infection from mother with smear-positive pulmonary TB and high risk of developing TB - should receive 6 months of isoniazid preventive therapy, followed by BCG immunization alternative policy is to give 3 months of isoniazid, then perform tuberculin skin test (TST) - if TST negative, isoniazid should be stopped and BCG vaccination given - if TST positive, isoniazid should be continued for another 3 months, after which it should be stopped and BCG given [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview http://www.dynamed.com/topics/dmp~AN~T905489#Recommendations
160	[ Indicator ] When a child guardian has a positive result for tuberculosis and a normal chest radiograph, the recommendations are: it is not necessary to separate the mother from the baby; no special evaluation or therapy for the baby; other family members should be evaluated for tuberculosis; and the mother can breastfeed the baby. [ Evidence ] If mother (or household contact) has positive tuberculin skin test or IGRA and normal chest x-ray(8) no separation of mother and infant required no special evaluation or therapy required for infant other household members should be evaluated for tuberculosis as positive test may represent unrecognized case of contagious tuberculosis mother can breastfeed infant [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis
161	[ Indicator ] Some measures must be taken when a child guardian has clinical symptoms or X-ray abnormalities compatible with tuberculosis. First, evaluate the baby for congenital tuberculosis and separate the guardian from the child until a complete evaluation is performed. If congenital tuberculosis is excluded, preventive therapy with isoniazid should be used for 3 to 4 months. When the child receives isoniazid, separation is no longer necessary, except under the following conditions regarding those responsible: suspected infection with drug resistant tuberculosis; low adherence to therapy; and directly observed therapy is impossible. If the mother has non-resistant tuberculosis and is treated properly for more than 2 weeks, she is allowed to breastfeed the baby. [ Evidence ] If mother (or household contact) has clinical signs and symptoms or abnormal findings on x-ray consistent with tuberculosis disease(8) immediately report to local health department evaluate infant for congenital tuberculosis separate mother (or household contact) from infant until full evaluation can be done, and if tuberculosis suspected, until mother found not to have tuberculosis mother and child both receive appropriate therapy mother understands and is willing to adhere to infection-control measures once infant receives isoniazid, separation not required unless mother (or household contact) has suspected drug resistant tuberculosis infection has poor adherence to therapy and directly observed therapy not possible women with drug-susceptible infection treated appropriately for ≥ 2 weeks may breastfeed if congenital tuberculosis excluded, give isoniazid for 3-4 months and perform skin test if skin test is positive reassess for tuberculosis disease if tuberculosis disease excluded, continue isoniazid for total of 9 months evaluate infants for signs of tuberculosis monthly during treatment if skin test is negative, and mother has good treatment adherence, discontinue isoniazid [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis
162	[ Indicator ] The following measures should be taken when a child guardian tests positive for tuberculosis, abnormal chest radiograph results and has no evidence of tuberculosis disease: the child can be considered at low risk of disease and separation is not necessary; the mother should be treated for latent tuberculosis infection; and other family members should be evaluated. [ Evidence ] If mother (or household contact) has positive skin test or IGRA and abnormal findings on chest x-ray but no evidence of tuberculosis disease(8) infant can be assumed to be at low risk of disease, and separation not necessary treat mother for latent tuberculosis infection evaluate other household members [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis
Prevention and Child Group dimension
153	[ Indicator ] Preventive therapy with isoniazid is considered for all infants and children with latent tuberculosis and no history of previous tuberculosis treatment. Therapy consists of the use of isoniazid for 6 months for children under 5 years of age. [ Evidence ] 1) consider isoniazid preventative therapy for all infants and children with latent tuberculosis infection who have no evidence of active disease or history of previous tuberculosis treatment 2) both the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend preventative therapy for children with latent tuberculosis infection (LTBI)(6, 8) WHO recommends isoniazid preventative therapy (10 mg/kg/day, maximum 300 mg/day) for 6 months to children aged < 5 years who are household or close contacts of people with tuberculosis but do not have active disease (WHO Strong recommendation, High-quality evidence) [ Reference ] 1) http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease 2) http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease
154	[ Indicator ] Preventive therapy should be initiated in all children under 4 years of age with impaired immunity who are exposed to patients with contagious tuberculosis, regardless of the results of diagnostic tests. [ Evidence ] Initiate preventative therapy in all children < 4 years old with impaired immunity exposed to patients with contagious tuberculosis regardless of diagnostic testing results [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease
157	[ Indicator ] In the prevention of tuberculosis in children with latent infection, rifapentine and isoniazid directly observed once a week for 3 months appear to be as effective as isoniazid once a day for 9 months. [ Evidence ] Directly observed rifapentine plus isoniazid once weekly for 3 months appears as effective as isoniazid once daily for 9 months in preventing tuberculosis in children with LTBI (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease
158	[ Indicator ] Four-month rifampicin may be as effective as 9-month isoniazid in children with latent tuberculosis infection. [ Evidence ] Four-month rifampicin may be as effective as 9-month isoniazid in children with LTBI (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease
Transmission and General Group dimension
131	[ Indicator ] Tuberculosis is transmitted through the air from one person to another when the bacteria are sprayed in an aerosol by a person with pulmonary tuberculosis. [ Evidence ] M. tuberculosis is spread through the air from one person to another when bacteria are aerosolized from a person with pulmonary TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Background
Transmission and General Risk Factors Group dimension
132	[ Indicator ] Risk factors for pulmonary tuberculosis are: (1) close contact with a person with infectious tuberculosis; (2) children under 5 years of age with a positive tuberculin skin test; (3) people who immigrated from regions of the world with high rates of tuberculosis; (4) groups with high rates of tuberculosis transmission, including people with HIV infection, injecting drug users and people living on the street; (5) work or reside with people at high risk of tuberculosis in facilities or institutions; (6) medical conditions that weaken the immune system such as treatment with immunosuppressive drugs, diabetes, malignancy, organ transplantation, silicosis, substance abuse disorder, severe kidney disease, or low body weight. [ Evidence ] Risk factors for developing TB include: Close contacts of a person with infectious TB disease. Children < 5 years old who have a positive tuberculin skin test. Persons who have immigrated from regions of the world with high rates of TB. Groups with high rates of TB transmission including persons with HIV infection, injection drug users, and homeless persons. Working or residing with people at high risk for TB in facilities or institutions. Medical conditions that weaken the immune system such as HIV infection, treatment with immunosuppressive medications, diabetes, malignancy, organ transplantation, silicosis, substance abuse disorder, severe kidney disease, or low body weight. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Background
Transmission and Risk Factors and HIV Group dimension
93	[ Indicator ] HIV is the most important risk factor for tuberculosis. People with HIV are 20 to 30 times more likely to develop tuberculosis than HIV-negative people. Risk factors include: (1) residence in tuberculosis-endemic regions, (2) close contact with tuberculosis patients, (3) crowded housing (including incarceration), (4) poor ventilation in home or work environments, (5) malnutrition and (6) limited access to quality health care. [ Evidence ] About 32% of patients with TB are co-infected with HIV. HIV is the single most important risk factor for TB and persons with HIV are 20-30 times more likely to develop TB than HIVnegative persons. Additional risk factors include residence in TB-endemic regions, close contact with patients with TB, crowded housing (including incarceration), poor ventilation in living or working quarters, poor nutrition, and limited access to quality health care. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Background
Transmission and Risk Factors and Children Group dimension
27	[ Indicator ] There is a high risk of infection and development of tuberculosis while breastfeeding if mothers test positive for a sputum smear (sputum test). [ Evidence ] breastfeeding infant - has high risk of infection from mother with smear-positive pulmonary TB and high risk of developing TB [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview
139	[ Indicator ] Factors associated with an increased risk of developing tuberculosis in children include recent acquisition of infection, younger age, compromised immunity (particularly HIV infection), and chronic comorbidities such as diabetes mellitus. [ Evidence ] Major risk factors for acquisition of infection include birth or residence in an endemic area, exposure to adults with active TB, and exposure to second hand smoke. Factors associated with increased risk of progressing from latent infection to active disease include recent acquisition of infection, younger age, immunocompromise, particularly HIV infection, and chronic comorbidities such as diabetes mellitus. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Background
Transmission and Risk Factors and Resistant TBs dimension
52	[ Indicator ] The risk factors for resistant tuberculosis are: (1) previous treatment exceeding one month; (2) history of treatment failure or TB relapse; (3) poor adherence or non-completion of medications during previous treatment; (4) exposure to people with this type of disease; (5) or to persons whose standard treatment is failing or has failed; (6) delayed treatment; (7) positive sputum smear (sputum test) after two months of combination therapy; (8) HIV; (9) foreign birth; (10) younger age; (11) female; (12) previous arrest; (13) and residence or travel to an area with a high prevalence of drug resistant tuberculosis. [ Evidence ] 1) Risk factors for MDR and XDR TB: - prior TB treatment (> 1 month) - failure of a TB treatment regimen containing second-Line drugs including an injectable agent and a fluoroquinolone - close contact with a patient with MDR TB, XDR TB, or with a patient whose treatment regimen including second-line drugs is failing or has failed - delayed treatment - HIV - foreign birth - younger age - female sex - previous imprisonment 2) Risk factors for MDR TB include: exposure to persons with MDR TB a history of TB with treatment failure or relapse poor adherence to or not completing anti- TB medications during previous TB treatment positive sputum smears after 2 months of standard anti-TB combination therapy residence in or travel to area with a high prevalence of drug resistance [ Reference ] 1) http://www.dynamed.com/topics/dmp~AN~T908130#Background 2) http://www.dynamed.com/topics/dmp~AN~T907301#Background
Symptoms and General Group dimension
133	[ Indicator ] Symptoms suggestive of pulmonary tuberculosis are fever, fatigue, weight loss, night sweats, cough, or hemoptysis (blood in the sputum). These symptoms combined with pleuritis (chest pain on inspiration and expiration) can also indicate tuberculosis. [ Evidence ] 1) Suspect pulmonary tuberculosis (TB) in patients with suggestive symptoms including fever, fatigue, weight loss, night sweats, cough, or hemoptysis. 2) inflammation of parietal pleura resulting in sudden and intense chest pain on inhalation and exhalation(1) ask about symptoms that may appear in combination with pain malaise may indicate malignancy(3) pleural effusion(1) tuberculosis(1) rheumatoid arthritis(1) weight loss may indicate malignancy(3) pleural effusion(1) tuberculosis(1) rheumatoid arthritis(1) fever may indicate(1) pneumonia tuberculosis familial Mediterranean fever systemic lupus erythematosus medication-induced pleuritis (Clin Chest Med 2004 Mar;25(1):141) other infection night sweats may indicate malignancy(3) pleural effusion (including malignant pleural effusion)(1) tuberculosis(1) rheumatoid arthritis(1) 3) Diagnostic testing for cause of hemoptysis may include: - blood tests, including coagulation testing and interferon-gamma release assay or Mantoux screen if suspected tuberculosis [ Reference ] 1) http://www.dynamed.com/topics/dmp~AN~T116300#Evaluation 2) http://www.dynamed.com/topics/dmp~AN~T922350#Description http://www.dynamed.com/topics/dmp~AN~T922350#History-of-present-illness-HPI 3) http://www.dynamed.com/topics/dmp~AN~T920582#Evaluation
Symptoms and Children Group dimension
144	[ Indicator ] Symptoms suggestive of tuberculosis in children are cough and/or fever, weight loss or failure to thrive, lymphadenopathy (enlarged lymph nodes), hepato/splenomegaly (enlarged liver/ spleen), meningitis, ascites, or others. [ Evidence ] Consider the diagnosis of tuberculosis (TB) in children born in endemic areas or with known exposure to an adult with active TB, presenting with cough and/or fever, weight loss or failure to thrive, lymphadenopathy, hepato- or splenomegaly, meningitis or ascites, or other suggestive signs and symptoms. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation
Diagnosis and General Group dimension
130	[ Indicator ] Pulmonary tuberculosis is the clinical syndrome of infection of the respiratory system caused by the mycobacterium tuberculosis. [ Evidence ] Pulmonary tuberculosis (TB) refers to the clinical syndrome associated with infection of the respiratory system caused by Mycobacterium tuberculosis. The World Health Organization estimates that in 2017, 10 million people developed TB and 1.6 million died from the disease, with 9,093 cases reported in the United States. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Background
134	[ Indicator ] The diagnosis of pulmonary tuberculosis is confirmed with the identification of mycobacteria in the respiratory sample of patients with symptoms of the disease. Tests used for diagnosis include sputum smear (sputum test), nucleic acid amplification test, and liquid and solid mycobacterial culture test (gold standard for diagnosis). The diagnosis is often complemented with radiological abnormalities of the chest and evidence of the immune response by the tuberculin skin test and/or by the interferon gamma release test. [ Evidence ] Identification of Mycobacterium tuberculosis in respiratory specimen confirms diagnosis of pulmonary TB in patients with compatible clinical symptoms. Tests used for bacteriologic diagnosis include: Acid fast bacillus (AFB) smear microscopy, though this test is not specific to M. tuberculosis. Nucleic acid amplification testing (NAAT). Liquid and solid mycobacterial culture (gold standard for diagnosis). Diagnosis often supplemented with additional evidence such as: Chest x-ray abnormalities. Evidence of immune response by tuberculin skin test (TST) and/or interferon gamma release assay (IGRA), though these tests will also be positive in patients with previously treated TB or latent TB infection. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Evaluation
Diagnosis and HIV Group dimension
12	[ Indicator ] The diagnosis of tuberculosis in patients with HIV is challenging due to the high frequency of negative cases on sputum smear (sputum test), the atypical radiographic presentation, and even extrapulmonary manifestations. [ Evidence ] Diagnosis of tuberculosis (TB) in patients with HIV is challenging due to high frequency of smear-negative cases, atypical radiographic presentation, and extrapulmonary manifestations. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation
13	[ Indicator ] All patients with HIV and suspected tuberculosis should have a chest X-ray immediately. For symptomatic patients with normal chest radiographs, sputum test and culture should be considered. [ Evidence ] All patients with suspected TB should have chest x-ray early in the course of investigation (Strong recommendation). - Radiologic presentation of chest x-ray varies with state of immunodeficiency. - In patients with CD4 T-cell count > 350 cells/mm3, presentation may resemble that in patients uninfected with HIV including upper lobe infiltrates, cavitation, and pleural disease. - In patients with profound immunocompromise, cavitation is less common and x-ray findings may include pleural effusion, lower or middle lobe infiltrates, miliary infiltrates, mediastinal adenopathy, interstitial nodules, or normal x-ray. - Consider sputum smear and culture in symptomatic patients with normal chest x-rays. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation
Diagnosis and Children Group dimension
145	[ Indicator ] Children with suspected tuberculosis infection should have a tuberculin skin test or interferon gamma release test. If the result is positive, they should have a complete physical examination, including a careful neurological evaluation and a chest X-ray. If the result is negative, further evaluation is considered in children who remain at risk of acquiring tuberculosis, as a negative result does not exclude active disease. [ Evidence ] Screen children with suspected latent or active infection using either a tuberculin skin test (TST) or interferon gamma release assay (IGRA). TST is preferred in children < 5 years old, but IGRA is preferred in children ≥ 5 years old with history of bacille Calmette-Guérin (BCG) vaccination. Either test is acceptable in children > 5 years old who lack a history of BCG vaccination. In children who screen positive, perform a thorough physical examination, including a careful neurologic assessment and a chest x-ray. In children who screen negative, consider additional evaluation in those who remain at increased risk for TB, as a negative result does not rule out active disease. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation
146	[ Indicator ] In the absence of bacterial confirmation, the diagnosis of tuberculosis can be made clinically based on risk factors, symptoms, and/or chest X-ray features. [ Evidence ] In the absence of bacterial confirmation, the diagnosis can be made clinically based on risk factors, signs and symptoms and/or characteristic chest x-ray findings. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation
Diagnosis and Resistant TB Group dimension
51	[ Indicator ] Multi-resistant tuberculosis is the form of tuberculosis resistant to at least isoniazid and rifampicin. Extensively resistant tuberculosis, in addition to these two drugs, is resistant to any fluoroquinolone and at least one of the three injectable drugs: amikacin, kanamycin or capreomycin. [ Evidence ] 1) MDR TB is defined as TB caused by Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin. An estimated 460,000 cases of MDR TB emerged globally in 2017. 2) XDR TB is defined as TB caused by Mycobacterium tuberculosis resistant to isoniazid, rifampicin, any fluoroquinolone, and at least 1 of 3 injectable second-line drugs (amikacin, kanamycin, or capreomycin). [ Reference ] 1) http://www.dynamed.com/topics/dmp~AN~T907301#Background 2) http://www.dynamed.com/topics/dmp~AN~T908130#Background
105	[ Indicator ] The signs of multi and extensively resistant tuberculosis do not differ from common tuberculosis. The diagnosis is traditionally confirmed with culture and drug susceptibility testing. [ Evidence ] 1) The clinical presentation of MDR TB does not differ from that of drug-susceptible TB. MDR TB diagnosis is traditionally confirmed with culture and drug-susceptibility testing. 2) Clinical presentation of XDR TB does not differ from that of drug-susceptible TB. XDR TB diagnosis is confirmed with culture and drug-susceptibility testing. [ Reference ] 1) http://www.dynamed.com/topics/dmp~AN~T907301#Evaluation 2) http://www.dynamed.com/topics/dmp~AN~T908130#Evaluation
Treatment and General Group dimension
58	[ Indicator ] Every patient hospitalized with suspected tuberculosis should be allocated to airborne infection isolation with appropriate infection control measures for both healthcare workers and visitors. [ Evidence ] Any hospitalized patient with suspected TB or who has acid-fast bacilli (AFB) smear-positive sputum should be placed in airborne infection isolation with appropriate infection control measures for providers and visitors. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Management
115	[ Indicator ] Directly observed therapy is preferable to self-administered therapy for the routine treatment of patients with all forms of tuberculosis. [ Evidence ] Directly observed therapy (DOT) is preferred over self-administered therapy (SAT) for routine treatment of patients with all forms of tuberculosis (Weak recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Management
135	[ Indicator ] The recommended treatment for pulmonary tuberculosis is: initial phase of two months with isoniazid, rifampicin, pyrazinamide and ethambutol; and a 4-month continuation phase with isoniazid plus rifampicin. [ Evidence ] The recommended empiric treatment for newly diagnosed pulmonary TB caused by Mycobacterium tuberculosis susceptible to all first-line drugs is a 2-month initial or intensive phase followed by a 4-month continuation phase (Strong recommendation). The 2-month initial phase consists of isoniazid, rifampicin, pyrazinamide, plus ethambutol. The 4-month continuation phase consists of isoniazid plus rifampicin. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Management
Treatment and HIV Group dimension
17	[ Indicator ] Treatment in patients with HIV and suspected tuberculosis should be started immediately, even before the full diagnosis is confirmed. Treatment regimens for adults with HIV infection follow the same principles as treatment for adults without HIV. [ Evidence ] Start empiric treatment in patients with HIV and suspected tuberculosis (TB) until diagnostic work-up is complete (Strong recommendation). - Recommendations for antituberculosis treatment regimens in adults with HIV infection follow the same principles as for adults without HIV infection. - Initial phase consists of a 4-drug regimen of isoniazid (INH), rifampicin (or rifabutin), pyrazinamide, and ethambutol daily for 2 months (Strong recommendation). - Continuation phase consists of a 2-drug regimen of INH plus rifampicin (or rifabutin) daily for drug-susceptible TB (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Management
18	[ Indicator ] Corticosteroids are recommended for the treatment of tuberculosis in HIV patients with central nervous system involvement or pericardial disease. [ Evidence ] Corticosteroids are recommended for patients with CNS or pericardial disease (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Management
Treatment and Resistant TB Group dimension
55	[ Indicator ] Multi- and extensively resistant tuberculosis should only be treated by specialists in these types of disease. Before obtaining drug susceptibility test results, appropriate treatment should be initiated in patients suspected of having these types of tuberculosis. [ Evidence ] 1) MDR TB should be managed by experts with experience in the treatment of drug-resistant TB. Prior to receipt of drug-susceptibility testing results, empiric treatment for MDR TB should be started in those in whom MDR TB is suspected. 2) XDR TB should be managed by only those expert in the treatment of drug-resistant TB. Prior to receipt of drug-susceptibility testing results, empiric treatment for XDR TB should be started in those in whom XDR TB is suspected. [ Reference ] 1) http://www.dynamed.com/topics/dmp~AN~T907301#Management 2) http://www.dynamed.com/topics/dmp~AN~T908130#Management
56	[ Indicator ] Treatment of extensively drug-resistant tuberculosis is guided by the results of drug susceptibility testing as follows: always try to use 3 or more previously unused drugs that have passed testing and consider regimens of four to six drugs, including one injectable. [ Evidence ] Treatment is guided by drug-susceptibility testing results: - Always try to use ≥ 3 previously unused drugs that have demonstrated in vitro susceptibility and consider regimens with 4-6 medications, including an injectable (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Management
57	[ Indicator ] For treatment of extensively resistant tuberculosis, therapy directly observed at home or in hospital should be performed daily. [ Evidence ] - Institute daily hospital-based or home-based directly observed therapy (DOT) (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Management
107	[ Indicator ] The initial treatment of multidrug-resistant tuberculosis includes at least 5 antibiotics. It lasts at least 9 to 12 months. It may last longer depending on the results of drug susceptibility tests. [ Evidence ] Initial treatment includes ≥ 5 antibiotics. Duration is at least 9-12 months, and may be longer depending on drug susceptibility results. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T907301#Management
108	[ Indicator ] None of the potential treatments for people infected with multidrug resistant tuberculosis have been fully tested for efficacy and these treatments are often poorly tolerated. [ Evidence ] None of the potential regimens for persons infected with MDR TB have been tested fully for efficacy, and these regimens are often poorly tolerated [ Reference ] http://www.dynamed.com/topics/dmp~AN~T907301#Contact-investigation
Treatment and Side Effects Group dimension
136	[ Indicator ] The treatment of pulmonary tuberculosis with isoniazid should be supplemented with pyridoxine to prevent side effects in patients with nutritional deficiency, diabetes, HIV infection, renal failure, alcoholism, in pregnant and lactating women and in children. [ Evidence ] Supplement isoniazid treatment with pyridoxine 25 mg/day in patients with nutritional deficiency, diabetes, HIV infection, renal failure, or alcoholism, in pregnant and breastfeeding women, and in children to prevent adverse events. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Management

Id	Indicator	Evaluation	Excerpt extracted from the topic 'Tuberculosis' of the Glossary 'Health from A to Z' of the Ministry of Health
Prevention and BCG Group dimension
23	The BCG vaccine should be given soon after birth in countries with a high prevalence of tuberculosis. It should also be applied if there is no information about the mother having HIV, as the benefits outweigh the risks.	Incomplete	The BCG (Bacillus Calmette-Guérin) vaccine, offered in the Unified Health System (SUS), protects children from the most severe forms of the disease, such as miliary tuberculosis and meningeal tuberculosis. The vaccine is available in the vaccination rooms of the basic health units and some maternity hospitals. IMPORTANT: This vaccine must be given to children at birth, or, at most, up to four years, 11 months and 29 days.
26	Babies should not be vaccinated with BCG in the following two cases: suspected HIV infection; or born to women with HIV.	Not found
29	In countries with a low prevalence of tuberculosis, the BCG vaccine should only be considered for children under the following conditions: negative skin test for tuberculosis; continuous exposure to tuberculosis; and cannot receive long-term primary preventive treatment. Besides these conditions, the vaccine should be considered if children cannot be separated from adults under the following conditions: ineffectively treated for tuberculosis; did not receive treatment; or have strains of tuberculosis resistant to isoniazid and rifampicin.	Not found
41	Revaccination of the BCG vaccine as a booster is not recommended. Moreover, the vaccine is unreliable against pulmonary tuberculosis for older adults and children.	Not found
Prevention and HIV Group dimension
20	HIV patients traveling or working in TB endemic regions should be counseled about the risks of the disease and the need to be tested for latent TB infection.	Complete	Thus, diagnosing and treating LTBI is an important prevention strategy to prevent the development of the active form of the disease, especially for: - household contacts of people diagnosed with TB - children - HIV infection - people using immunosuppressive treatments IMPORTANT: Latent infection with Mycobacterium tuberculosis should be investigated and treated and active tuberculosis diagnosed and treated early for people living with HIV.
21	Patients with HIV and latent tuberculosis infection, with no previous treatment, should receive preventive therapy with isoniazid.	Incomplete	Thus, it is important that the health team evaluate the contacts of people with TB and offer the exam for the diagnosis of LTBI to the population groups mentioned above, per the criteria for indicating the preventive treatment. Learn more about the Surveillance Protocol for Latent Infection by Mycobacterium tuberculosis in Brazil
22	Antiretroviral therapy can reduce the incidence of tuberculosis in patients with HIV infection.	Incomplete	Early diagnosis of HIV infection in people with tuberculosis and timely initiation of antiretroviral treatment reduce mortality.
102	Preventive therapy with isoniazid for children with HIV infection is associated with reduced mortality and incidence of tuberculosis, but only if they do not receive antiretroviral therapy. However, if babies were immunized with the BCG vaccine, this preventive therapy may not improve TB-free survival, whether or not they have HIV.	Not found
Prevention and Child Guardian Group dimension
28	If the mother has a positive sputum smear (sputum test) for tuberculosis, the baby should receive 6 months of preventive therapy with isoniazid, followed by immunization with the BCG vaccine. An alternative is to perform a tuberculin skin test after 3 months of isoniazid. If the test is negative, isoniazid should be stopped and the BCG vaccine given. If positive, isoniazid should be continued for another 3 months before the BCG vaccine.	Not found
160	When a child guardian has a positive result for tuberculosis and a normal chest radiograph, the recommendations are: it is not necessary to separate the mother from the baby; no special evaluation or therapy for the baby; other family members should be evaluated for tuberculosis; and the mother can breastfeed the baby.	Not found
161	Some measures must be taken when a child guardian has clinical symptoms or X-ray abnormalities compatible with tuberculosis. First, the baby should be evaluated for congenital tuberculosis and the guardian should be separated from the child until a complete evaluation is carried out. If congenital tuberculosis is excluded, preventive therapy with isoniazid should be used for 3 to 4 months. When the child receives isoniazid, separation is no longer necessary, except under the following conditions regarding those responsible: suspected infection with drug resistant tuberculosis; low adherence to therapy; and directly observed therapy is not possible. If the mother has non-resistant tuberculosis and is treated properly for more than 2 weeks, she is allowed to breastfeed the baby.	Not found
162	The following measures should be taken when a child guardian tests positive for tuberculosis, abnormal chest radiograph results, with no evidence of tuberculosis disease: the child can be considered at low risk of disease and separation is not necessary; the mother should be treated for latent tuberculosis infection; and other family members should be evaluated.	Not found
Prevention and Child Group dimension
153	Preventive therapy with isoniazid is considered for all infants and children with latent tuberculosis and no history of previous tuberculosis treatment. Therapy consists of the use of isoniazid for 6 months for children under 5 years of age.	Not found
154	Preventive therapy should be initiated in all children under 4 years of age with impaired immunity who are exposed to patients with contagious tuberculosis, regardless of the results of diagnostic tests.	Not found
157	In the prevention of tuberculosis in children with latent infection, rifapentine and isoniazid directly observed once a week for 3 months appear to be as effective as isoniazid once a day for 9 months.	Not found
158	4-month rifampicin may be as effective as 9-month isoniazid in children with latent tuberculosis infection.	Not found
Transmission and General Group dimension
131	Tuberculosis is transmitted through the air from one person to another when the bacteria are sprayed in an aerosol by a person with pulmonary tuberculosis.	Complete	Tuberculosis transmission occurs via the respiratory route, through the elimination of aerosols produced by coughing, speaking or sneezing of a person with active (pulmonary or laryngeal) TB, without treatment; and inhalation of aerosols by a susceptible individual.
Transmission and General Risk Factors Group dimension
132	Risk factors for pulmonary tuberculosis are: (1) close contact with a person with infectious tuberculosis; (2) children under 5 years of age with a positive tuberculin skin test; (3) people who immigrated from regions of the world with high rates of tuberculosis; (4) groups with high rates of tuberculosis transmission, including people with HIV infection, injecting drug users and people living on the street; (5) work or reside with people at high risk of tuberculosis in facilities or institutions; (6) medical conditions that weaken the immune system such as treatment with immunosuppressive drugs, diabetes, malignancy, organ transplantation, silicosis, substance abuse disorder, severe kidney disease, or low body weight.	Incomplete	Besides factors related to each person’s immune system and exposure to the bacillus, illness from tuberculosis is often linked to substandard living conditions. Thus, some population groups may be in greater vulnerability. The table below shows some of these populations and their respective risks of illness compared to the general population. Poorly ventilated cells, reduced sunlight and difficult access to health services: these are some of the factors that contribute to the high number of tuberculosis cases in the prison system.
Transmission and Risk Factors and HIV Group dimension
93	HIV is the most important risk factor for tuberculosis. People with HIV are 20 to 30 times more likely to develop tuberculosis than HIV-negative people. Risk factors include: (1) residence in tuberculosisendemic regions, (2) close contact with tuberculosis patients, (3) crowded housing (including incarceration), (4) poor ventilation in home or work environments, (5) malnutrition and (6) limited access to quality health care.	Incomplete	People Living with HIV (PLHIV) Tuberculosis in people living with HIV is one of the conditions with the greatest impact on HIV and tuberculosis mortality in the country. These people are at higher risk of developing TB, and are often only diagnosed with HIV infection during investigation/confirmation of TB.
Transmission and Risk Factors and Children Group dimension
27	There is a high risk of infection and development of tuberculosis while breastfeeding if mothers have a positive sputum smear test.	Not found
139	Factors associated with an increased risk of developing tuberculosis in children include recent acquisition of infection, younger age, compromised immunity (particularly HIV infection), and chronic comorbidities such as diabetes mellitus.	Not found
Transmission and Risk Factors and Resistant TBs dimension
52	The risk factors for resistant tuberculosis are: (1) previous treatment for more than one month; (2) history of treatment failure or relapse of tuberculosis; (3) poor adherence or non-completion of medications during previous treatment; (4) exposure to people with this type of disease; (5) or to people whose standard treatment is failing or has failed; (6) delayed treatment; (7) positive sputum smear (sputum test) after two months of combination therapy; (8) HIV; (9) foreign birth; (10) younger age; (11) female; (12) previous arrest; (13) and residence or travel to an area with a high prevalence of drug-resistant tuberculosis.	Not found
Dimensão Sintomas e Grupo Geral
133	Symptoms suggestive of pulmonary tuberculosis are fever, fatigue, weight loss, night sweats, hemoptysis (blood in the sputum), or coughing for two or more weeks. These symptoms combined with pleuritis (chest pain on inspiration and expiration) can also indicate tuberculosis.	Incorrect	What are TB symptoms? - Cough for 3 weeks or more - Evening fever - Night sweats - Slimming The main symptom of pulmonary tuberculosis is coughing. This cough can be dry or productive (with phlegm). IMPORTANT: It is recommended that every person with respiratory symptoms, that is, who has had a cough for three weeks or more, be investigated for tuberculosis.
Dimensão Sintomas e Grupo Children
144	Symptoms suggestive of tuberculosis in children are cough and/or fever, weight loss or failure to thrive, lymphadenopathy (enlarged lymph nodes), hepato- splenomegaly (enlarged liver/spleen), meningitis, ascites, or others.	Not found
Dimensão Diagnóstico e Grupo Geral
130	Pulmonary tuberculosis is the clinical syndrome of infection of the respiratory system caused by the mycobacteria tuberculosis.	Incomplete	Tuberculosis is an infectious and transmissible disease caused by the bacterium Mycobacterium tuberculosis, also known as Koch’s bacillus. The disease primarily affects the lungs (pulmonary form), although it can affect other organs and/or systems.
134	The diagnosis of pulmonary tuberculosis is confirmed with the identification of mycobacteria in the respiratory sample of patients with symptoms of the disease. Tests used for diagnosis include sputum smear (sputum test), nucleic acid amplification test, and liquid and solid mycobacterial culture test (gold standard for diagnosis). The diagnosis is often complemented with radiological abnormalities of the chest and evidence of the immune response by the tuberculin skin test and/or by the interferon gamma release test	Incomplete	How is TB diagnosed? The following tests are used to diagnose TB: - smear - rapid molecular test for tuberculosis - culture for mycobacteria IMPORTANT: These tests are essential to identify the tuberculosis bacillus and are used to confirm the bacteriological diagnosis of the disease.
Diagnosis and HIV Group dimension
12	The diagnosis of tuberculosis in patients with HIV is challenging due to the high frequency of negative cases on sputum smear (sputum test), the atypical radiographic presentation, and even extrapulmonary manifestations.	Incomplete	ATTENTION: For the diagnosis of tuberculosis among the most vulnerable populations (deprived of liberty, indigenous people, people living with HIV, people living on the street, and health professionals), it is recommended that everyone with cough REGARDLESS OF THE TIME OF DURATION and/or chest X-ray suggestive of tuberculosis be evaluated by the health team and perform sputum collection for sputum smear or TRM-TB, culture and sensitivity test.
13	All patients with HIV and suspected tuberculosis should have a chest X-ray immediately. Sputum tests and culture should be considered for symptomatic patients with normal chest radiographs.	Incomplete	ATTENTION: For the diagnosis of tuberculosis among the most vulnerable populations (deprived of liberty, indigenous people, people living with HIV, people living on the street, and health professionals), it is recommended that everyone with cough REGARDLESS OF THE TIME OF DURATION and/or chest X-ray suggestive of tuberculosis be evaluated by the health team and perform sputum collection for sputum smear or TRM-TB, culture and sensitivity test.
Dimensão Diagnóstico e Grupo Children
145	Children with suspected tuberculosis infection should have a tuberculin skin test or interferon gamma release test. If the result is positive, they should have a complete physical examination, including a careful neurological evaluation and a chest X-ray. If the result is negative, further evaluation is considered in children who remain at risk of acquiring tuberculosis, as a negative result does not exclude active disease.	Not found
146	TB diagnosis can be made clinically based on risk factors, symptoms, and/or chest X-ray features In the absence of bacterial confirmation.	Not found
Diagnosis and Resistant TB Group dimension
51	Multi-resistant tuberculosis is the form of tuberculosis resistant to at least isoniazid and rifampicin. Extensively resistant tuberculosis, in addition to these two drugs, is resistant to any fluoroquinolone and at least one of the three injectable drugs: amikacin, kanamycin or capreomycin.	Not found
105	The signs of multi and extensively resistant tuberculosis do not differ from common tuberculosis. The diagnosis is traditionally confirmed with culture and drug susceptibility testing.	Not found
Treatment and General Group dimension
58	Every patient hospitalized with suspected tuberculosis should be allocated to airborne infection isolation with appropriate infection control measures for both healthcare workers and visitors.	Not found
115	Directly observed therapy is preferable to self-administered therapy for the routine treatment of patients with all forms of tuberculosis.	Incomplete	One of the main strategies to promote treatment adherence is Directly Observed Treatment (DOT). DOT consists of observing the person with tuberculosis taking the medication under the observation of a health professional or other trained professionals, such as social assistance professionals, among others, provided they are supervised by health professionals. This treatment regimen should ideally be carried out on every working day of the week, or exceptionally, three times a week. The place and time for performing DOT must be agreed with the person and with the health service.
135	The recommended treatment for pulmonary tuberculosis is: initial phase of two months with isoniazid, rifampicin, pyrazinamide and ethambutol; and a 4-month continuation phase with isoniazid plus rifampicin.	Incomplete	Tuberculosis treatment lasts at least six months, is free of charge and is available through the Unified Health System (SUS). Four drugs are used for the treatment of tuberculosis cases using the basic regimen: rifampicin, isoniazid, pyrazinamide, and ethambutol.
Treatment and HIV Group dimension
17	Treatment in patients with HIV and suspected tuberculosis should be started immediately, even before the full diagnosis is confirmed. Treatment regimens for adults with HIV infection follow the same principles as treatment for adults without HIV.	Not found
18	Corticosteroids are recommended for the treatment of tuberculosis in patients with HIV who have central nervous system involvement or pericardial disease.	Not found
Treatment and Resistant TB Group dimension
55	Multi- and extensively resistant tuberculosis should only be treated by experts in these types of disease. Before obtaining drug susceptibility test results, appropriate treatment should be initiated in patients suspected of having these TB types.	Not found
56	Treatment of extensively drug-resistant tuberculosis is guided by the results of drug susceptibility testing as follows: always try to use 3 or more previously unused drugs that have passed testing and consider regimens of four to six drugs, including one injectable.	Not found
57	Directly observed therapy at home or in hospital should be performed daily for treatment of extensively resistant tuberculosis.	Not found
107	The initial treatment of multidrug-resistant tuberculosis includes at least 5 antibiotics. It lasts at least 9 to 12 months. It may last longer depending on the results of drug susceptibility tests.	Not found
108	None of the potential treatments for people infected with multidrug resistant tuberculosis have been fully tested for efficacy and these treatments are often poorly tolerated.	Not found
-Treatment and Side Effects Group dimension
136	the treatment of pulmonary tuberculosis with isoniazid should be supplemented with pyridoxine to prevent side effects in patients with nutritional deficiency, diabetes, HIV infection, renal failure, alcoholism, in pregnant and lactating women, and in children.	Not found

Id	Indicators	Topics	Groups	Registration dates
1	[ Indicator ] Abdominal tuberculosis is a form of extrapulmonary tuberculosis that involves the peritoneum, the gastrointestinal tract, solid organs such as the liver, spleen, and pancreas, or abdominal lymph nodes. It is responsible for about 5% of cases of extrapulmonary tuberculosis. [ Evidence ] Abdominal tuberculosis (TB) is a form of extrapulmonary tuberculosis involving the peritoneum, the gastrointestinal tract, solid organs such as the liver, spleen, and pancreas, or abdominal lymph nodes. Abdominal TB accounts for about 5% of cases of extrapulmonary TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Background	Abdominal tuberculosis	- Definitions	17/07/2019 at 14:47
2	[ Indicator ] Abdominal tuberculosis can be contracted in the as follows: ingestion of infected food or milk; transmission through the bloodstream from the lung or other infected body site; or even through the spread of adjacent organs or lymphnodes. [ Evidence ] Infection may result from ingestion of infected food or milk, swallowing infected sputum, hematogenous spread from the primary pulmonary site or other site of infection, or direct spread from adjacent organs or lymph nodes. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Background	Abdominal tuberculosis	- Transmission	17/07/2019 at 14:57
3	[ Indicator ] Abdominal tuberculosis symptoms may be nonspecific: fever, weight loss, abdominal pain or tenderness, bloating, constipation, diarrhea, enlarged liver, or an enlarged spleen. [ Evidence ] Patients may present with nonspecific symptoms including fever and weight loss. Other symptoms may include abdominal pain or tenderness, abdominal distention, constipation, diarrhea, hepatomegaly, or splenomegaly. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Background	Abdominal tuberculosis	- Symptoms	17/07/2019 at 15:06
4	[ Indicator ] Risk factors for abdominal tuberculosis include alcoholic liver disease and cirrhosis, continuous ambulatory peritoneal dialysis for chronic kidney failure, diabetes mellitus, and HIV infection. [ Evidence ] Risk factors for abdominal TB include alcoholic liver disease and cirrhosis, continuous ambulatory peritoneal dialysis for chronic renal failure, diabetes mellitus, and HIV infection. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Background	Abdominal tuberculosis	- Risk factor - Transmission	17/07/2019 at 15:17
5	[ Indicator ] The diagnosis of abdominal tuberculosis should include images of the suspected site. Images including barium studies, CT scans, and abdominal ultrasound may be helpful. [ Evidence ] The diagnostic evaluation should include imaging of the suspected site of involvement. Imaging including barium studies, computed tomography (CT) scans, and an abdominal ultrasound may be helpful to visualize findings associated with abdominal tuberculosis (TB), including strictures, fistulae, erosions, regional adenopathy, thickened omentum, or ascitic fluid. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Evaluation	Abdominal tuberculosis	- Diagnosis	17/07/2019 at 15:23
6	[ Indicator ] An ascitic fluid (excessive fluid in the abdominal cavity) culture or a biopsy sample is required for the definitive diagnosis of abdominal tuberculosis. [ Evidence ] A culture of ascitic fluid or of a biopsy specimen is required for definitive diagnosis, and drug-susceptibility testing aids in the selection of the proper anti-TB therapy. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Evaluation	Abdominal tuberculosis	- Diagnosis	17/07/2019 at 15:27
7	[ Indicator ] If abdominal tuberculosis is confirmed, a chest X-ray is required because of a possible concomitant lung disease. [ Evidence ] Because of the possibility of concomitant pulmonary disease, perform a chest x-ray for all persons with confirmed or suspected abdominal TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Evaluation	Abdominal tuberculosis	- Diagnosis	17/07/2019 at 15:31
8	[ Indicator ] Treatment of abdominal tuberculosis follows the standard multidrug anti-tuberculosis regimen: intensive initial phase with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months; and a continuation phase with isoniazid and rifampicin for 4 months. [ Evidence ] Treat patients with abdominal TB caused by drug-susceptible organisms with the standard antituberculosis multidrug regimen: - initial intensive phase with isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months - continuation phase with isoniazid and rifampicin for 4 months [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Management	Abdominal tuberculosis	- Treatment	17/07/2019 at 15:36
9	[ Indicator ] Patients in whom drug-resistant abdominal TB is suspected or confirmed should be treated based on the drug susceptibility profile and after consulting with an expert. [ Evidence ] Treat patients with suspected or confirmed drug-resistant organisms based on the drug-susceptibility profile and in consultation with an expert. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910286#Management	Abdominal tuberculosis	- Treatment - Resistant tuberculosis	17/07/2019 at 15:42
10	[ Indicator ] HIV infection is the most important risk factor for tuberculosis, as people with HIV are 20 to 30 times more likely to develop the disease. [ Evidence ] HIV infection is the most important risk factor for TB, and persons with HIV are 20-30 times more likely to develop TB than persons who are HIV-negative. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Background	Active tuberculosis in patients with HIV infection	- Risk factor - HIV	17/07/2019 at 16:11
11	[ Indicator ] Additional risk factors for people with HIV include residence in TB-endemic regions, close contact with TB patients, crowded housing (including incarceration), poor ventilation in living or working environments, poor nutrition, and limited access to quality health care. [ Evidence ] Additional risk factors include residence in TB-endemic regions, close contact with patients with TB, crowded housing (including incarceration), poor ventilation in living or working quarters, poor nutrition, and limited access to quality health care. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Background	Active tuberculosis in patients with HIV infection	- Risk factor - HIV - Transmission	17/07/2019 at 16:15
12	[ Indicator ] The diagnosis of tuberculosis in patients with HIV is challenging due to the high frequency of negative cases in sputum smears (sputum tests), atypical radiographic presentation, and extrapulmonary manifestations. [ Evidence ] Diagnosis of tuberculosis (TB) in patients with HIV is challenging due to high frequency of smear-negative cases, atypical radiographic presentation, and extrapulmonary manifestations. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnosis - HIV	17/07/2019 at 16:21
13	[ Indicator ] All patients with HIV and suspected TB should have a chest X-ray immediately. Consider sputum testing and culture in symptomatic patients with normal chest radiographies. [ Evidence ] All patients with suspected TB should have chest x-ray early in the course of investigation (Strong recommendation). - Radiologic presentation of chest x-ray varies with state of immunodeficiency. - In patients with CD4 T-cell count > 350 cells/mm3, presentation may resemble that in patients uninfected with HIV including upper lobe infiltrates, cavitation, and pleural disease. - In patients with profound immunocompromise, cavitation is less common and x-ray findings may include pleural effusion, lower or middle lobe infiltrates, miliary infiltrates, mediastinal adenopathy, interstitial nodules, or normal x-ray. - Consider sputum smear and culture in symptomatic patients with normal chest x-rays. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnosis - HIV	17/07/2019 at 16:31
14	[ Indicator ] Additional diagnostic tests such as needle aspiration or biopsy for histopathological examination, acid resistant bacilli, sputum, culture should be considered for patients with HIV and suspected lymphadenitis (infection of the lymph nodes) from tuberculosis, including a sample of pleural fluid, pericardial fluid, ascites, or cerebrospinal fluid, if there is evidence of involvement. [ Evidence ] Additional diagnostic testing is directed at sites of disease. - For patients with suspected TB lymphadenitis, consider needle aspiration or biopsy for histopathology, acid fast bacilli, smear, and culture. - Sample pleural fluid, pericardial fluid, ascites, or cerebrospinal fluid (CSF) if there is evidence of involvement. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnosis - HIV	17/07/2019 at 16:38
15	[ Indicator ] Consider nucleic acid amplification tests in patients with advanced immunodeficiency, as the test is faster than culture, more sensitive than sputum smear, and allows distinguishing between tuberculosis and nontuberculous mycobacterial infections. [ Evidence ] Consider nucleic acid amplification tests in patients with advanced immunodeficiency, as testing is more rapid than culture, more sensitive than smear microscopy, and allows distinction between tuberculosis and nontuberculous mycobacterial infections. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnosis - HIV	17/07/2019 at 16:43
16	[ Indicator ] Skin and interferon gamma-releasing tests (IGRAs) may be useful in supporting the diagnosis of tuberculosis if specimens are difficult to obtain for sputum and culture tests, or if specimens are not revealing. [ Evidence ] Tuberculin skin tests and interferon gamma release assays (IGRAs) may be useful to corroborate diagnosis of TB if samples for smear and culture are difficult to obtain or are unrevealing, although tests do not distinguish between latent and active disease. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnosis - HIV	17/07/2019 at 16:51
17	[ Indicator ] Treatment in patients with HIV and suspected tuberculosis should be initiated even before the full diagnosis is confirmed. Treatment regimens for adults with HIV infection follow the same principles as treatment for adults without HIV. [ Evidence ] Start empiric treatment in patients with HIV and suspected tuberculosis (TB) until diagnostic work-up is complete (Strong recommendation). - Recommendations for antituberculosis treatment regimens in adults with HIV infection follow the same principles as for adults without HIV infection. - Initial phase consists of a 4-drug regimen of isoniazid (INH), rifampicin (or rifabutin), pyrazinamide, and ethambutol daily for 2 months (Strong recommendation). - Continuation phase consists of a 2-drug regimen of INH plus rifampicin (or rifabutin) daily for drug-susceptible TB (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Management	Active tuberculosis in patients with HIV infection	- HIV - Treatment	17/07/2019 at 17:03
18	[ Indicator ] Corticosteroids are recommended for the treatment of tuberculosis in HIV patients who have central nervous system involvement or pericardial disease. [ Evidence ] Corticosteroids are recommended for patients with CNS or pericardial disease (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Management	Active tuberculosis in patients with HIV infection	- HIV - Treatment	17/07/2019 at 17:07
19	[ Indicator ] Patients with HIV infection and tuberculosis are at risk of developing immune reconstitution inflammatory syndrome (IRIS) with deteriorating signs and symptoms after initiation of antituberculosis and antiretroviral therapy. [ Evidence ] Patients with HIV infection and TB are at risk of developing immune reconstitution inflammatory syndrome (IRIS) with worsening of signs and symptoms after beginning antituberculosis and antiretroviral therapy. - Risk of IRIS is higher in those who start ART within 2 weeks of starting antituberculosis treatment compared to those who started at 8-12 weeks. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Management	Active tuberculosis in patients with HIV infection	- Side effects - HIV	17/07/2019 at 17:14
20	[ Indicator ] HIV patients traveling or working in TB endemic regions should be counseled about the risks of the disease and the need for testing for latent infection when they return. [ Evidence ] counsel patients with HIV who travel or work in tuberculosis (TB)-endemic regions about the risks of TB and need for testing for latent TB infection (LTBI) upon return. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening	Active tuberculosis in patients with HIV infection	- HIV - Prevention	17/07/2019 at 17:41
21	[ Indicator ] Patients with HIV and latent tuberculosis infection, with no previous treatment, should receive preventive therapy with isoniazid. [ Evidence ] patients with HIV and LTBI, no evidence of active TB, and no previous treatment for active or latent TB should receive isoniazid preventative therapy (IPT) (CDC/NIH/IDSA Grade A-I) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening	Active tuberculosis in patients with HIV infection	- HIV - Prevention	17/07/2019 at 17:44
22	[ Indicator ] Antiretroviral therapy can reduce the incidence of tuberculosis in patients with HIV infection. [ Evidence ] antiretroviral therapy may reduce incidence of tuberculosis in patients with HIV infection regardless of baseline CD4 T-cell count (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening	Active tuberculosis in patients with HIV infection	- HIV - Prevention	17/07/2019 at 17:46
23	[ Indicator ] The BCG vaccine should be given after birth in countries with high TB prevalence. [ Evidence ] BCG vaccination as soon as possible after birth in countries with a high tuberculosis (TB) prevalence revaccination not recommended. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Babies - Prevention	18/07/2019 at 10:59
24	[ Indicator ] Revaccination of the BCG vaccine as a booster is not recommended. [ Evidence ] revaccination not recommended [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Prevention	18/07/2019 at 11:00
25	[ Indicator ] Babies born to women with unknown HIV status should be vaccinated with BCG, as the benefits outweigh the risks. [ Evidence ] benefits outweigh risks in infants born to women of unknown HIV status and should be immunized [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Babies - HIV - Prevention	18/07/2019 at 11:02
26	[ Indicator ] Babies suspected of having HIV infection or if born to an HIV-infected woman should not be vaccinated with BCG, as the risks often outweigh the benefits. [ Evidence ] risks usually outweigh benefits for infants and should not be immunized if HIV infection is suspected or if born to woman with HIV infection [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Babies - HIV - Prevention	18/07/2019 at 11:05
27	[ Indicator ] During breastfeeding, there is a high risk of infection and development of tuberculosis by a mother with a positive sputum smear (sputum test). [ Evidence ] breastfeeding infant - has high risk of infection from mother with smear-positive pulmonary TB and high risk of developing TB - should receive 6 months of isoniazid preventive therapy, followed by BCG immunization [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Breastfeeding - Babies - Transmission	18/07/2019 at 11:17
28	[ Indicator ] If the mother has a positive sputum smear (sputum test) for tuberculosis, the baby should receive 6 months of preventive therapy with isoniazid, followed by immunization with the BCG vaccine. An alternative is to perform a tuberculin skin test after 3 months of isoniazid. If the test is negative, isoniazid should be stopped and the BCG vaccine given. If positive, isoniazid should be continued for another 3 months before the BCG vaccine. [ Evidence ] breastfeeding infant - has high risk of infection from mother with smear-positive pulmonary TB and high risk of developing TB - should receive 6 months of isoniazid preventive therapy, followed by BCG immunization alternative policy is to give 3 months of isoniazid, then perform tuberculin skin test (TST) - if TST negative, isoniazid should be stopped and BCG vaccination given - if TST positive, isoniazid should be continued for another 3 months, after which it should be stopped and BCG given [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview http://www.dynamed.com/topics/dmp~AN~T905489#Recommendations	Bacille Calmette- Guerin vaccine (BCG)	- Breastfeeding - Babies - Prevention	18/07/2019 at 11:20
29	[ Indicator ] In countries with a low prevalence of tuberculosis, the BCG vaccine should only be considered for children in the following conditions: negative skin test for tuberculosis; continuous exposure to tuberculosis; cannot be separated from adults who are ineffectively/untreated for tuberculosis or have isoniazid and rifampicin resistant strains of tuberculosis; and cannot receive long-term primary preventive treatment. [ Evidence ] Centers for Disease Control and Prevention (CDC) recommendations - consider BCG vaccination only in children - with negative TB skin test - with continual exposure - who cannot be separated from adults who - are ineffectively treated or untreated for TB and child cannot be given longterm primary preventive treatment for TB infection - have TB strains resistant to isoniazid and rifampicin [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Children - Prevention - Resistant tuberculosis	18/07/2019 at 11:35
30	[ Indicator ] The BCG vaccine for healthcare professionals should be considered on a case-by-case basis under the following conditions: high percentage of patients with tuberculosis resistant to isoniazid and rifampicin; continuous transmission of resistant tuberculosis to health professionals; and when precautions taken to control tuberculosis are unsuccessful. [ Evidence ] consider BCG vaccination in healthcare workers on case-by-case basis in settings with - high percentage of TB patients infected with TB strains resistant to isoniazid and rifampicin - ongoing transmission of drug-resistant TB strains to healthcare workers and subsequent infection likely - comprehensive TB infection-control precautions implemented but not successful [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Prevention - Health professional - Resistant tuberculosis	18/07/2019 at 11:41
31	[ Indicator ] Bone and joint tuberculosis can involve any bone in the body. About half of the cases involve the spine of which half in the thoracic spine. Common extraspinal sites are the large bones and weight-bearing joints, including the hip, knee, foot, and ankle. About 10% of patients with extrapulmonary tuberculosis are compromised by it. [ Evidence ] About 10% of patients with extrapulmonary tuberculosis (TB) have skeletal involvement. Skeletal TB can involve nearly any bone in the body. - About one-half of cases involve the spine, and one-half of those are located in the thoracic spine. - Large weight-bearing bones and joints including the hip, knee, foot, and ankle are common extra-spinal sites. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Background	Bone and joint tuberculosis	- Definitions	18/07/2019 at 11:55
32	[ Indicator ] Bone tuberculosis is associated with localized heat, swelling, and sensibility. Joint tuberculosis is associated with sensibility, soft tissue swelling/effusion, and restricted movements. Back pain is the most common symptom, along with neurological losses, fever, and back swelling. [ Evidence ] Osseous involvement is associated with localized warmth, swelling, and tenderness. Articular involvement is associated with tenderness, soft tissue swelling/effusion, and a restriction of movement. Back pain is the most common symptom of spinal tuberculosis (TB), with other symptoms including neurologic deficits, fever, and back swelling. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Evaluation	Bone and joint tuberculosis	- Symptoms	18/07/2019 at 12:03
33	[ Indicator ] If bone or joint tuberculosis is suspected/confirmed, concomitant pulmonary tuberculosis should be investigated. [ Evidence ] Concurrent pulmonary TB should be sought in all patients with suspected or confirmed skeletal TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Evaluation	Bone and joint tuberculosis	- Diagnosis	18/07/2019 at 12:06
34	[ Indicator ] Radiography, CT and MRI can be used to evaluate bone and soft tissue, but it is not a diagnosis for bone and joint tuberculosis. [ Evidence ] Radiographic testing can be used to define bony and soft tissue involvement but is not diagnostic for tuberculosis. - Plain x-ray may identify substantial bony destruction, but early findings may not be visualized. - Computed tomography provides bony detail and may be helpful in guiding biopsy. - Magnetic resonance imaging is preferred for assessing vertebral collapse, involvement of vertebral bodies, soft tissue involvement, or the presence of abscess. - Abscesses appear as paravertebral soft tissue shadows, and the detection of calcifications within an abscess is virtually diagnostic of spinal TB. - A retropharyngeal abscess may be diagnosed in cervical spine films by the presence of an increased prevertebral soft tissue space. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Evaluation	Bone and joint tuberculosis	- Diagnosis	18/07/2019 at 12:12
35	[ Indicator ] Confirmatory diagnosis of bone and joint tuberculosis can be made by image-guided biopsy or needle aspiration of the involved site to collect samples for testing. [ Evidence ] A confirmatory diagnosis may be made by image-guided biopsy or needle aspiration of the involved area with specimens tested for mycobacterial smear and culture, nucleic acid amplification test, histology and cytology. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Evaluation	Bone and joint tuberculosis	- Diagnosis	18/07/2019 at 12:15
36	[ Indicator ] Treatment of bone and joint tuberculosis follows the standard multi-drug anti-TB drugs regimen, including isoniazid, rifampicin, pyrazinamide, and ethambutol. [ Evidence ] Treat patients with bone and joint TB with the standard first-line antituberculosis regimen including isoniazid, rifampicin, pyrazinamide, and ethambutol (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Treatment	18/07/2019 at 12:27
37	[ Indicator ] If bone and joint tuberculosis is due to infection with drug-susceptible organisms, pyrazinamide and ethambutol should be discontinued after 2 months and treatment continued with isoniazid and rifampicin for 4 to 7 months. The decision on the duration of treatment must be made on a case-by-case basis. [ Evidence ] With infections by fully susceptible organisms, stop pyrazinamide and ethambutol after 2 months and continue isoniazid and rifampicin for 4-7 months; a decision on duration of therapy should be made on a case-by-case basis (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Treatment	18/07/2019 at 12:30
38	[ Indicator ] Bone and joint tuberculosis caused by drug-resistant organisms or multidrug-resistant organisms usually responds well to appropriate individualized therapy. [ Evidence ] Bone and joint TB caused by drug-resistant organisms or multidrug-resistant organisms usually responds well to appropriate individualized therapy. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Treatment - Resistant tuberculosis	18/07/2019 at 12:32
39	[ Indicator ] If the patient has no neurological impairment, an unstable spine, or spinal cord compression, drug therapy for bone and joint tuberculosis is usually sufficient. [ Evidence ] Medical therapy is usually sufficient if the patient does not have neurologic impairment, an unstable spine, or spinal cord compression. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Treatment	18/07/2019 at 12:37
40	[ Indicator ] For bone and joint tuberculosis, the role of surgery is controversial, but it can be used to debride infected tissue, stabilize the spine, or relieve spinal cord or nerve compression. [ Evidence ] The role of surgery is controversial but may be used to debride infected tissue, stabilize the spine, or relieve spinal cord or nerve compression. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Treatment	18/07/2019 at 12:41
41	[ Indicator ] The BCG vaccine is unreliable against pulmonary tuberculosis for adults and older children. [ Evidence ] BCG is unreliable against adult forms of pulmonary tuberculosis. - efficacy variable (0% to > 80%) in older children and adults, with some reports of net harm ( JAMA 2004 May 5;291(17):2127) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T905489#Efficacy	Bacille Calmette- Guerin vaccine (BCG)	- Adults - Prevention	18/07/2019 at 12:46
42	[ Indicator ] Disseminated tuberculosis is a systemic disease that can result in infection of multiple organ systems. This disease is also called miliary tuberculosis. For immunocompetent adults, it accounts for less than 2% of tuberculosis cases and up to 20% of extrapulmonary cases. [ Evidence ] Disseminated tuberculosis (TB) is a systemic disease resulting from massive lymphohematogenous dissemination of Mycobacterium tuberculosis that can result in infection of multiple organ systems. This disease is also called miliary tuberculosis. In immunocompetent adults, disseminated TB is reported to account for less than 2% of all cases of TB and up to 20% of all cases of extrapulmonary TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901421#Background	Disseminated tuberculosis	- Definitions	18/07/2019 at 14:17
43	[ Indicator ] Symptoms of disseminated (miliary) tuberculosis are nonspecific, including fever and weight loss, anorexia, weakness, cough, night sweats, and chills. Due to the systemic nature of the disease, other symptoms may vary depending on the organ(s) involved. [ Evidence ] Patients may present with nonspecific symptoms including fever and weight loss, anorexia, weakness, cough, night sweats, and chills and rigors. Due to the systemic nature of the disease, other presenting signs and symptoms can vary depending on the organ(s) involved. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901421#Background	Disseminated tuberculosis	- Symptoms	18/07/2019 at 14:20
44	[ Indicator ] Risk factors for disseminated (miliary) tuberculosis include HIV infection, young and old, female gender, and Asian or African origin. [ Evidence ] Risk factors for extrapulmonary TB and disseminated TB include HIV infection, young and old age, female gender, and Asian or African origin. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901421#Background	Disseminated tuberculosis	- Risk factor	18/07/2019 at 14:23
45	[ Indicator ] The definitive diagnosis of disseminated (miliary) tuberculosis is made by culture or detection of mycobacterium tuberculosis at the affected site. However, this method can take up to 8 weeks. The use of nucleic acid amplification tests provides an alternative and faster means of diagnosis. [ Evidence ] A definitive diagnosis requires either culture or detection of Mycobacterium tuberculosis from the affected site. Culture of the organism provides a definitive diagnosis but it may take up to 8 weeks. The use of nucleic acid amplification tests (NAATs) provide an alternate and more rapid means of diagnosis. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901421#Evaluation	Disseminated tuberculosis	- Diagnosis	18/07/2019 at 14:26
46	[ Indicator ] Disseminated (miliary) tuberculosis may be evident in about 50% of chest radiographs. However, computed tomography can show the disease even in patients with normal radiography. [ Evidence ] Perform a chest x-ray for all persons to rule out concurrent pulmonary tuberculosis for all patients. - The characteristic miliary pattern may be evident in about 50% of chest x-rays. High-resolution computed tomography may reveal a miliary pattern even in patients with a normal x-ray. - Other findings on the chest x-ray may include nodules, ground glass appearance, air-space consolidation, or, more rarely, parenchymal lesions and cavitation or pleural effusion. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901421#Evaluation	Disseminated tuberculosis	- Diagnosis	18/07/2019 at 14:47
47	[ Indicator ] Treatment of non-drug resistant disseminated (miliary) tuberculosis follows the standard multidrug regimen: intensive initial phase with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months; and a continuation phase with isoniazid and rifampicin for 4 months. [ Evidence ] Treat patients with disseminated TB caused by drug-susceptible organisms with the standard antituberculosis multidrug regimen: - initial intensive phase with isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months - continuation phase with isoniazid and rifampicin for 4 months [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901421#Management	Disseminated tuberculosis	- Treatment	18/07/2019 at 14:50
48	[ Indicator ] Patients in whom drug-resistant disseminated (miliary) tuberculosis is suspected or confirmed should be treated based on the drug susceptibility profile and consulting with an expert. [ Evidence ] Treat patients with suspected or confirmed drug-resistant organisms based on the drug-susceptibility profile and in consultation with an expert. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901421#Management	Disseminated tuberculosis	- Treatment	18/07/2019 at 14:51
49	[ Indicator ] Corticosteroids are not recommended in patients with disseminated (miliary) tuberculosis without central nervous system involvement. [ Evidence ] Corticosteroids are not recommended in patients with disseminated TB without central nervous system involvement. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901421#Management	Disseminated tuberculosis	- Treatment	18/07/2019 at 14:54
50	[ Indicator ] Endobronchial tuberculosis, bronchial stenosis, or strictures can be treated with: laser therapy; cryosurgery; electrocautery; argon plasma coagulation. [ Evidence ] Endobronchial tuberculosis - bronchial stenosis or strictures may be treated with - laser therapy - cryosurgery - electrocautery - argon plasma coagulation [ Reference ] http://www.dynamed.com/topics/dmp~AN~T916926#Overview	Endobronchial ablative therapies	- Treatment	18/07/2019 at 15:19
51	[ Indicator ] Extensively drug-resistant tuberculosis is the form of the disease resistant to isoniazid, rifampicin, any fluoroquinolone, and at least one of three injectable drugs: amikacin, kanamycin, or capreomycin. [ Evidence ] XDR TB is defined as TB caused by Mycobacterium tuberculosis resistant to isoniazid, rifampicin, any fluoroquinolone, and at least 1 of 3 injectable second-line drugs (amikacin, kanamycin, or capreomycin). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Background	Extensively drug-resistant tuberculosis (XDR TB)	- Definitions - Resistant tuberculosis	18/07/2019 at 15:22
52	[ Indicator ] Risk factors for resistant tuberculosis are: (1) previous treatment for more than one month; (2) failure of a tuberculosis treatment regimen containing second-line drugs, including an injectable agent and a fluoroquinolone; (3) close contact with a patient who has resistant tuberculosis or whose treatment regimen with second-line drugs is failing or has failed; (4) delayed treatment; (5) HIV; (6) foreign birth; (7) younger age; (8) female; and (9) previous arrest. [ Evidence ] Risk factors for MDR and XDR TB: - prior TB treatment (> 1 month) - failure of a TB treatment regimen containing second-line drugs including an injectable agent and a fluoroquinolone - close contact with a patient with MDR TB, XDR TB, or with a patient whose treatment regimen including second-line drugs is failing or has failed - delayed treatment - HIV - foreign birth - younger age - female sex - previous imprisonment [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Background	Extensively drug-resistant tuberculosis (XDR TB)	- Risk factor - HIV - Deprivation of liberty - Sex - Resistant tuberculosis	18/07/2019 at 15:29
53	[ Indicator ] As the clinical presentation of resistant tuberculosis does not differ from that of non-resistant tuberculosis, the diagnosis is confirmed with culture and drug susceptibility tests. [ Evidence ] Clinical presentation of XDR TB does not differ from that of drug-susceptible TB. XDR TB diagnosis is confirmed with culture and drugsusceptibility testing. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Evaluation	Extensively drug-resistant tuberculosis (XDR TB)	- Diagnosis - Resistant tuberculosis	18/07/2019 at 15:32
54	[ Indicator ] One should suspect resistant tuberculosis before receiving culture test results if risk factors for multidrug resistant tuberculosis are identified; positive sputum smears (sputum tests) and/or cultures persist; or little/no improvement in tuberculosis symptoms with the standard regimen of treatment. [ Evidence ] XDR TB may be suspected prior to receipt of culture results if risk factors for multidrug-resistant (MDR) TB are present or there are persistently positive sputum smears and/or cultures or little/no improvement in signs and symptoms of TB, despite standard anti-TB treatment. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Evaluation	Extensively drug-resistant tuberculosis (XDR TB)	- Diagnosis - Resistant tuberculosis	18/07/2019 at 15:37
55	[ Indicator ] Resistant tuberculosis should only be treated by experts in this type of disease. However, before receiving drug susceptibility test results, appropriate treatment should be initiated in patients suspected of having resistant tuberculosis. [ Evidence ] XDR TB should be managed by only those expert in the treatment of drug-resistant TB. Prior to receipt of drug-susceptibility testing results, empiric treatment for XDR TB should be started in those in whom XDR TB is suspected. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Treatment - Resistant tuberculosis	18/07/2019 at 15:42
56	[ Indicator ] Treatment of resistant tuberculosis is guided by the results of drug susceptibility tests as follows: always try to use 3 or more previously unused drugs that have passed the tests and consider regimens with four to six drugs, including one injectable. [ Evidence ] Treatment is guided by drug-susceptibility testing results: - Always try to use ≥ 3 previously unused drugs that have demonstrated in vitro susceptibility and consider regimens with 4-6 medications, including an injectable (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Treatment - Resistant tuberculosis	18/07/2019 at 16:04
57	[ Indicator ] Daily hospital-based therapy or directly observed therapy at home should be established for the treatment of resistant tuberculosis. [ Evidence ] - Institute daily hospital-based or home-based directly observed therapy (DOT) (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Treatment - Resistant tuberculosis	18/07/2019 at 16:05
58	[ Indicator ] Any hospitalized patient with suspected tuberculosis should be placed in airborne infection isolation with appropriate infection control measures for both healthcare workers and visitors. [ Evidence ] Any hospitalized patient with suspected TB or who has acid-fast bacilli (AFB) smear-positive sputum should be placed in airborne infection isolation with appropriate infection control measures for providers and visitors. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Treatment	18/07/2019 at 16:08
59	[ Indicator ] The management of patients with latent tuberculosis infection who have contact with other patients with multidrug resistant tuberculosis should be guided, when possible, by the drug susceptibility results of the source patient. [ Evidence ] Treatment for latent TB infection in contacts of multidrug-resistant (MDR) TB patients should be guided by drug-susceptibility results in the source patient, when possible. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Treatment - Resistant tuberculosis	18/07/2019 at 16:11
60	[ Indicator ] As multidrug-resistant tuberculosis can have a prolonged infectious period if treatment is ineffective, patients should be continually reassessed by consulting experts. [ Evidence ] - since multidrug-resistant TB (MDR TB) can have an extended infectious period if treatment is ineffective, continually reassess patients for recent contacts - seek expert consultation for treatment of persons exposed to patients with MDR TB [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Contact-investigation	Extensively drug-resistant tuberculosis (XDR TB)	- Prevention - Resistant tuberculosis	18/07/2019 at 16:18
61	[ Indicator ] The recommended program for tuberculosis infection control consists of the following actions: (1) implement administrative control to reduce the risk of exposure to patients who may have tuberculosis; (2) assign responsibility for tuberculosis infection control; (3) perform a tuberculosis risk assessment; (4) develop and implement a written tuberculosis infection control plan to ensure prompt detection of people who have suspected or confirmed tuberculosis, air precautions, and treatment; (5) ensure availability of recommended laboratory processing, testing, and reporting of results to the requesting physician; (6) implement effective work practices for the management of patients with suspected or confirmed tuberculosis; (7) perform adequate cleaning and sterilization or disinfection of equipment that may be contaminated with tuberculosis; (8) train and educate healthcare professionals about tuberculosis, including symptoms, transmission and prevention; (9) implement a tuberculosis screening program to assess workers at risk of disease or who may be exposed; (10) apply environment-related infection control data and other epidemiology-based prevention principles; (11) use appropriate signage advocating cough mask and respiratory hygiene; (12) coordinate efforts with local and state health departments. [ Evidence ] implementation of infection control program recommended, consisting of - administrative controls to reduce risk for exposure to patients who might have tuberculosis (TB) - assign responsibility for TB infection control - conduct a TB risk assessment - develop and implement a written TB infection-control plan to ensure prompt detection of persons who have suspected or confirmed TB, airborne precautions, and treatment - ensure timely availability of recommended laboratory processing, testing, and reporting of results to the ordering physician - implement effective work practices for the management of patients with suspected or confirmed TB - proper cleaning and sterilization or disinfection of equipment that may be contaminated with M. tuberculosis - train and educate healthcare workers about TB including symptoms, transmission, and prevention - implement TB screening program to evaluated workers at risk for TB disease or who might be exposed to M. tuberculosis - apply setting-related infection-control data and other epidemiologic-based prevention principles - use appropriate signage advocating cough etiquette and respiratory hygiene - coordinate efforts with state and local health departments [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Infection-control	Extensively drug-resistant tuberculosis (XDR TB)	- Prevention - Health System	18/07/2019 at 16:26
62	[ Indicator ] Environmental control must be performed to prevent the spread of infectious droplet nuclei in the air: primary environmental control; local exhaust ventilation (hoods, tents or cabins) to control the source of infection; general ventilation to dilute and remove contaminated air; secondary environmental control includes high-efficiency particulate air filtration or ultraviolet germicidal irradiation to control airflow, preventing air contamination in areas adjacent to the source, and cleaning the air. [ Evidence ] environmental controls to prevent spreading of infectious droplet nuclei in ambient air - primary environmental controls - local exhaust ventilation (hoods, tents, or booths) to control the source of infection - general ventilation to dilute and remove contaminated air - secondary environmental controls include high efficiency particulate air filtration or ultraviolet germicidal irradiation to control the airflow to prevent contamination of air in areas adjacent to the source and clean the air [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Infection-control	Extensively drug-resistant tuberculosis (XDR TB)	- Prevention - Health System	18/07/2019 at 16:44
63	[ Indicator ] Respiratory protection control should be conducted to reduce the risk of exposure of healthcare workers to infectious droplets expelled into the air by patients with tuberculosis: implement respiratory protection program; train health professionals in respiratory protection; train patients in cough mask and respiratory hygiene procedures. [ Evidence ] respiratory protection controls to reduce risk for exposure of healthcare workers to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease - implement a respiratory protection program - train healthcare workers on respiratory protection - train patients on cough etiquette procedures and respiratory hygiene [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908130#Infection-control	Extensively drug-resistant tuberculosis (XDR TB)	- Prevention - Health professional - Health System	18/07/2019 at 16:48
64	[ Indicator ] Genitourinary tuberculosis is a form of extrapulmonary tuberculosis that involves any part of the male or female reproductive or urinary tract. It accounts for about 5% to 6% of cases of extrapulmonary tuberculosis. [ Evidence ] Genitourinary tuberculosis (TB) is a form of extrapulmonary TB that involves any part of the male or female reproductive or urinary tracts. Genitourinary TB accounts for about 5%-6% of cases of extrapulmonary TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Background	Genitourinary tuberculosis	- Definitions	19/07/2019 at 10:04
65	[ Indicator ] Risk factors for genitourinary tuberculosis include congenital urogenital anomalies, renal cysts, urolithiasis, renal failure, and renal transplantation. The infection usually occurs through the bloodstream from the lung infection and subsequently spreads from the kidney to the ureter and bladder. [ Evidence ] Specific risk factors for genitourinary TB include congenital urogenital anomalies, renal cysts, urolithiasis, renal failure, and renal transplantation. Genitourinary infection typically occurs by hematogenous dissemination from pulmonary infection and subsequently spreads from kidney to ureter to bladder. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Background	Genitourinary tuberculosis	- Risk factor - Transmission	19/07/2019 at 10:32
66	[ Indicator ] Symptoms of genitourinary tuberculosis can be similar to other urinary tract infections and include dysuria (discomfort, pain, or burning when urinating), frequency, urgency, and hematuria (blood in the urine). Moreover, there may be pain in the back or flank (abdominal region). In all cases, systemic symptoms associated with tuberculosis, such as fever, weight loss, or sweating may be identified. [ Evidence ] When TB affects the urinary tract, symptoms may be similar to other urinary tract infections and include dysuria, frequency, urgency, and hematuria. With upper tract involvement, back or flank pain may be present. The finding of sterile pyuria, with or without proteinuria and hematuria, should also prompt investigation, particularly in patients with previous or current pulmonary tuberculosis. Also consider genitourinary TB in patients with a suspected urinary tract infection that does not respond to antibiotics (except fluoroquinolones). In all cases, systemic symptoms associated with TB including fever, weight loss, or sweating can be present. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Symptoms	19/07/2019 at 10:43
67	[ Indicator ] Sterile pyuria (pus in the urine), with or without proteinuria (excess protein in the urine) and hematuria (blood in the urine) can be symptoms of genitourinary tuberculosis, particularly in patients with previous or current pulmonary tuberculosis. Another sign is a urinary tract infection that does not respond to antibiotics (except fluoroquinolones). Also, infertility can be the only sign of this type of TB in both men and women. [ Evidence ] The finding of sterile pyuria, with or without proteinuria and hematuria, should also prompt investigation, particularly in patients with previous or current pulmonary tuberculosis. Also consider genitourinary TB in patients with a suspected urinary tract infection that does not respond to antibiotics (except fluoroquinolones). Infertility may be the sole presenting sign of genital TB in both males and females. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Sex - Symptoms	19/07/2019 at 10:52
68	[ Indicator ] Additional signs of genitourinary tuberculosis in women include abdominal pain, menstrual irregularity, abnormal vaginal discharge, postcoital bleeding, and the presence of uterine enlargement or an adnexal mass on physical examination. [ Evidence ] Additional signs of genital tract involvement in females include abdominal pain, menstrual irregularity, abnormal vaginal discharge, postcoital bleeding, and the presence of uterine enlargement or an adnexal mass on physical examination. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Sex - Symptoms	19/07/2019 at 10:55
69	[ Indicator ] Additional signs of genitourinary tuberculosis in men include epididymitis (inflammation of the tube at the back of the testicle that stores and transports sperm) or epididymal orchitis (in the testicles), prostatitis (pain, swelling or inflammation in the prostate glands), scrotal mass or epididymal, scrotal sinus secretion, or decreased semen volume. [ Evidence ] Additional signs of genital tract involvement in males include epididymitis or epididymo-orchitis, prostatitis, scrotal or epididymal mass, scrotal sinus discharge, or decreased semen volume. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Sex - Symptoms	19/07/2019 at 11:00
70	[ Indicator ] Diagnosis of genitourinary tuberculosis includes images of the site of suspected involvement. The approach varies with anatomy and may include IV urography, CT scan, ultrasound, cystoscopy, hysteroscopy, or diagnostic laparoscopy. [ Evidence ] The diagnostic evaluation should include imaging of the suspected site of involvement. The approach will vary with anatomy and may include IV urography, computed tomography, ultrasound, cystoscopy, hysteroscopy, or diagnostic laparoscopy. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Diagnosis	19/07/2019 at 11:02
71	[ Indicator ] Definitive diagnosis of genitourinary tuberculosis requires detection at the affected site (typically urine with or without tissue biopsy) by culture or nucleic acid amplification testing. [ Evidence ] Definitive diagnosis requires detection of Mycobacterium tuberculosis at the affected site (typically urine with or without tissue biopsy) by culture or nucleic acid amplification testing (NAAT). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Diagnosis	19/07/2019 at 11:05
72	[ Indicator ] Genitourinary tuberculosis can occur concomitantly with pulmonary tuberculosis. Review and chest radiography should be performed in all patients, as well as HIV testing due to high rates of co-infection. [ Evidence ] Note that genitourinary tuberculosis can occur concurrently with pulmonary TB, and a review of systems and a chest x-ray should be performed in all patients to rule out active pulmonary disease. Due to high rates of HIV co-infection, testing for HIV is also recommended. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Diagnosis	19/07/2019 at 11:10
73	[ Indicator ] Treatment of genitourinary tuberculosis follows the standard multidrug anti-tuberculosis regimen: intensive initial phase with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months; and a continuation phase with isoniazid and rifampicin for 4 months. [ Evidence ] Treat patients with genitourinary TB caused by drug-susceptible organisms with the standard antituberculosis multidrug regimen (Strong recommendation): - initial intensive phase with isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months - continuation phase with isoniazid and rifampicin is for 4 months [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Management	Genitourinary tuberculosis	- Treatment	19/07/2019 at 11:18
74	[ Indicator ] Patients in whom drug-resistant genitourinary tuberculosis is suspected or confirmed should be treated based on the drug susceptibility profile and consulting an expert. [ Evidence ] Treat patients with suspected or confirmed drug-resistant organisms based on the drug susceptibility profile and in consultation with an expert. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Management	Genitourinary tuberculosis	- Treatment - Resistant tuberculosis	19/07/2019 at 11:20
75	[ Indicator ] For genitourinary tuberculosis, surgery should be considered for patients with extensive disease or a recurrent infection. Surgical options include excision (extraction) of affected tissue such as nephrectomy (kidney removal) or epididymectomy (removal of the duct that collects and stores sperm) and reconstructive therapy such as enterocystoplasty (bladder enlargement) and stent implantation. [ Evidence ] Consider surgery for patients with extensive disease or a recurrent infection. Surgical options include excision of affected tissue such as nephrectomy or epididymectomy, reconstructive therapy such as enterocystoplasty, and stenting. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909302#Management	Genitourinary tuberculosis	- Treatment	19/07/2019 at 11:27
76	[ Indicator ] Hemoptysis (blood mixed with sputum) can be a symptom of tuberculosis. The clotting test is used to find out the cause of hemoptysis. The interferon gamma release assay or Mantoux assay is used to identify tuberculosis if this is suspected. [ Evidence ] Diagnostic testing for cause of hemoptysis may include: - blood tests, including coagulation testing and interferon-gamma release assay or Mantoux screen if suspected tuberculosis [ Reference ] http://www.dynamed.com/topics/dmp~AN~T920582#Evaluation	Hemoptysis - approach to the patient	- Diagnosis - Symptoms	19/07/2019 at 15:45
77	[ Indicator ] Bronchovascular artery embolization may be an effective treatment for massive hemoptysis (blood in sputum) secondary to tuberculosis in adults. [ Evidence ] bronchovascular artery embolization may be effective treatment for massive hemoptysis secondary to tuberculosis in adults (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T920582#Tuberculosis	Hemoptysis - approach to the patient	- Adults - Treatment	19/07/2019 at 15:49
78	[ Indicator ] Bronchovascular artery embolization may be an effective treatment for life-threatening hemoptysis secondary to tuberculosis in patients 16 years of age or older. [ Evidence ] bronchovascular artery embolization may be effective treatment for life-threatening hemoptysis secondary to tuberculosis in patients ≥ 16 years old (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T920582#Tuberculosis	Hemoptysis - approach to the patient	- Adults - Treatment	19/07/2019 at 15:52
79	[ Indicator ] Isoniazid-resistant tuberculosis generally refers to infections resistant to isoniazid alone. It is also called mono isoniazid-resistant tuberculosis. Estimated rates of isoniazid resistance in all TB cases were about 50% in Eastern Europe and 14% outside Eastern Europe from 1994 to 2009. [ Evidence ] Isoniazid-resistant tuberculosis (TB) generally refers to infections caused by Mycobacterium tuberculosis that are resistant to isoniazid only and it is also called isoniazid mono-resistant tuberculosis. The estimated rates of resistance to isoniazid among all TB cases was about 50% in Eastern Europe and 14% outside of Eastern Europe during 1994-2009. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T913244#Background	Isoniazidresistant tuberculosis	- Definitions	19/07/2019 at 15:56
80	[ Indicator ] Risk factors for isoniazid-resistant tuberculosis include: failure of the initial treatment or retreatment regimen; close contact with people with drug-resistant tuberculosis; relapse after apparently successful treatment; and low adherence to TB drugs. [ Evidence ] Risk factors include failure of initial or retreatment regimen, close contact with persons with known drug-resistant TB, relapse after apparently successful treatment, and poor adherence to TB medications. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T913244#Background	Isoniazidresistant tuberculosis	- Risk factor	19/07/2019 at 15:58
81	[ Indicator ] The clinical presentation of mono isoniazid-resistant tuberculosis does not differ significantly from that of common tuberculosis. Accurate diagnosis is performed using culture and sensitivity tests or nucleic acid amplification tests. [ Evidence ] Clinical presentation of isoniazid mono-resistant tuberculosis (TB) does not significantly differ from that of drug-susceptible TB. Determination of isoniazid mono-resistance can be determined through culture and susceptibility testing or nucleic acid amplification tests. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T913244#Evaluation	Isoniazidresistant tuberculosis	- Diagnosis - Symptoms	19/07/2019 at 16:03
82	[ Indicator ] The recommended treatment for patients with isoniazid-resistant tuberculosis includes rifampicin, ethambutol and pyrazinamide for a minimum period of 6 to 9 months. A fluoroquinolone may be added to this regimen, especially for patients with extensive and/or cavity (injury) disease. [ Evidence ] The recommended regimen for patients with confirmed resistance to isoniazid alone includes rifampicin, ethambutol, and pyrazinamide for a minimum of 6-9 months. A fluoroquinolone may be added to the above regimen, especially in patients with extensive and/or cavitary disease. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T913244#Management	Isoniazidresistant tuberculosis	- Treatment	19/07/2019 at 16:06
83	[ Indicator ] Latent tuberculosis infection occurs when a patient is infected with tuberculosis but does not have the disease. About a quarter of the world’s population has this type of infection. When untreated and without HIV infection, 5% to 10% of patients develop active tuberculosis throughout their lives. [ Evidence ] LTBI is defined as infection with Mycobacterium tuberculosis in the absence of clinical disease and is detected by the presence of an immune response to M. tuberculosis antigens. About one-quarter of the world’s population has LTBI. When untreated, in the absence of HIV infection, 5%-10% of patients with LTBI develop active TB over the course of their lifetimes. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Background	Latent tuberculosis infection (LTBI)	- Definitions	22/07/2019 at 11:42
84	[ Indicator ] The following populations are most at risk of acquiring tuberculosis infection: close contacts of people with active pulmonary tuberculosis; infants, children and adolescents exposed to adults at increased risk of latent or active tuberculosis; people born in or visiting areas with a high prevalence of tuberculosis; health professionals; residents or workers in clustered settings such as prisons or shelters for people living on the street; lowincome populations, medically disadvantaged and people who abuse alcohol or illicit drugs. [ Evidence ] Populations at an increased risk for acquiring M. tuberculosis infection include: - close contacts of persons with known active pulmonary TB - infants, children, and adolescents exposed to adults at a higher risk for LTBI or active TB - persons born in areas or who visit areas with a high prevalence of TB - healthcare workers - residents or workers in congregate settings such as prisons or homeless shelters - the medically underserved, low-income populations, and persons who abuse alcohol or illicit drugs [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Background	Latent tuberculosis infection (LTBI)	- Low income - Children - Risk factor - People living on the street - Deprivation of liberty - Health professional - Drug user	22/07/2019 at 11:48
85	[ Indicator ] At-risk populations should be tested for latent tuberculosis infection. Options include the tuberculin skin test and the interferon gamma release test (IGRA). IGRA is preferred in patients with a history of BCG vaccination or when patients are unlikely to return for skin test results. [ Evidence ] Testing for LTBI should be performed in at-risk populations. - Options for testing include the tuberculin skin test (TST) and interferongamma release assays (IGRAs). - Use of IGRAs for testing is preferred in patients with a history of Bacille Calmette-Guérin (BCG) vaccination or when patients are unlikely to return to obtain TST results. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Evaluation	Latent tuberculosis infection (LTBI)	- Diagnosis	22/07/2019 at 11:54
86	[ Indicator ] Patients who test positive for latent infection on the tuberculin skin test or interferon gamma release test should have a symptom review and a chest X-ray to exclude the possibility of having active tuberculosis. [ Evidence ] For patients with a positive TST or IGRA, exclude active tuberculosis by a review of symptoms and a chest x-ray. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Evaluation	Latent tuberculosis infection (LTBI)	- Diagnosis	22/07/2019 at 11:58
87	[ Indicator ] One treatment option for latent tuberculosis infection is isoniazid monotherapy. It should be administered with vitamin B6 (pyridoxine) orally in patients at risk of neuropathy and pregnant women. Dosage and duration of treatment varies for adults and children. Moreover, the incidence of tuberculosis in the region where patients live also influences treatment. [ Evidence ] Isoniazid (INH) monotherapy - Should be given with vitamin B6 (pyridoxine) 25-50 mg/day orally in patients at risk for neuropathy and those who are pregnant - Centers for Disease Control and Prevention (CDC) dosing recommendations: - Adults 5 mg/kg or children 10-20 mg/kg (maximum 300 mg/day) orally once daily for 9 months - Adults 15 mg/kg or children 20-40 mg/kg (maximum 900 mg) orally twice weekly for 9 months - Adults 5 mg/kg (maximum 300 mg) orally once daily for 6 months (not recommended for children) - Adults 15 mg/kg (maximum 900 mg) orally twice weekly for 6 months (not recommended for children) - World Health Organization (WHO) dosing recommendations: - Adults 5 mg/kg or children 10 mg/kg (maximum 300 mg) orally once daily for 6 months - Once daily 9-month regimen may be considered in regions with low TB incidence [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Associated disease - Pregnant women - Treatment	22/07/2019 at 12:10
88	[ Indicator ] One treatment option for latent tuberculosis infection is rifampicin monotherapy. [ Evidence ] Rifampicin (rifampicin) monotherapy in adults 10 mg/kg or children 15-20 mg/kg (maximum 600 mg/day) orally once daily for 4 months [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Treatment	22/07/2019 at 12:14
89	[ Indicator ] One treatment option for latent tuberculosis infection is isoniazid plus oral rifapentine once a week for 3 months. Dosages vary depending on the age and weight of the patient. [ Evidence ] Isoniazid plus rifapentine orally once weekly for 3 months For adults and children > 12 years of age: Isoniazid 15 mg/kg (maximum 900 mg) Rifapentine 300 mg for patients 10–14.0 kg 450 mg for patients 14.1–25.0 kg 600 mg for patients 25.1–32.0 kg 750 mg for patients 32.1–49.9 kg 900 mg for patients ≥ 50.0 kg For children 2-11 years of age: Isoniazid 25 mg/kg (maximum 900 mg) Rifapentine weight-based dosing same as above [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Treatment	22/07/2019 at 12:17
90	[ Indicator ] Treatment for patients with latent tuberculosis infection and exposed to multidrug resistant tuberculosis should be managed by an expert. [ Evidence ] Treatment for patients with known exposure to multidrug-resistant TB (MDR-TB) should be determined by the resistance pattern identified in the source case and managed by a specialist. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Treatment - Resistant tuberculosis	22/07/2019 at 12:20
91	[ Indicator ] Most treatments are associated with hepatotoxicity (liver damage). Although liver function testing is not routinely recommended, it should be monitored in patients with chronic liver disease, HIV infection, those who consume alcohol regularly, during pregnancy and postpartum. [ Evidence ] Most regimens are associated with hepatotoxicity; liver function testing is not recommended routinely but should be monitored in patients with chronic liver disease, HIV infection, those who use alcohol regularly, and during pregnancy and postpartum. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Associated disease - Side effects - Pregnant women - HIV - Treatment - Drug user	22/07/2019 at 12:26
92	[ Indicator ] HIV is the most important risk factor for tuberculosis. People with HIV are 20 to 30 times more likely to develop tuberculosis than HIVnegative people. About 32% of tuberculosis patients are coinfected with HIV. HIV-endemic regions are also endemic for tuberculosis. [ Evidence ] About 32% of patients with TB are co-infected with HIV. Regions endemic for HIV are also endemic for TB. HIV is the single most important risk factor for TB and persons with HIV are 20-30 times more likely to develop TB than HIV-negative persons. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Background	Latent tuberculosis infection in patients with HIV	- Risk factor - HIV	22/07/2019 at 12:35
93	[ Indicator ] HIV is the most important risk factor for tuberculosis. People with HIV are 20 to 30 times more likely to develop tuberculosis than HIVnegative people. About 32% of tuberculosis patients are coinfected with HIV. Additional risk factors include residence in tuberculosis-endemic regions, close contact with tuberculosis patients, crowded housing (including incarceration), poor ventilation in living or working environments, poor nutrition, and limited access to quality health care. [ Evidence ] About 32% of patients with TB are co-infected with HIV. HIV is the single most important risk factor for TB and persons with HIV are 20-30 times more likely to develop TB than HIV-negative persons. Additional risk factors include residence in TB-endemic regions, close contact with patients with TB, crowded housing (including incarceration), poor ventilation in living or working quarters, poor nutrition, and limited access to quality health care. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Background	Latent tuberculosis infection in patients with HIV	- Low income - Risk factor - HIV - Deprivation of liberty	22/07/2019 at 12:38
94	[ Indicator ] All people with HIV should be tested for latent tuberculosis infection. Testing options include tuberculin skin test and interferon gamma release tests. However, a negative result in these tests does not definitively exclude a diagnosis of tuberculosis. All patients with HIV infection and suspected tuberculosis or with symptoms should undergo chest radiography and clinical evaluation to exclude the possibility of active tuberculosis. [ Evidence ] Perform testing for latent tuberculosis infection (LTBI) in all persons with HIV. Options for testing include the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs). A negative TST or IGRA does not definitively exclude a diagnosis of tuberculosis (TB). In all patients with HIV infection and suspected LTBI or symptoms of TB, perform chest radiography and clinical evaluation promptly to rule out active TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Evaluation	Latent tuberculosis infection in patients with HIV	- Diagnosis - HIV	22/07/2019 at 12:41
95	[ Indicator ] Patients with HIV should be treated for latent infection with latent tuberculosis when: the diagnosis test is positive, there is no evidence of tuberculosis disease and there is no previous history of treatment for active or latent tuberculosis; and there is close contact with people with infectious pulmonary tuberculosis, regardless of latent infection status. [ Evidence ] Treat patients with HIV for latent tuberculosis infection (LTBI) when: the patient has a positive diagnostic test for LTBI, no evidence of tuberculosis (TB) disease, and no prior history of treatment for active or latent TB (Strong recommendation) the patient is a close contact of persons with infectious pulmonary TB, regardless of LTBI status (Strong recommendation) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- HIV - Treatment	22/07/2019 at 12:50
96	[ Indicator ] Active tuberculosis (presence of the disease) must be ruled out before starting treatment for latent tuberculosis, as treating active disease as if it were latent can lead to the development of drug-resistant tuberculosis. [ Evidence ] Rule out active TB prior to initiating treatment for LTBI, as treatment of active disease with regimens to treat LTBI can lead to development of drug-resistant TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- Treatment - Resistant tuberculosis	22/07/2019 at 12:54
97	[ Indicator ] For HIV patients exposed to drug resistant tuberculosis, drugs should be advised in consultation with experts or public health authorities. [ Evidence ] For patients exposed to drug-resistant Mycobacterium tuberculosis, select anti-TB drugs after consultation with experts or public health authorities (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- HIV - Treatment - Resistant tuberculosis	22/07/2019 at 12:57
98	[ Indicator ] Antiretroviral therapy for HIV patients should be added to the treatment of latent tuberculosis infection to reduce the risk of developing the disease. Drug dose adjustments may be necessary due to drug interactions. [ Evidence ] Give ART in addition to LTBI treatment to reduce the risk of TB disease (Strong recommendation). Dose adjustments of antiretroviral drugs and/or TB drugs may be required due to drug-drug interactions. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- HIV - Treatment	22/07/2019 at 12:59
99	[ Indicator ] Treating latent tuberculosis infection reduces the risk of developing the disease by 60%. [ Evidence ] Treatment for LTBI reduces the risk of developing active TB by about 60%. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- Prevention - Treatment	22/07/2019 at 13:02
100	[ Indicator ] HIV patients traveling or working in TB endemic regions should be counseled about the risks and to be tested for latent TB infection when they return. [ Evidence ] counsel patients with HIV who travel or work in TB-endemic regions about the risk of TB and testing for latent TB infection (LTBI) upon return [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Prevention-and-Screening	Latent tuberculosis infection in patients with HIV	- Prevention	22/07/2019 at 13:05
101	[ Indicator ] The treatment of latent tuberculosis infection and the restoration of immunodeficiency is important for the prevention of tuberculosis in patients with HIV infection. Preventive therapy with isoniazid is associated with reduced mortality in patients with HIV and reduced incidence of tuberculosis in adults with HIV infection (treated with antiretroviral therapy). (level 2 [medium level] evidence) Empirical TB therapy may not improve outcomes compared with IPT in patients with advanced HIV disease starting ART in high HIV/TB prevalence (level 2 [medium level] evidence) [ Evidence ] Isoniazid preventative therapy (IPT) both treatment of LTBI and restoration of immunity with ART important for prevention of TB in patients with HIV infection efficacy of IPT in adults with HIV infection IPT associated with reduced mortality in patients with HIV in high TB prevalence setting (level 2 [mid-level] evidence) IPT appears to reduce incidence of TB in adults with HIV infection receiving ART (level 2 [mid-level] evidence) empiric TB therapy may not improve outcomes compared to IPT in patients with advanced HIV disease initiating ART in high HIV/TB prevalence setting (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Isoniazid-preventative-therapy-IPT	Latent tuberculosis infection in patients with HIV	- Adults - HIV - Prevention - Treatment	22/07/2019 at 13:22
102	[ Indicator ] Preventive therapy with isoniazid for children with HIV infection is associated with reduced mortality and incidence of tuberculosis if they do not receive antiretroviral therapy. Therapy may not reduce mortality or active tuberculosis in children with HIV infection who receive antiretroviral therapy. In addition, it may not improve tuberculosis-free survival in babies with or without HIV infection, immunized with the BCG vaccine. [ Evidence ] efficacy of IPT in children with HIV infection IPT may not reduce mortality or active TB in children with HIV infection receiving ART (level 2 [mid-level] evidence) IPT in children with HIV infection not receiving ART associated with reduced mortality and incidence of TB (level 2 [mid-level] evidence) IPT may not improve TB-disease-free survival in infants with or without HIV infection immunized with Bacille Calmette–Guérin (BCG) vaccine (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909352#Isoniazid-preventative-therapy-IPT	Latent tuberculosis infection in patients with HIV	- Babies - Children - HIV - Prevention - Treatment	22/07/2019 at 13:34
103	[ Indicator ] Multi-resistant tuberculosis is the form of tuberculosis resistant to at least isoniazid and rifampicin. A total of 460,000 cancer cases were estimated in 2017 globally. [ Evidence ] MDR TB is defined as TB caused by Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin. An estimated 460,000 cases of MDR TB emerged globally in 2017. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T907301#Background	Multidrug-resistant tuberculosis (MDR TB)	- Definitions - Resistant tuberculosis	22/07/2019 at 15:49
104	[ Indicator ] Risk factors for multi-resistant tuberculosis include exposure to people with this type of disease; history of treatment failure or relapse of tuberculosis; low adherence or non-completion of medications during previous treatment; positive sputum smear (sputum test) after two months of combined therapy; residing or traveling to an area with a high prevalence of drug-resistant tuberculosis. [ Evidence ] Risk factors for MDR TB include: exposure to persons with MDR TB a history of TB with treatment failure or relapse poor adherence to or not completing anti-TB medications during previous TB treatment positive sputum smears after 2 months of standard anti-TB combination therapy residence in or travel to area with a high prevalence of drug resistance [ Reference ] http://www.dynamed.com/topics/dmp~AN~T907301#Background	Multidrug-resistant tuberculosis (MDR TB)	- Risk factor - Resistant tuberculosis	22/07/2019 at 15:55
105	[ Indicator ] The signs of multidrug-resistant tuberculosis do not differ from those of drug-susceptible tuberculosis. The diagnosis is traditionally confirmed with culture and drug susceptibility tests. [ Evidence ] The clinical presentation of MDR TB does not differ from that of drug-susceptible TB. MDR TB diagnosis is traditionally confirmed with culture and drug-susceptibility testing. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T907301#Evaluation	Multidrug-resistant tuberculosis (MDR TB)	- Diagnosis - Resistant tuberculosis	22/07/2019 at 15:58
106	[ Indicator ] For multidrug resistant tuberculosis, molecular testing can quickly identify resistance to rifampicin and isoniazid and is preferable to conventional testing for initial management. When molecular testing is not performed, this type of tuberculosis should be suspected if one or more of the following conditions is found: risk factors; persistence of positive smears and culture tests; and negligible improvement in symptoms, both despite adherence to standard treatment. [ Evidence ] The addition of molecular testing can rapidly identify resistance to rifampicin and isoniazid and is preferred to conventional testing for initial management. When molecular testing is not performed, MDR TB may be suspected prior to receipt of drug susceptibility results if 1 or more of the following: risk factors for MDR TB are present there are persistently positive sputum smears and/or serial cultures despite adherence to standard anti-TB treatment there is little improvement in signs and symptoms of TB despite adherence to standard anti-TB treatment [ Reference ] http://www.dynamed.com/topics/dmp~AN~T907301#Evaluation	Multidrug-resistant tuberculosis (MDR TB)	- Diagnosis - Resistant tuberculosis	22/07/2019 at 16:05
107	[ Indicator ] Multi-resistant tuberculosis should be managed by experts with experience in the treatment of this type of tuberculosis. Before receiving drug sensitivity test results, treatment should be initiated for patients suspected of having multidrug resistant tuberculosis. Initial treatment includes at least five antibiotics. It lasts at least 9-12 months. It may last longer depending on drug susceptibility results. [ Evidence ] MDR TB should be managed by experts with experience in the treatment of drug-resistant TB. Prior to receipt of drug-susceptibility testing results, empiric treatment for MDR TB should be started in those in whom MDR TB is suspected. Initial treatment includes ≥ 5 antibiotics. Duration is at least 9-12 months, and may be longer depending on drug susceptibility results. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T907301#Management	Multidrug-resistant tuberculosis (MDR TB)	- Treatment - Resistant tuberculosis	22/07/2019 at 16:13
108	[ Indicator ] None of the potential treatments for people infected with multidrug resistant tuberculosis have been fully tested for efficacy and these treatments are often poorly tolerated. [ Evidence ] none of the potential regimens for persons infected with MDR TB have been tested fully for efficacy, and these regimens are often poorly tolerated [ Reference ] http://www.dynamed.com/topics/dmp~AN~T907301#Contact-investigation	Multidrug-resistant tuberculosis (MDR TB)	- Treatment - Resistant tuberculosis	22/07/2019 at 16:18
109	[ Indicator ] Pericardial tuberculosis is caused by infection and inflammation of the pericardium. This type is the most common cause of pericarditis (swelling and irritation of the membrane surrounding the heart) in countries with endemic tuberculosis. However, it represents only 4% of patients with pericardial effusion in developed countries. [ Evidence ] Pericardial tuberculosis is caused by infection and inflammation of the pericardium by Mycobacterium tuberculosis. In tuberculosis (TB)-endemic countries, pericardial TB is the most common cause of pericarditis, however it only accounts for 4% of patients with pericardial effusion in developed countries. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Background	Pericardial tuberculosis	- Definitions	22/07/2019 at 16:25
110	[ Indicator ] Pericardial infection can occur from the spread of tuberculosis from the mediastinal, peritracheal, and peribronchial lymph nodes, hematogenous (bloodstream) spread during primary infection, or direct spread from a tuberculous lesion in the lung, pleura, rib cage, diaphragm, or peritoneum to the pericardium. [ Evidence ] Infection of the pericardium can occur by M. tuberculosis spreading from mediastinal, peritracheal, and peribronchial lymph nodes, hematogenous spread during primary infection, or direct spread from a tuberculous lesion in lung, pleura, rib cage, diaphragm, or peritoneum to the pericardium. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Background	Pericardial tuberculosis	- Transmission	22/07/2019 at 16:28
111	[ Indicator ] Pericardial tuberculosis often has nonspecific systemic symptoms, including fever, night sweats, fatigue, weight loss, chest pain, and cough. [ Evidence ] Pericardial tuberculosis (TB) typically presents with nonspecific systemic symptoms including fever, night sweats, fatigue, weight loss, chest pain, and cough. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Evaluation	Pericardial tuberculosis	- Symptoms	22/07/2019 at 16:54
112	[ Indicator ] The first step in diagnosing pericardial tuberculosis is a chest X-ray, which usually shows an enlarged cardiac shadow and may also show changes suggestive of pulmonary tuberculosis. An echocardiogram should be performed in patients with suspected pericardial effusion. [ Evidence ] Imaging is typically the first step in patient evaluation. Order a chest x-ray, which typically shows enlarged cardiac shadow and may also show changes suggestive of pulmonary TB. Echocardiography should be performed for patients suspected of having a pericardial effusion. Presence of fibrinous strands suggest an exudate, but are not specific for TB. Almost all patients have abnormal findings on electrocardiography in the form of ST-T wave changes, but none of these are specific for TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Evaluation	Pericardial tuberculosis	- Diagnosis	22/07/2019 at 17:00
113	[ Indicator ] All patients with suspected pericardial tuberculosis with effusion should be evaluated for signs of cardiac tamponade or compromise, as they constitute a medical emergency. [ Evidence ] Assess all patients suspected of having pericardial TB with an effusion for signs of cardiac tamponade or compromise, as these constitute a medical emergency. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Evaluation	Pericardial tuberculosis	- Diagnosis	22/07/2019 at 17:06
114	[ Indicator ] Diagnosis of pericardial tuberculosis can be confirmed by examination of culture from pericardial fluid samples, biopsy specimens, and evidence of acid-resistant bacilli. However, due to the low yield of these specimens, a negative result does not exclude the diagnosis of pericardial tuberculosis. Finding acid-resistant granulomas and bacilli on pericardial biopsy also provides a definitive diagnosis. [ Evidence ] Diagnosis can be confirmed by culturingMycobacterium tuberculosis from pericardial fluid or biopsy specimens or demonstration of acidfast bacilli, but because yield is low from these specimens, a negative result does not rule out the diagnosis of pericardial TB. Finding of granulomas and acid-fast bacilli on pericardial biopsy also provides definitive diagnosis. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Evaluation	Pericardial tuberculosis	- Diagnosis	22/07/2019 at 17:10
115	[ Indicator ] Directly observed therapy is preferable to self-administered therapy for the routine treatment of patients with all forms of tuberculosis. [ Evidence ] Directly observed therapy (DOT) is preferred over self-administered therapy (SAT) for routine treatment of patients with all forms of tuberculosis (Weak recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Management	Pericardial tuberculosis	- Treatment	22/07/2019 at 17:13
116	[ Indicator ] Concerning pericardial tuberculosis, adjuvant corticosteroids are recommended during the first eleven weeks of treatment in patients without HIV infection, although recommendations vary for patients with HIV infection. [ Evidence ] Use adjunctive corticosteroids during the first 11 weeks of treatment in patients without HIV infection (Strong recommendation), although recommendations vary for patients with HIV infection. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Management	Pericardial tuberculosis	- HIV - Treatment	22/07/2019 at 17:16
117	[ Indicator ] Patients with pericardial tuberculosis, unstable with cardiac tamponade, require immediate drainage of pericardial fluid by pericardiocentesis or surgery. [ Evidence ] Unstable patients with cardiac tamponade require immediate drainage of pericardial fluid by needle pericardiocentesis or surgery. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Management	Pericardial tuberculosis	- Treatment	22/07/2019 at 17:19
118	[ Indicator ] Surgical pericardiectomy (removal of part of the pericardium) should be considered in patients with constrictive tuberculous pericarditis who do not improve or deteriorate after 4 to 8 weeks of antituberculosis therapy. [ Evidence ] Consider surgical pericardiectomy in patients with constrictive tuberculous pericarditis who do not improve or deteriorate after 4-8 weeks of anti-TB therapy. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T910018#Management	Pericardial tuberculosis	- Treatment	22/07/2019 at 17:22
119	[ Indicator ] Pleural tuberculosis refers to a pleural effusion that results from infection of the pleura (lung membrane) combined with a delayed hypersensitivity response to that infection. It is one of the most common forms of extrapulmonary tuberculosis worldwide. [ Evidence ] Pleural tuberculosis refers to a pleural effusion that results from infection of the pleura with Mycobacterium tuberculosis combined with a delayed hypersensitivity response to that infection. It is one of the most common forms of extrapulmonary tuberculosis (TB) worldwide. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Background	Pleural tuberculosis	- Definitions	22/07/2019 at 17:28
120	[ Indicator ] Pleural tuberculosis can result from primary infection or from reactivation of latent infection. Concomitant tuberculosis infection of the lung parenchyma is common and found in about 20% to 50% of patients. [ Evidence ] Pleural TB may result from primary infection or from reactivation of latent TB infection. Concurrent TB infection of the lung parenchyma is common, and present in about 20%-50% of patients. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Background	Pleural tuberculosis	- Transmission	22/07/2019 at 17:30
121	[ Indicator ] Symptoms of acute pleural tuberculosis include fever, cough, and pleuritic chest pain. Pleural tuberculosis must be suspected in a patient with a pleural effusion on chest radiography and a history of exposure to someone with tuberculosis or a history of living in or traveling to an area where tuberculosis is endemic. Most effusions are unilateral and small to moderate. [ Evidence ] Symptoms associated with acute pleural tuberculosis (TB) include fever, cough, and pleuritic chest pain. With long-standing infection, draining empyema (empyema necessitans) can develop. Suspect pleural TB in a patient with a pleural effusion on chest x-ray and a history of exposure to someone with TB or history of living in or travelling to an area where TB is endemic. Note that most effusions are unilateral and small to moderate in size. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnosis - Symptoms	22/07/2019 at 17:34
122	[ Indicator ] Additional imaging such as computed tomography can help detect complications such as concomitant infection with pleural tuberculosis, for example tuberculosis infection of the lung parenchyma. [ Evidence ] Additional imaging, such as a computed tomography (CT) scan, may help detect complications such as loculations or concurrent TB infection of the lung parenchyma. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnosis	22/07/2019 at 17:36
123	[ Indicator ] Definitive diagnosis of pleural tuberculosis requires evidence of tuberculosis in sputum, pleural fluid by culture, or nucleic acid amplification testing. Pleural biopsy may be necessary when the organism cannot be detected in sputum or pleural fluid analysis. [ Evidence ] Definitive diagnosis requires demonstration of Mycobacterium tuberculosis in either sputum or pleural fluid by culture or nucleic acid amplification testing. Pleural biopsy may be needed when the organism cannot be detected in sputum or pleural fluid analysis. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnosis	22/07/2019 at 17:39
124	[ Indicator ] In regions with high tuberculosis rates, where resources are limited, the diagnosis of pleural tuberculosis can be inferred by the detection of an exudative lymphocytic effusion. [ Evidence ] In regions with high rates of TB where resources are limited, diagnosis can be inferred by detecting an exudative lymphocytic effusion with high ADA levels. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnosis	22/07/2019 at 17:42
125	[ Indicator ] Patients diagnosed with or suspected pleural tuberculosis should also be tested for HIV infection due to high rates of co-infection and/or co-endemicity. [ Evidence ] In all cases, patients with known or suspected pleural TB should also be tested for HIV infection due to high rates of coinfection and/or co-endemicity. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnosis - HIV	22/07/2019 at 17:43
126	[ Indicator ] The recommended treatment for patients with pleural tuberculosis caused by non-resistant organisms includes: initial phase of 2 months with isoniazid, rifampicin, pyrazinamide and ethambutol; and a 4-month continuation phase with isoniazid and rifampicin. [ Evidence ] The recommended regimen for patients with pleural TB caused by drug-susceptible organisms includes (Strong recommendation): a 2-month initial phase with isoniazid, rifampicin, pyrazinamide, and ethambutol PLUS a 4-month continuation phase with isoniazid and rifampicin [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Management	Pleural tuberculosis	- Treatment	22/07/2019 at 17:46
127	[ Indicator ] For pleural tuberculosis, drainage of pleural effusions is not routinely recommended, but may be considered for patients with a large effusion causing difficulty breathing or for patients with empyema (accumulation of pus). [ Evidence ] Drainage of pleural effusions is not routinely recommended but can be considered for patients with a large effusion causing difficulty in breathing or in patients with empyema. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Management	Pleural tuberculosis	- Treatment	22/07/2019 at 17:49
128	[ Indicator ] After the initiation of anti-tuberculosis treatment, the patient may worsen due to an increased size of pleural effusion or the development of new lesions. In most cases, reactions resolve without further therapy. [ Evidence ] Be aware that paradoxical worsening after initiation of antituberculosis treatment can occur and may be characterized by an increase in size of a pleural effusion or development of new lesions. Paradoxical reactions resolve without additional therapy in most cases. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T909686#Management	Pleural tuberculosis	- Side effects	22/07/2019 at 17:53
129	[ Indicator ] Pleuritis is inflammation of the parietal pleura that results in sudden, severe chest pain on inspiration and expiration. This pain combined with malaise, weight loss, fever, or night sweats could indicate tuberculosis. [ Evidence ] inflammation of parietal pleura resulting in sudden and intense chest pain on inhalation and exhalation(1) ask about symptoms that may appear in combination with pain malaise may indicate malignancy(3) pleural effusion(1) tuberculosis(1) rheumatoid arthritis(1) weight loss may indicate malignancy(3) pleural effusion(1) tuberculosis(1) rheumatoid arthritis(1) fever may indicate(1) pneumonia tuberculosis familial Mediterranean fever systemic lupus erythematosus medication-induced pleuritis (Clin Chest Med 2004 Mar;25(1):141) other infection night sweats may indicate malignancy(3) pleural effusion (including malignant pleural effusion)(1) tuberculosis(1) rheumatoid arthritis(1) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T922350#Description http://www.dynamed.com/topics/dmp~AN~T922350#History-of-present-illness-HPI	Pleuritis - approach to the patient	- Symptoms	22/07/2019 at 19:06
130	[ Indicator ] Pulmonary tuberculosis refers to the clinical syndrome associated with infection of the respiratory system caused by the mycobacteria tuberculosis. In 2017, the World Health Organization estimated that 10 million people developed tuberculosis and 1.6 million died from the disease. [ Evidence ] Pulmonary tuberculosis (TB) refers to the clinical syndrome associated with infection of the respiratory system caused by Mycobacterium tuberculosis. The World Health Organization estimates that in 2017, 10 million people developed TB and 1.6 million died from the disease, with 9,093 cases reported in the United States. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Background	Pulmonary tuberculosis	- Definitions	23/07/2019 at 10:45
131	[ Indicator ] Tuberculosis is transmitted by the air from one person to another when the bacteria are sprayed in an aerosol by a person with pulmonary tuberculosis. [ Evidence ] M. tuberculosis is spread through the air from one person to another when bacteria are aerosolized from a person with pulmonary TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Background	Pulmonary tuberculosis	- Transmission	23/07/2019 at 10:48
132	[ Indicator ] Risk factors for pulmonary tuberculosis are: (1) close contact with a person with infectious tuberculosis; (2) children under 5 years of age with a positive tuberculin skin test; (3) people who immigrated from regions of the world with high rates of tuberculosis; (4) groups with high rates of tuberculosis transmission, including people with HIV infection, injecting drug users and people living on the street; (5) work or reside with people at high risk of tuberculosis in facilities or institutions; (6) medical conditions that weaken the immune system such as treatment with immunosuppressive drugs, diabetes, malignancy, organ transplantation, silicosis, substance abuse disorder, severe kidney disease, or low body weight. [ Evidence ] Risk factors for developing TB include: Close contacts of a person with infectious TB disease. Children < 5 years old who have a positive tuberculin skin test. Persons who have immigrated from regions of the world with high rates of TB. Groups with high rates of TB transmission including persons with HIV infection, injection drug users, and homeless persons. Working or residing with people at high risk for TB in facilities or institutions. Medical conditions that weaken the immune system such as HIV infection, treatment with immunosuppressive medications, diabetes, malignancy, organ transplantation, silicosis, substance abuse disorder, severe kidney disease, or low body weight. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Background	Pulmonary tuberculosis	- Associated disease - Risk factor - HIV - People living on the street - Drug user	23/07/2019 at 11:04
133	[ Indicator ] Pulmonary tuberculosis has symptoms suggestive of fever, fatigue, weight loss, night sweats, cough, or hemoptysis (blood in the sputum). [ Evidence ] Suspect pulmonary tuberculosis (TB) in patients with suggestive symptoms including fever, fatigue, weight loss, night sweats, cough, or hemoptysis. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Evaluation	Pulmonary tuberculosis	- Symptoms	23/07/2019 at 11:07
134	[ Indicator ] The diagnosis of pulmonary tuberculosis is confirmed with the identification of mycobacteria in the respiratory sample of patients with compatible clinical symptoms. Tests used for bacteriological diagnosis include bacilloscopy (sputum test), nucleic acid amplification test, and liquid and solid mycobacterial culture test (gold standard for diagnosis). The diagnosis is often supplemented with radiological abnormalities of the chest and evidence of the immune response by the tuberculin skin test and/or the interferon gamma release test, although these tests are also positive in patients with previously treated tuberculosis or latent tuberculosis infection. [ Evidence ] Identification of Mycobacterium tuberculosis in respiratory specimen confirms diagnosis of pulmonary TB in patients with compatible clinical symptoms. Tests used for bacteriologic diagnosis include: Acid fast bacillus (AFB) smear microscopy, though this test is not specific to M. tuberculosis. Nucleic acid amplification testing (NAAT). Liquid and solid mycobacterial culture (gold standard for diagnosis). Diagnosis often supplemented with additional evidence such as: Chest x-ray abnormalities. Evidence of immune response by tuberculin skin test (TST) and/or interferon gamma release assay (IGRA), though these tests will also be positive in patients with previously treated TB or latent TB infection. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Evaluation	Pulmonary tuberculosis	- Diagnosis	23/07/2019 at 11:15
135	[ Indicator ] The recommended treatment for newly diagnosed pulmonary tuberculosis susceptible to all first-line drugs is: initial phase of two months with isoniazid, rifampicin, pyrazinamide and ethambutol; and a 4-month continuation phase with isoniazid plus rifampicin. [ Evidence ] The recommended empiric treatment for newly diagnosed pulmonary TB caused by Mycobacterium tuberculosis susceptible to all first-line drugs is a 2-month initial or intensive phase followed by a 4-month continuation phase (Strong recommendation). The 2-month initial phase consists of isoniazid, rifampicin, pyrazinamide, plus ethambutol. The 4-month continuation phase consists of isoniazid plus rifampicin. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Management	Pulmonary tuberculosis	- Treatment	23/07/2019 at 11:21
136	[ Indicator ] The treatment of pulmonary tuberculosis with isoniazid should be supplemented with pyridoxine in patients with nutritional deficiency, diabetes, HIV infection, renal failure, alcoholism, in pregnant and lactating women and in children to prevent side effects. [ Evidence ] Supplement isoniazid treatment with pyridoxine 25 mg/day in patients with nutritional deficiency, diabetes, HIV infection, renal failure, or alcoholism, in pregnant and breastfeeding women, and in children to prevent adverse events. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Management	Pulmonary tuberculosis	- Children - Associated disease - Side effects - Pregnant women - HIV - Treatment	23/07/2019 at 11:25
137	[ Indicator ] For pulmonary tuberculosis, if cavities are present on initial chest X-ray and if a sample culture obtained within 2 months of treatment remains positive, extending the continuation phase to 7 months (9 months in total) should be considered. [ Evidence ] If cavities are present on an initial chest radiograph and if a culture of a specimen obtained at 2 months remains positive, consider extending the continuation phase to 7 months (9 months total). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Management	Pulmonary tuberculosis	- Treatment	23/07/2019 at 11:30
138	[ Indicator ] Isoniazid prophylaxis may reduce the risk of tuberculosis in kidney transplant patients. [ Evidence ] isoniazid prophylaxis may reduce risk of tuberculosis in patients having kidney transplant (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T116300#Treatment-of-latent-tuberculosis-infection	Pulmonary tuberculosis	- Prevention	23/07/2019 at 11:35
139	[ Indicator ] The main risk factors for acquiring tuberculosis in children include birth or residence in an endemic area and exposure to adults with active tuberculosis and exposure to secondhand smoke. Furthermore, factors associated with increased risk of developing the disease include recent acquisition of infection, younger age, compromised immunity (particularly HIV infection), and chronic comorbidities such as diabetes mellitus. [ Evidence ] Major risk factors for acquisition of infection include birth or residence in an endemic area, exposure to adults with active TB, and exposure to second hand smoke. Factors associated with increased risk of progressing from latent infection to active disease include recent acquisition of infection, younger age, immunocompromise, particularly HIV infection, and chronic comorbidities such as diabetes mellitus. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Background	Tuberculosis in children	- Babies - Children - Associated disease - Risk factor - HIV	23/07/2019 at 11:41
140	[ Indicator ] The most common clinical presentation of tuberculosis in children is parenchymal lung disease with associated intrathoracic lymphadenopathy. [ Evidence ] The most common clinical presentation of tuberculosis in children is pulmonary parenchymal disease with associated intrathoracic lymphadenopathy. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Background	Tuberculosis in children	- Children - Symptoms	23/07/2019 at 11:47
141	[ Indicator ] Extrapulmonary tuberculosis is more common in children than adults, most often manifesting as tuberculous lymphadenitis or pleural disease. Less common are the extrapulmonary forms in the pericardium, central nervous system, skeletal and miliary. [ Evidence ] Extrapulmonary disease is also more common in children than in adults, most often manifesting as tuberculous lymphadenitis or pleural disease. Less common extrapulmonary manifestations include pericardial, central nervous system, skeletal, and miliary disease. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Background	Tuberculosis in children	- Children - Diagnosis - Symptoms	23/07/2019 at 11:48
142	[ Indicator ] Congenital tuberculosis is very rare, but it is reported. It may present with fever, respiratory distress, hepato/splenomegaly (enlarged liver/ spleen) or nonspecific symptoms such as poor diet or lethargy. [ Evidence ] Congenital TB is very rare, but reported, and may present with fever, respiratory distress, hepato/splenomegaly, or with nonspecific symptoms such as poor feeding or lethargy. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Background	Tuberculosis in children	- Babies - Symptoms	23/07/2019 at 11:56
144	[ Indicator ] Children born in endemic areas or exposed to an adult with tuberculosis should be investigated for cough and/or fever, weight loss or failure to thrive, lymphadenopathy (enlarged lymph nodes), hepato/splenomegaly (enlarged liver/spleen) , meningitis, ascites, or other suggestive symptoms. [ Evidence ] Consider the diagnosis of tuberculosis (TB) in children born in endemic areas or with known exposure to an adult with active TB, presenting with cough and/or fever, weight loss or failure to thrive, lymphadenopathy, hepato- or splenomegaly, meningitis or ascites, or other suggestive signs and symptoms. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation	Tuberculosis in children	- Babies - Children - Symptoms	23/07/2019 at 12:00
145	[ Indicator ] Children with suspected tuberculosis infection should have a tuberculin skin test or interferon gamma release test. Skin testing is preferred for children under 5 years of age. The second test is preferred for children 5 years and older who have a history of the BCG vaccine. However, any test is acceptable in children over 5 years of age who have no vaccine history. Children who test positive should have a complete physical examination, including a careful neurological assessment and a chest X-ray. If the result is negative, further evaluation is considered in children who remain at risk of acquiring tuberculosis, as a negative result does not exclude active disease. [ Evidence ] Screen children with suspected latent or active infection using either a tuberculin skin test (TST) or interferon gamma release assay (IGRA). TST is preferred in children < 5 years old, but IGRA is preferred in children ≥ 5 years old with history of bacille Calmette-Guérin (BCG) vaccination. Either test is acceptable in children > 5 years old who lack a history of BCG vaccination. In children who screen positive, perform a thorough physical examination, including a careful neurologic assessment and a chest x-ray. In children who screen negative, consider additional evaluation in those who remain at increased risk for TB, as a negative result does not rule out active disease. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation	Tuberculosis in children	- Children - Diagnosis	23/07/2019 at 12:06
146	[ Indicator ] In the absence of bacterial confirmation, the diagnosis of tuberculosis can be made clinically based on risk factors, symptoms, and/or chest X-ray features. [ Evidence ] In the absence of bacterial confirmation, the diagnosis can be made clinically based on risk factors, signs and symptoms and/or characteristic chest x-ray findings. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation	Tuberculosis in children	- Children - Diagnosis	23/07/2019 at 13:17
147	[ Indicator ] HIV testing should be performed on all children with suspected or confirmed tuberculosis due to the association between HIV infection and tuberculosis. [ Evidence ] Due to the association between HIV infection and TB, consider HIV testing in all children with suspected or confirmed TB. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation	Tuberculosis in children	- Children - HIV	23/07/2019 at 13:18
148	[ Indicator ] The diagnosis of tuberculosis in children usually represents a recent transmission. Therefore, it is necessary to investigate the source case. [ Evidence ] The diagnosis in children often represents a recent transmission and should trigger a source case investigation. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management	Tuberculosis in children	- Children - Diagnosis - Treatment	23/07/2019 at 13:22
149	[ Indicator ] In children, the recommended treatment for pulmonary tuberculosis not resistant to all first-line drugs is a 2-month initial phase, followed by a 4-month continuation phase. The initial phase includes isoniazid, rifampicin, pyrazinamide, and ethambutol. The continuation phase includes isoniazid and rifampicin. [ Evidence ] American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America (ATS/CDC/IDSA)- recommended empiric treatment for tuberculosis in children with pulmonary tuberculosis caused by Mycobacterium tuberculosis known or suspected to be susceptible to all first-line drugs is a 2-month initial phase followed by a 4-month continuation phase (Strong recommendation). The 2-month initial phase includes: isoniazid 5 mg/kg/day (maximum 300 mg/day, 10 mg/kg/day in children) orally, IV, or intramuscularly rifampicin 10 mg/kg/day (maximum 600 mg/day, 15 mg/kg/day in children) orally or IV pyrazinamide 25 mg/kg/day (maximum 2 g/day, 15-30 mg/kg/day in children) orally ethambutol 15 mg/kg/day (maximum 1.6 g/day, 20 mg/kg/day in children) orally The 4-month continuation phase includes: isoniazid 5 mg/kg/day (maximum 300 mg/day, 10 mg/kg/day in children) orally, IV, or intramuscularly rifampicin 10 mg/kg/day (maximum 600 mg/day, 15 mg/kg/day in children) orally or IV [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management	Tuberculosis in children	- Children - Treatment	23/07/2019 at 13:29
150	[ Indicator ] The continuation phase of tuberculosis treatment in children should be extended if there is cavitation on the initial chest X-ray, sputum cultures that are positive after 2 months of therapy, tuberculous meningitis, or skeletal tuberculosis. [ Evidence ] Extend the continuation phase for patients with cavitation on initial chest radiograph and positive sputum cultures after 2 months of therapy, tuberculous meningitis, or skeletal tuberculosis. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management	Tuberculosis in children	- Children - Treatment	23/07/2019 at 13:31
151	[ Indicator ] Adjuvant corticosteroids are recommended for all children with tuberculous meningitis and/or airway involvement by lymphadenopathy (enlarged lymph nodes). They may also be considered for children with severe pleural, pericardial, abdominal, or miliary disease. [ Evidence ] Adjunctive corticosteroids are recommended for all children with tuberculous meningitis, airway impingement from lymphadenopathy, and can be considered for those with pleural, pericardial, abdominal, or severe miliary disease. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management	Tuberculosis in children	- Children - Associated disease - Treatment	23/07/2019 at 13:35
152	[ Indicator ] Preventive therapy is recommended for children with latent tuberculosis infection. It consists of the use of isoniazid for 6 months for children under 5 years of age who are in close contact with people with tuberculosis, but who do not have the disease. [ Evidence ] Both the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend preventative therapy for children with latent tuberculosis infection (LTBI)(6, 8) WHO recommends isoniazid preventative therapy (10 mg/kg/day, maximum 300 mg/day) for 6 months to children aged < 5 years who are household or close contacts of people with tuberculosis but do not have active disease (WHO Strong recommendation, High-quality evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Children - Prevention	23/07/2019 at 13:43
153	[ Indicator ] Preventive therapy with isoniazid is considered for all infants and children with latent tuberculosis who do not have active disease or a history of previous treatment for tuberculosis. [ Evidence ] Consider isoniazid preventative therapy for all infants and children with latent tuberculosis infection who have no evidence of active disease or history of previous tuberculosis treatment [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Babies - Children - Prevention	23/07/2019 at 13:45
154	[ Indicator ] Preventive therapy should be initiated in all children under 4 years of age with impaired immunity who are exposed to patients with contagious tuberculosis, regardless of the results of diagnostic tests. [ Evidence ] Initiate preventative therapy in all children < 4 years old with impaired immunity exposed to patients with contagious tuberculosis regardless of diagnostic testing results [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Babies - Children - Prevention	23/07/2019 at 13:48
155	[ Indicator ] Preventive therapy for children with latent tuberculosis infection includes isoniazid for 9 months. There are alternative regimens with different doses and durations per the child’s age. Furthermore, rifampicin can be included for a 3-month duration regimen. For children who were started on therapy and had no active disease, 2 months of rifampicin and pyrazinamide given as part of the four-drug regimen is considered sufficient. If the source of the infection is tuberculosis resistant to isoniazid but susceptible to rifampicin, rifampicin should be administered daily for 4 months (some experts recommend 6 months in children over 12 years of age). [ Evidence ] Regimens for children with latent tuberculosis infection isoniazid 10 mg/kg/day (maximum 300 mg/day) for 9 months preferred consider isoniazid 20-30 mg/kg/dose (maximum 900 mg/dose) twice weekly as directly observed therapy for 9 months if adherence to daily therapy cannot not assured alternative regimens isoniazid 15 mg/kg (maximum 900 mg) plus rifampicin 300-900 mg weekly for 12 weeks may be used in children ≥ 12 years old can be considered in children < 12 years old if low likelihood of completion of other therapies (note regimen unstudied in this age group) should not be used in children < 2 years old isoniazid 10 mg/kg/day (maximum 300 mg/day) plus rifampicin 10-15 mg/kg/day (maximum 600 mg) for 3 months for children who have been started on empiric therapy and subsequently found not to have active disease, 2 months of daily rifampicin and pyrazinamide given as part of the empiric 4-drug regimen considered sufficient for treatment of LTBI if source of infection found to have isoniazid-resistant, rifampicin-susceptible tuberculosis, give rifampicin daily for 4 months (some experts recommend 6 months in children < 12 years old) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Babies - Children - Prevention	23/07/2019 at 13:59
156	[ Indicator ] Children with a negative tuberculin skin test or gamma interferon release test should be retested 8 to 10 weeks after the last exposure to the source of infection. Preventive therapy can be discontinued in immunocompetent patients who continue to test negative. The full regimen of preventive treatment should be continued in immunocompromised patients in whom latent infection cannot be excluded. [ Evidence ] Retest children with negative tuberculin skin test (TST) or interferon gamma release assay (IGRA) 8-10 weeks after last exposure to source of infection therapy can be discontinued in immunocompetent patients who continue to have negative TST or IGRA continue full treatment regimen in patients with immunocompromised in whom LTBI cannot be excluded [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Children - Prevention	23/07/2019 at 14:03
157	[ Indicator ] Directly observed rifapentine and isoniazid once weekly for 3 months appear as effective as isoniazid once daily for 9 months in preventing tuberculosis in children with latent infection. [ Evidence ] Directly observed rifapentine plus isoniazid once weekly for 3 months appears as effective as isoniazid once daily for 9 months in preventing tuberculosis in children with LTBI (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Children - Prevention	23/07/2019 at 14:06
158	[ Indicator ] Four-month rifampicin may be as effective as 9-month isoniazid in children with latent tuberculosis infection. [ Evidence ] 4-month rifampicin may be as effective as 9-month isoniazid in children with LTBI (level 2 [mid-level] evidence) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Children - Prevention	23/07/2019 at 14:09
159	[ Indicator ] Tuberculosis in children is rarely contagious. However, children with adult-type tuberculosis features can be potentially contagious, and these features are cough, productive cough, skin drainage/soft tissue injury, lack of adequate treatment for tuberculosis or having only been started with medication for short duration and airway instrumentation. The radiographic features are cavity lesions, apical and laryngeal involvement. Furthermore, they can be contagious if they are smear positive. [ Evidence ] Children with tuberculosis (TB) rarely contagious ( Tuberculosis (Edinb) 2011 Dec;91 Suppl 1:S11) children with features of adult-type TB may potentially be contagious, including clinical symptoms presence of cough productive cough draining skin/soft tissue lesion lack of appropriate treatment for TB, or only having been started on TB medications for short duration airway instrumentation radiographic features cavitary lesions apical involvement laryngeal involvement positive acid-fast sputum smear [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Isolation-of-children-with-active-tuberculosis	Tuberculosis in children	- Children - Transmission	23/07/2019 at 14:16
160	[ Indicator ] If the mother or household contact has a positive tuberculin skin test or interferon gamma release assay, but a chest radiograph is normal, the recommendations are: it is not necessary to separate the mother from the baby; no special evaluation or therapy required for the baby; other family members should be evaluated for tuberculosis, as the positive test may represent an unrecognized case of contagious tuberculosis; and the mother can breastfeed the baby. [ Evidence ] If mother (or household contact) has positive tuberculin skin test or IGRA and normal chest x-ray(8) no separation of mother and infant required no special evaluation or therapy required for infant other household members should be evaluated for tuberculosis as positive test may represent unrecognized case of contagious tuberculosis mother can breastfeed infant [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis	Tuberculosis in children	- Breastfeeding - Babies - Prevention	23/07/2019 at 14:21
161	[ Indicator ] If the mother or family member has clinical symptoms or abnormal X-ray results compatible with tuberculosis, the following measures should be taken: evaluate the baby for congenital tuberculosis; separate the mother or family member from the child until a complete evaluation is performed; when the child receives isoniazid, separation is not necessary, unless the mother or family member is suspected of being infected with drug-resistant tuberculosis or has poor adherence to therapy and directly observed therapy is not possible; women with a drug-susceptible infection who have been treated properly for more than 2 weeks can breastfeed. If congenital tuberculosis is excluded, isoniazid should be used for 3 to 4 months and the skin test performed afterwards. If the test is negative and the mother or family member has good adherence to treatment, isoniazid can be discontinued. If the test is positive, tuberculosis should be investigated again. If not detected, isoniazid should be continued for 9 months and the child evaluated monthly during treatment. [ Evidence ] If mother (or household contact) has clinical signs and symptoms or abnormal findings on x-ray consistent with tuberculosis disease(8) immediately report to local health department evaluate infant for congenital tuberculosis separate mother (or household contact) from infant until full evaluation can be done, and if tuberculosis suspected, until mother found not to have tuberculosis mother and child both receive appropriate therapy mother understands and is willing to adhere to infection-control measures once infant receives isoniazid, separation not required unless mother (or household contact) has suspected drug resistant tuberculosis infection has poor adherence to therapy and directly observed therapy not possible women with drug-susceptible infection treated appropriately for ≥ 2 weeks may breastfeed if congenital tuberculosis excluded, give isoniazid for 3-4 months and perform skin test if skin test is positive reassess for tuberculosis disease if tuberculosis disease excluded, continue isoniazid for total of 9 months evaluate infants for signs of tuberculosis monthly during treatment if skin test is negative, and mother has good treatment adherence, discontinue isoniazid [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis	Tuberculosis in children	- Babies - Children - Prevention	23/07/2019 at 14:35
162	[ Indicator ] The following measures should be taken if the mother or family member has a positive tuberculin skin test or interferon gamma release assay and abnormal chest radiograph results but no evidence of tuberculous disease: illness and separation is not necessary; the mother should be treated for latent tuberculosis infection; other family members should be evaluated. [ Evidence ] If mother (or household contact) has positive skin test or IGRA and abnormal findings on chest x-ray but no evidence of tuberculosis disease(8) infant can be assumed to be at low risk of disease, and separation not necessary treat mother for latent tuberculosis infection evaluate other household members [ Reference ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis	Tuberculosis in children	- Babies - Children - Prevention	23/07/2019 at 14:39
163	[ Indicator ] Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis, occurring in about 35% of patients with extrapulmonary tuberculosis. Tuberculous lymphadenitis may occur in the presence of disease at other anatomical sites. [ Evidence ] Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis (TB), occurring in about 35% of patients with extrapulmonary TB. Tuberculous lymphadenitis may occur in the presence of disease in other anatomical sites. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901422#Background	Tuberculous lymphadenitis	- Definitions - Associated disease	23/07/2019 at 14:42
164	[ Indicator ] Risk factors for lymphadenitis tuberculosis include female sex, peak age of 30 to 40 years, residence in endemic countries, particularly in Southeast Asia and Africa, and immunocompromise, including HIV infection. [ Evidence ] Risk factors include female sex, peak age 30-40 years, residence in endemic countries, particularly in Southeast Asia and Africa, and immunocompromise, including HIV infection. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901422#Background	Tuberculous lymphadenitis	- Risk factor - HIV - Sex	23/07/2019 at 14:43
165	[ Indicator ] The definitive diagnosis of tuberculosis lymphadenitis is made by culture or molecular identification of tuberculosis mycobacteria in the tissue of an affected lymph node. The preferred method of collecting a biopsy specimen is fine-needle aspiration, as it is safer and less invasive than excisional biopsy. However, commonly used diagnoses include microbiological testing, cytology, and nucleic acid amplification tests. Chest radiography should be performed to determine the presence of pulmonary tuberculosis. [ Evidence ] Definitive diagnosis is made by culture or molecular identification of Mycobacterium tuberculosis in tissue from an affected lymph node. Fine needle aspiration is the preferred method of collecting biopsy samples, as it is safer and less invasive than excisional biopsy. Commonly used diagnostics include: microbiologic testing cytology nucleic acid amplification tests Chest x-ray should be performed to determine the presence of pulmonary tuberculosis. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901422#Evaluation	Tuberculous lymphadenitis	- Diagnosis	23/07/2019 at 14:46
166	[ Indicator ] The total duration of treatment for lymphadenitis tuberculosis is 6 months. The initial phase is 2 months and includes isoniazid, rifampicin, pyrazinamide and ethambutol. The continuation phase is 4 months and includes isoniazid and rifampicin. [ Evidence ] Treatment recommendations derived from the American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America (ATS/CDC/IDSA) and World Health Organization (WHO) (Strong recommendation): The total length of therapy is 6 months. The 2-month initial phase includes: isoniazid orally, IV, or intramuscularly 5 mg/kg/day (maximum 300 mg/day, 10 mg/kg/day in children) rifampicin orally or IV 10 mg/kg/day (maximum 600 mg/day, 15 mg/kg/day in children) pyrazinamide orally 25 mg/kg/day (maximum 2 g/day, 15-30 mg/kg/ day in children) ethambutol orally 15 mg/kg/day (maximum 1.6 g/day, 20 mg/kg/day in children) The 4-month continuation phase includes: isoniazid orally, IV, or intramuscularly 5 mg/kg/day (maximum 300 mg/day, 10 mg/kg/day in children) rifampicin orally or IV 10 mg/kg/day (maximum 600 mg/day, 15 mg/kg/day in children) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901422#Management	Tuberculous lymphadenitis	- Treatment	23/07/2019 at 14:48
167	[ Indicator ] Excision (extraction) of the affected lymph nodes is usually reserved for unusual cases or treatment failure. [ Evidence ] Excision of affected lymph nodes is generally reserved for unusual cases or treatment failure. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901422#Management	Tuberculous lymphadenitis	- Treatment	23/07/2019 at 14:50
168	[ Indicator ] During treatment, monitoring should be done for drug toxicities, paradoxical amelioration reaction and immune reconstitution inflammatory syndrome. [ Evidence ] During treatment, monitor for drug toxicities, a paradoxical upgrading reaction, and immune reconstitution inflammatory syndrome [ Reference ] http://www.dynamed.com/topics/dmp~AN~T901422#Management	Tuberculous lymphadenitis	- Treatment	23/07/2019 at 14:51
169	[ Indicator ] Tuberculous meningitis (also called meningeal tuberculosis) is caused by an infection of the central nervous system. It is the most serious form of tuberculosis, with high morbidity and mortality, and neurological complications are common when diagnosis or treatment is delayed. [ Evidence ] Tuberculous meningitis (also called meningeal tuberculosis) is caused by infection of the central nervous system with Mycobacterium tuberculosis. It is the most severe form of tuberculosis, with high morbidity and mortality, and neurologic complications are common with delayed diagnosis or treatment. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Background	Tuberculous meningitis	- Definitions	23/07/2019 at 14:57
170	[ Indicator ] Populations most at risk of contracting tuberculous meningitis include children and people with HIV infection. [ Evidence ] Those at highest risk for tuberculous meningitis include children and persons with HIV infection. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Background	Tuberculous meningitis	- Children - Risk factor - HIV	23/07/2019 at 14:58
171	[ Indicator ] The spread of tuberculosis to the central nervous system occurs by hematogenous (bloodstream) spread of organisms to the brain. [ Evidence ] Spread to the central nervous system occurs by hematogenous dissemination of organisms to the brain. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Background	Tuberculous meningitis	- Transmission	23/07/2019 at 14:59
172	[ Indicator ] Tuberculous meningitis is difficult to diagnose and requires a lot of suspicion. The initial clinical presentation may be nonspecific and similar to other types of meningitis. Diagnosis should be considered when a patient has consistent signs and symptoms combined with risk factors for tuberculosis. [ Evidence ] Tuberculous meningitis is difficult to diagnose and a high index of suspicion is required. Diagnosis should be considered when a patient presents with consistent signs and symptoms combined with risk factors for tuberculosis (TB). Early clinical presentation may be nonspecific, and similar to other types of meningitis. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Diagnosis - Symptoms	23/07/2019 at 15:02
173	[ Indicator ] Meningeal tuberculosis symptoms in children can include meningeal irritation, poor weight gain or weight loss, altered consciousness, and fever. Symptoms often emerge within 3 months of primary pulmonary tuberculosis. Meningeal tuberculosis is closely associated with disseminated (miliary) tuberculosis, with more rapid progression of symptoms and neurological complications compared to adults. [ Evidence ] Symptoms in children may include meningeal irritation, poor weight gain or weight loss, altered consciousness, and fever. It often presents within 3 months of primary pulmonary TB. It is closely associated with disseminated TB with more rapid progression of symptoms and neurological complications compared to adults. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Children - Symptoms	23/07/2019 at 15:04
174	[ Indicator ] The meningeal tuberculosis symptoms in adults include stiff neck, headache, fever, and vomiting. [ Evidence ] Symptoms in adults include stiff neck, headache, fever, and vomiting. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Symptoms	23/07/2019 at 15:05
175	[ Indicator ] About a third of patients with tuberculous meningitis have cranial neuropathies with involvement of the sixth most common nerve. [ Evidence ] About one-third of patients with tuberculous meningitis have cranial neuropathies, with involvement of the sixth nerve most common. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Symptoms	23/07/2019 at 15:06
176	[ Indicator ] Patients with HIV typically have a similar clinical presentation of tuberculous meningitis to patients without HIV. [ Evidence ] Patients with HIV typically have a similar clinical presentation of tuberculous meningitis as patients without HIV. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- HIV - Symptoms	23/07/2019 at 15:07
177	[ Indicator ] A careful neurological examination should be performed in search of motor deficits, cranial nerve palsies, and photophobia to make the diagnosis of meningeal tuberculosis. Diagnosis is typically based on detection of mycobacteria in cerebrospinal fluid by microscopy, mycobacterial culture, or a nucleic acid amplification test. Imaging abnormalities may include basal cistern enhancement, subarachnoid space enlargement, hydrocephalus, cranial nerve changes, and chest X-ray abnormalities. [ Evidence ] A careful neurologic exam should be performed looking for motor deficits, cranial nerve palsies, and photophobia. Diagnosis is typically based on detection of mycobacteria in cerebrospinal fluid (CSF) by smear microscopy, mycobacterial culture, or a nucleic acid amplification test. Abnormalities on imaging may include basal cistern enhancement, widening of subarachnoid space, hydrocephalus, changes to cranial nerves, and abnormalities on chest x-ray. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Diagnosis	23/07/2019 at 15:10
178	[ Indicator ] Prompt treatment for meningeal tuberculosis is very important. Due to the nature of the disease, the time required for culture results, and the morbidity and mortality, initial treatment is necessary in most cases. [ Evidence ] Prompt treatment is very important. Because of the paucibacillary nature of tuberculous meningitis, time required for culture results, and morbidity and mortality that may delay treatment of tuberculous meningitis, initial empiric treatment is necessary in most instances. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Management	Tuberculous meningitis	- Treatment	23/07/2019 at 15:17
179	[ Indicator ] Treatment of meningeal tuberculosis is based on the standard anti-tuberculosis regimen, but with a longer continuation phase: initial phase with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months; continuation phase with isoniazid plus rifampicin for 7 to 10 months. [ Evidence ] Treatment is based on the standard antituberculosis regimen but with a longer continuation phase, including: initiation phase of isoniazid, rifampicin, pyrazinamide, ethambutol for 2 months (Strong recommendation) continuation phase of isoniazid plus rifampicin for 7-10 months (Weak recommendation) [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Management	Tuberculous meningitis	- Treatment	23/07/2019 at 15:18
180	[ Indicator ] Although their role remains controversial, adjuvant corticosteroids are strongly recommended in the context of tuberculous meningitis. [ Evidence ] Although their role remains controversial, adjunctive corticosteroids are recommended in the context of tuberculous meningitis (Strong recommendation). [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Management	Tuberculous meningitis	- Treatment	23/07/2019 at 15:19
181	[ Indicator ] For meningeal tuberculosis, surgery may be indicated in patients with hydrocephalus, tuberculous brain abscess, or vertebral tuberculosis with paraparesis. [ Evidence ] Surgery may be indicated in patients with hydrocephalus, tuberculous cerebral abscess, or vertebral tuberculosis with paraparesis. [ Reference ] http://www.dynamed.com/topics/dmp~AN~T114554#Management	Tuberculous meningitis	- Treatment	23/07/2019 at 15:20

Id	Indicadores	Tópicos	Grupos	Cadastrado em
1	[ Indicador ] A tuberculose abdominal é uma forma de tuberculose extrapulmonar que envolve o peritônio, o trato gastrointestinal, órgãos sólidos como fígado, baço e pâncreas ou linfonodos abdominais. Ela é responsável por cerca de 5% dos casos de tuberculose extrapulmonar. [ Evidência ] Abdominal tuberculosis (TB) is a form of extrapulmonary tuberculosis involving the peritoneum, the gastrointestinal tract, solid organs such as the liver, spleen, and pancreas, or abdominal lymph nodes. Abdominal TB accounts for about 5% of cases of extrapulmonary TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Background	Abdominal tuberculosis	- Definição	17/07/2019 às 14:47
2	[ Indicador ] A tuberculose abdominal pode ser contraída das seguintes formas: ingestão de alimentos ou leite infectados; transmissão através da corrente sanguínea advinda do pulmão ou outro local do corpo infectado; ou ainda, através da disseminação de órgãos adjacentes ou linfonodos. [ Evidência ] Infection may result from ingestion of infected food or milk, swallowing infected sputum, hematogenous spread from the primary pulmonary site or other site of infection, or direct spread from adjacent organs or lymph nodes. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Background	Abdominal tuberculosis	- Transmissão	17/07/2019 às 14:57
3	[ Indicador ] Os sintomas da tuberculose abdominal podem ser inespecíficos: febre, perda de peso, dor ou sensibilidade abdominal, distensão abdominal, constipação, diarreia, fígado aumentado ou aumento do volume do baço. [ Evidência ] Patients may present with nonspecific symptoms including fever and weight loss. Other symptoms may include abdominal pain or tenderness, abdominal distention, constipation, diarrhea, hepatomegaly, or splenomegaly. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Background	Abdominal tuberculosis	- Sintomas	17/07/2019 às 15:06
4	[ Indicador ] Os fatores de risco para turberculose abdominal incluem doença hepática alcoólica e cirrose, diálise peritoneal ambulatorial contínua para insuficiência renal crônica, diabetes mellitus e infecção por HIV. [ Evidência ] Risk factors for abdominal TB include alcoholic liver disease and cirrhosis, continuous ambulatory peritoneal dialysis for chronic renal failure, diabetes mellitus, and HIV infection. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Background	Abdominal tuberculosis	- Fator de risco - Transmissão	17/07/2019 às 15:17
5	[ Indicador ] O diagnóstico da tuberculose abdominal deve incluir imagens do local suspeito. Imagens incluindo estudos do bário, tomografia computadorizada e ultrassonografia abdominal podem ser úteis. [ Evidência ] The diagnostic evaluation should include imaging of the suspected site of involvement. Imaging including barium studies, computed tomography (CT) scans, and an abdominal ultrasound may be helpful to visualize findings associated with abdominal tuberculosis (TB), including strictures, fistulae, erosions, regional adenopathy, thickened omentum, or ascitic fluid. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Evaluation	Abdominal tuberculosis	- Diagnóstico	17/07/2019 às 15:23
6	[ Indicador ] Uma cultura de fluido ascítico (líquido excessivo cavidade abdominal) ou de uma amostra de biópsia é necessária para o diagnóstico definitivo da tuberculose abdominal. [ Evidência ] A culture of ascitic fluid or of a biopsy specimen is required for definitive diagnosis, and drug-susceptibility testing aids in the selection of the proper anti-TB therapy. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Evaluation	Abdominal tuberculosis	- Diagnóstico	17/07/2019 às 15:27
7	[ Indicador ] Caso a tuberculose abdominal seja confirmada, é necessário realizar uma radiografia de tórax por causa da possibilidade de doença pulmonar concomitante. [ Evidência ] Because of the possibility of concomitant pulmonary disease, perform a chest x-ray for all persons with confirmed or suspected abdominal TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Evaluation	Abdominal tuberculosis	- Diagnóstico	17/07/2019 às 15:31
8	[ Indicador ] O tratamento da tuberculose abdominal segue o regime padrão de multi drogas anti tuberculose: fase inicial intensiva com isoniazida, rifampicina, pirazinamida e etambutol por 2 meses; e fase de continuação com isoniazida e rifampicina por 4 meses. [ Evidência ] Treat patients with abdominal TB caused by drug-susceptible organisms with the standard antituberculosis multidrug regimen: - initial intensive phase with isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months - continuation phase with isoniazid and rifampin for 4 months [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Management	Abdominal tuberculosis	- Tratamento	17/07/2019 às 15:36
9	[ Indicador ] Os pacientes em que há suspeita ou confirmação de tuberculose abdominal resistente aos medicamentos devem ser tratados com base no perfil de suscetibilidade a drogas e em consulta com um especialista. [ Evidência ] Treat patients with suspected or confirmed drug-resistant organisms based on the drug-susceptibility profile and in consultation with an expert. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910286#Management	Abdominal tuberculosis	- Tratamento - Tuberculose resistente	17/07/2019 às 15:42
10	[ Indicador ] A infecção pelo HIV é o fator de risco mais importante para a tuberculose, pois as pessoas com HIV têm de 20 a 30 vezes mais chances de desenvolver a doença. [ Evidência ] HIV infection is the most important risk factor for TB, and persons with HIV are 20-30 times more likely to develop TB than persons who are HIV-negative. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Background	Active tuberculosis in patients with HIV infection	- Fator de risco - HIV	17/07/2019 às 16:11
11	[ Indicador ] Fatores de risco adicionais para pessoas com HIV incluem residência em regiões endêmicas de tuberculose, contato próximo com pacientes com tuberculose, alojamento lotado (incluindo encarceramento), ventilação deficiente em ambientes de moradia ou trabalho, má nutrição e acesso limitado a cuidados de saúde de qualidade. [ Evidência ] Additional risk factors include residence in TB-endemic regions, close contact with patients with TB, crowded housing (including incarceration), poor ventilation in living or working quarters, poor nutrition, and limited access to quality health care. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Background	Active tuberculosis in patients with HIV infection	- Fator de risco - HIV - Transmissão	17/07/2019 às 16:15
12	[ Indicador ] O diagnóstico de tuberculose em pacientes com HIV é desafiador devido à alta frequência de casos negativos à baciloscopia (exame de escarro), apresentação radiográfica atípica e manifestações extrapulmonares. [ Evidência ] Diagnosis of tuberculosis (TB) in patients with HIV is challenging due to high frequency of smear-negative cases, atypical radiographic presentation, and extrapulmonary manifestations. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnóstico - HIV	17/07/2019 às 16:21
13	[ Indicador ] Todos os pacientes com HIV e suspeita de TB devem fazer radiografia de tórax imediatamente. Considerar exame de escarro e cultura em pacientes sintomáticos com radiografias de tórax normais. [ Evidência ] All patients with suspected TB should have chest x-ray early in the course of investigation (Strong recommendation). - Radiologic presentation of chest x-ray varies with state of immunodeficiency. - In patients with CD4 T-cell count > 350 cells/mm3, presentation may resemble that in patients uninfected with HIV including upper lobe infiltrates, cavitation, and pleural disease. - In patients with profound immunocompromise, cavitation is less common and x-ray findings may include pleural effusion, lower or middle lobe infiltrates, miliary infiltrates, mediastinal adenopathy, interstitial nodules, or normal x-ray. - Consider sputum smear and culture in symptomatic patients with normal chest x-rays. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnóstico - HIV	17/07/2019 às 16:31
14	[ Indicador ] Para pacientes com HIV e suspeita de linfadenite (infecção dos gânglios linfáticos) por tuberculose, devem ser considerados testes de diagnóstico adicionais como: aspiração por agulha ou biópsia para exame histopatológico, bacilos ácidos resistentes, escarro, cultura. Além desses, amostra de líquido pleural, líquido pericárdico, ascite ou líquido cefalorraquidiano, se houver evidência de envolvimento. [ Evidência ] Additional diagnostic testing is directed at sites of disease. - For patients with suspected TB lymphadenitis, consider needle aspiration or biopsy for histopathology, acid fast bacilli, smear, and culture. - Sample pleural fluid, pericardial fluid, ascites, or cerebrospinal fluid (CSF) if there is evidence of involvement. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnóstico - HIV	17/07/2019 às 16:38
15	[ Indicador ] Considerar os testes de amplificação de ácido nucleico em pacientes com imunodeficiência avançada, pois o teste é mais rápido que a cultura, mais sensível que a baciloscopia, e permite a distinção entre tuberculose e infecções por micobactérias não tuberculosas. [ Evidência ] Consider nucleic acid amplification tests in patients with advanced immunodeficiency, as testing is more rapid than culture, more sensitive than smear microscopy, and allows distinction between tuberculosis and nontuberculous mycobacterial infections. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnóstico - HIV	17/07/2019 às 16:43
16	[ Indicador ] Testes cutâneos e de liberação de interferon gama (IGRAs) podem ser úteis para corroborar o diagnóstico de tuberculose se for difícil obter amostras para exame de escarro e cultura ou se as amostras não forem reveladoras. [ Evidência ] Tuberculin skin tests and interferon gamma release assays (IGRAs) may be useful to corroborate diagnosis of TB if samples for smear and culture are difficult to obtain or are unrevealing, although tests do not distinguish between latent and active disease. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Evaluation	Active tuberculosis in patients with HIV infection	- Diagnóstico - HIV	17/07/2019 às 16:51
17	[ Indicador ] O tratamento em pacientes com HIV e suspeita de tuberculose deve ser iniciado mesmo antes do diagnóstico completo ser confirmado. Os regimes de tratamento em adultos com infecção por HIV seguem os mesmos princípios que o tratamento para adultos sem HIV. [ Evidência ] Start empiric treatment in patients with HIV and suspected tuberculosis (TB) until diagnostic work-up is complete (Strong recommendation). - Recommendations for antituberculosis treatment regimens in adults with HIV infection follow the same principles as for adults without HIV infection. - Initial phase consists of a 4-drug regimen of isoniazid (INH), rifampin (or rifabutin), pyrazinamide, and ethambutol daily for 2 months (Strong recommendation). - Continuation phase consists of a 2-drug regimen of INH plus rifampin (or rifabutin) daily for drug-susceptible TB (Strong recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Management	Active tuberculosis in patients with HIV infection	- HIV - Tratamento	17/07/2019 às 17:03
18	[ Indicador ] Os corticosteroides são recomendados para tratamento da tuberculose em pacientes com HIV que tenham envolvimento com o sistema nervoso central ou doença pericárdica. [ Evidência ] Corticosteroids are recommended for patients with CNS or pericardial disease (Strong recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Management	Active tuberculosis in patients with HIV infection	- HIV - Tratamento	17/07/2019 às 17:07
19	[ Indicador ] Pacientes com infecção pelo HIV e tuberculose correm o risco de desenvolver a síndrome inflamatória de reconstituição imune (IRIS) com piora dos sinais e sintomas após o início da terapia antituberculose e antirretroviral. [ Evidência ] Patients with HIV infection and TB are at risk of developing immune reconstitution inflammatory syndrome (IRIS) with worsening of signs and symptoms after beginning antituberculosis and antiretroviral therapy. - Risk of IRIS is higher in those who start ART within 2 weeks of starting antituberculosis treatment compared to those who started at 8-12 weeks. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Management	Active tuberculosis in patients with HIV infection	- Efeitos colaterais - HIV	17/07/2019 às 17:14
20	[ Indicador ] Pacientes com HIV que viajam ou trabalham em regiões endêmicas de tuberculose devem ser aconselhados sobre os riscos da doença e a necessidade de testes para infecção latente quando retornarem. [ Evidência ] counsel patients with HIV who travel or work in tuberculosis (TB)-endemic regions about the risks of TB and need for testing for latent TB infection (LTBI) upon return. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening	Active tuberculosis in patients with HIV infection	- HIV - Prevenção	17/07/2019 às 17:41
21	[ Indicador ] Pacientes com HIV e infecção latente por tuberculose, sem nenhum tratamento prévio, devem receber terapia preventiva com isoniazida. [ Evidência ] patients with HIV and LTBI, no evidence of active TB, and no previous treatment for active or latent TB should receive isoniazid preventative therapy (IPT) (CDC/NIH/IDSA Grade A-I) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening	Active tuberculosis in patients with HIV infection	- HIV - Prevenção	17/07/2019 às 17:44
22	[ Indicador ] A terapia anti retroviral pode reduzir a incidência de tuberculose em pacientes com infecção pelo HIV. [ Evidência ] antiretroviral therapy may reduce incidence of tuberculosis in patients with HIV infection regardless of baseline CD4 T-cell count (level 2 [mid-level] evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909161#Prevention-and-Screening	Active tuberculosis in patients with HIV infection	- HIV - Prevenção	17/07/2019 às 17:46
23	[ Indicador ] A vacina BCG deve ser aplicada após o nascimento em países com alta prevalência de tuberculose. [ Evidência ] BCG vaccination as soon as possible after birth in countries with a high tuberculosis (TB) prevalence revaccination not recommended. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Bebês - Prevenção	18/07/2019 às 10:59
24	[ Indicador ] A revacinação da vacina BCG como reforço não é recomendada. [ Evidência ] revaccination not recommended [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Prevenção	18/07/2019 às 11:00
25	[ Indicador ] Bebês nascidos de mulheres com status de HIV desconhecido devem ser vacinados com a BCG, pois os benefícios superam os riscos. [ Evidência ] benefits outweigh risks in infants born to women of unknown HIV status and should be immunized [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Bebês - HIV - Prevenção	18/07/2019 às 11:02
26	[ Indicador ] Bebês com suspeita de infecção pelo HIV ou se nascer de uma mulher infectada pelo HIV não devem ser vacinados com a BCG, pois os riscos normalmente superam os benefícios. [ Evidência ] risks usually outweigh benefits for infants and should not be immunized if HIV infection is suspected or if born to woman with HIV infection [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Bebês - HIV - Prevenção	18/07/2019 às 11:05
27	[ Indicador ] Durante a amamentação, há alto risco de infecção e desenvolvimento da tuberculose por mãe com baciloscopia positiva (exame de escarro). [ Evidência ] breastfeeding infant - has high risk of infection from mother with smear-positive pulmonary TB and high risk of developing TB - should receive 6 months of isoniazid preventive therapy, followed by BCG immunization [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Amamentação - Bebês - Transmissão	18/07/2019 às 11:17
28	[ Indicador ] Caso a mãe tenha baciloscopia (exame de escarro) positivo para tuberculose, o bebê deve receber 6 meses de terapia preventiva com isoniazida, seguida de imunização com a vacina BCG. Uma alternativa é realizar teste cutâneo tuberculínico após 3 meses de isoniazida. Se o teste der negativo, a isoniazida deve ser interrompida e a vacina BCG aplicada. Se der positivo, a isoniazida deve ser continuada por mais 3 meses antes da vacina BCG. [ Evidência ] breastfeeding infant - has high risk of infection from mother with smear-positive pulmonary TB and high risk of developing TB - should receive 6 months of isoniazid preventive therapy, followed by BCG immunization alternative policy is to give 3 months of isoniazid, then perform tuberculin skin test (TST) - if TST negative, isoniazid should be stopped and BCG vaccination given - if TST positive, isoniazid should be continued for another 3 months, after which it should be stopped and BCG given [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview http://www.dynamed.com/topics/dmp~AN~T905489#Recommendations	Bacille Calmette- Guerin vaccine (BCG)	- Amamentação - Bebês - Prevenção	18/07/2019 às 11:20
29	[ Indicador ] Em países com baixa prevalência da tuberculose, a vacina BCG deve ser considerada somente para crianças nas seguintes condições: teste cutâneo negativo para tuberculose; exposição contínua à tuberculose; não podem ser separadas de adultos que são inefetivamente/não tratados para tuberculose ou têm cepas de tuberculose resistentes a isoniazida e rifampicina; e não podem receber tratamento preventivo primário a longo prazo. [ Evidência ] Centers for Disease Control and Prevention (CDC) recommendations - consider BCG vaccination only in children - with negative TB skin test - with continual exposure - who cannot be separated from adults who - are ineffectively treated or untreated for TB and child cannot be given long-term primary preventive treatment for TB infection - have TB strains resistant to isoniazid and rifampin [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Crianças - Prevenção - Tuberculose resistente	18/07/2019 às 11:35
30	[ Indicador ] A vacina BCG para profissionais de saúde deve ser considerada caso a caso nas seguintes condições: alta porcentagem de pacientes com tuberculose resistente a isoniazida e rifampicina; transmissão contínua da tuberculose resistente para profissionais de saúde; e quando as precauções tomadas para controle da tuberculose não bem-sucedidas. [ Evidência ] consider BCG vaccination in healthcare workers on case-by-case basis in settings with - high percentage of TB patients infected with TB strains resistant to isoniazid and rifampin - ongoing transmission of drug-resistant TB strains to healthcare workers and subsequent infection likely - comprehensive TB infection-control precautions implemented but not successful [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Overview	Bacille Calmette- Guerin vaccine (BCG)	- Prevenção - Profissional de saúde - Tuberculose resistente	18/07/2019 às 11:41
31	[ Indicador ] A tuberculose óssea e articular pode envolver qualquer osso do corpo. Cerca de metade dos casos envolvem a coluna dos quais metade na coluna torácica. Locais extra espinhais comuns são os grandes ossos e articulações que suportam o peso, incluindo o quadril, o joelho, o pé e o tornozelo. Cerca de 10% dos pacientes com tuberculose extrapulmonar apresentam comprometimento devido a ela. [ Evidência ] About 10% of patients with extrapulmonary tuberculosis (TB) have skeletal involvement. Skeletal TB can involve nearly any bone in the body. - About one-half of cases involve the spine, and one-half of those are located in the thoracic spine. - Large weight-bearing bones and joints including the hip, knee, foot, and ankle are common extra-spinal sites. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Background	Bone and joint tuberculosis	- Definição	18/07/2019 às 11:55
32	[ Indicador ] A tuberculose óssea está associada ao calor localizado, inchaço e sensibilidade. Já a tuberculose articular está associada à sensibilidade, edema/ derrame de tecido mole e restrição de movimento. A dor nas costas é o sintoma mais comum, junto com perdas neurológicas, febre e inchaço nas costas. [ Evidência ] Osseous involvement is associated with localized warmth, swelling, and tenderness. Articular involvement is associated with tenderness, soft tissue swelling/effusion, and a restriction of movement. Back pain is the most common symptom of spinal tuberculosis (TB), with other symptoms including neurologic deficits, fever, and back swelling. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Evaluation	Bone and joint tuberculosis	- Sintomas	18/07/2019 às 12:03
33	[ Indicador ] Caso haja suspeita/confirmação de tuberculose óssea ou articular, a tuberculose pulmonar concomitante deve ser investigada. [ Evidência ] Concurrent pulmonary TB should be sought in all patients with suspected or confirmed skeletal TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Evaluation	Bone and joint tuberculosis	- Diagnóstico	18/07/2019 às 12:06
34	[ Indicador ] A radiografia, a tomografia e a ressonância magnética podem ser usados para avaliar o ossos e os tecidos moles, mas não é diagnóstico para tuberculose óssea e articular. [ Evidência ] Radiographic testing can be used to define bony and soft tissue involvement but is not diagnostic for tuberculosis. - Plain x-ray may identify substantial bony destruction, but early findings may not be visualized. - Computed tomography provides bony detail and may be helpful in guiding biopsy. - Magnetic resonance imaging is preferred for assessing vertebral collapse, involvement of vertebral bodies, soft tissue involvement, or the presence of abscess. - Abscesses appear as paravertebral soft tissue shadows, and the detection of calcifications within an abscess is virtually diagnostic of spinal TB. - A retropharyngeal abscess may be diagnosed in cervical spine films by the presence of an increased prevertebral soft tissue space. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Evaluation	Bone and joint tuberculosis	- Diagnóstico	18/07/2019 às 12:12
35	[ Indicador ] O diagnóstico confirmatório da tuberculose óssea e articular pode ser feito através de biópsia guiada por imagem ou aspiração por agulha da área envolvida para coletar amostras a serem testadas. [ Evidência ] A confirmatory diagnosis may be made by image-guided biopsy or needle aspiration of the involved area with specimens tested for mycobacterial smear and culture, nucleic acid amplification test, histology and cytology. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Evaluation	Bone and joint tuberculosis	- Diagnóstico	18/07/2019 às 12:15
36	[ Indicador ] O tratamento da tuberculose óssea e articular segue o regime padrão de multi drogas anti tuberculose, incluindo isoniazida, rifampicina, pirazinamida e etambutol. [ Evidência ] Treat patients with bone and joint TB with the standard first-line antituberculosis regimen including isoniazid, rifampin, pyrazinamide, and ethambutol (Strong recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Tratamento	18/07/2019 às 12:27
37	[ Indicador ] Caso a tuberculose óssea e articula seja por infecção der organismos suscetíveis aos medicamentos, a pirazinamida e o etambutol devem ser suspensos após 2 meses e o tratamento deve continuar com isoniazida e rifampicina de 4 a 7 meses. A decisão sobre a duração do tratamento deve ser feita caso a caso. [ Evidência ] With infections by fully susceptible organisms, stop pyrazinamide and ethambutol after 2 months and continue isoniazid and rifampin for 4-7 months; a decision on duration of therapy should be made on a case-by-case basis (Strong recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Tratamento	18/07/2019 às 12:30
38	[ Indicador ] A tuberculose óssea e articular causada por organismos resistentes a medicamentos ou organismos resistentes a múltiplos fármacos geralmente responde bem à terapia individualizada apropriada. [ Evidência ] Bone and joint TB caused by drug-resistant organisms or multidrug-resistant organisms usually responds well to appropriate individualized therapy. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Tratamento - Tuberculose resistente	18/07/2019 às 12:32
39	[ Indicador ] Se o paciente não tiver comprometimento neurológico, nem coluna instável ou compressão da medula espinhal, geralmente, a terapia medicamentosa para a tuberculose óssea e articular é suficiente. [ Evidência ] Medical therapy is usually sufficient if the patient does not have neurologic impairment, an unstable spine, or spinal cord compression. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Tratamento	18/07/2019 às 12:37
40	[ Indicador ] Para a tuberculose óssea e articular, o papel da cirurgia é controverso, mas ela pode ser usada para desbridar o tecido infectado, estabilizar a coluna ou aliviar a compressão da medula espinhal ou do nervo. [ Evidência ] The role of surgery is controversial but may be used to debride infected tissue, stabilize the spine, or relieve spinal cord or nerve compression. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909571#Management	Bone and joint tuberculosis	- Tratamento	18/07/2019 às 12:41
41	[ Indicador ] A vacina BCG não é confiável contra tuberculose pulmonar para adultos e crianças mais velhas. [ Evidência ] BCG is unreliable against adult forms of pulmonary tuberculosis. - efficacy variable (0% to > 80%) in older children and adults, with some reports of net harm ( JAMA 2004 May 5;291(17):2127) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T905489#Efficacy	Bacille Calmette- Guerin vaccine (BCG)	- Adultos - Prevenção	18/07/2019 às 12:46
42	[ Indicador ] A tuberculose disseminada é uma doença sistêmica que pode resultar na infecção de múltiplos sistemas orgânicos. Esta doença é também chamada de tuberculose miliar. Para adultos imunocompetentes, ela é responsável por menos de 2% dos casos de tuberculose e até 20% dos casos extrapulmonares. [ Evidência ] Disseminated tuberculosis (TB) is a systemic disease resulting from massive lymphohematogenous dissemination of Mycobacterium tuberculosis that can result in infection of multiple organ systems. This disease is also called miliary tuberculosis. In immunocompetent adults, disseminated TB is reported to account for less than 2% of all cases of TB and up to 20% of all cases of extrapulmonary TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901421#Background	Disseminated tuberculosis	- Definição	18/07/2019 às 14:17
43	[ Indicador ] Os sintomas da tuberculose disseminada (miliar) são inespecíficos, incluindo febre e perda de peso, anorexia, fraqueza, tosse, suores noturnos e calafrios. Devido à natureza sistêmica da doença, outros sintomas podem variar dependendo do(s) órgão(s) envolvido(s). [ Evidência ] Patients may present with nonspecific symptoms including fever and weight loss, anorexia, weakness, cough, night sweats, and chills and rigors. Due to the systemic nature of the disease, other presenting signs and symptoms can vary depending on the organ(s) involved. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901421#Background	Disseminated tuberculosis	- Sintomas	18/07/2019 às 14:20
44	[ Indicador ] Fatores de risco para tuberculose disseminada (miliar) incluem infecção por HIV, jovens e idosos, sexo feminino e origem asiática ou africana. [ Evidência ] Risk factors for extrapulmonary TB and disseminated TB include HIV infection, young and old age, female gender, and Asian or African origin. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901421#Background	Disseminated tuberculosis	- Fator de risco	18/07/2019 às 14:23
45	[ Indicador ] O diagnóstico definitivo para tuberculose disseminada (miliar) é realizado por cultura ou detecção da mycobacterium tuberculose no local afetado. No entanto, esse método pode levar até 8 semanas. O uso de testes de amplificação de ácidos nucleicos fornece um meio de diagnóstico alternativo e mais rápido. [ Evidência ] A definitive diagnosis requires either culture or detection of Mycobacterium tuberculosis from the affected site. Culture of the organism provides a definitive diagnosis but it may take up to 8 weeks. The use of nucleic acid amplification tests (NAATs) provide an alternate and more rapid means of diagnosis. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901421#Evaluation	Disseminated tuberculosis	- Diagnóstico	18/07/2019 às 14:26
46	[ Indicador ] A tuberculose disseminada (miliar) pode ser evidente em cerca de 50% das radiografias de tórax. Contudo, a tomografia computadorizada pode evidenciar a doença mesmo em pacientes com radiografia normal. [ Evidência ] Perform a chest x-ray for all persons to rule out concurrent pulmonary tuberculosis for all patients. - The characteristic miliary pattern may be evident in about 50% of chest x-rays. High-resolution computed tomography may reveal a miliary pattern even in patients with a normal x-ray. - Other findings on the chest x-ray may include nodules, ground glass appearance, air-space consolidation, or, more rarely, parenchymal lesions and cavitation or pleural effusion. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901421#Evaluation	Disseminated tuberculosis	- Diagnóstico	18/07/2019 às 14:47
47	[ Indicador ] O tratamento da tuberculose disseminada (miliar) não resistente a medicamentos segue o regime padrão de multi drogas: fase inicial intensiva com isoniazida, rifampicina, pirazinamida e etambutol por 2 meses; e fase de continuação com isoniazida e rifampicina por 4 meses. [ Evidência ] Treat patients with disseminated TB caused by drug-susceptible organisms with the standard antituberculosis multidrug regimen: - initial intensive phase with isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months - continuation phase with isoniazid and rifampin for 4 months [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901421#Management	Disseminated tuberculosis	- Tratamento	18/07/2019 às 14:50
48	[ Indicador ] Os pacientes em que há suspeita ou confirmação de tuberculose disseminada (miliar) resistente aos medicamentos devem ser tratados com base no perfil de suscetibilidade a drogas e em consulta com um especialista. [ Evidência ] Treat patients with suspected or confirmed drug-resistant organisms based on the drug-susceptibility profile and in consultation with an expert. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901421#Management	Disseminated tuberculosis	- Tratamento	18/07/2019 às 14:51
49	[ Indicador ] Os corticosteroides não são recomendados em pacientes com tuberculose disseminada (miliar) sem envolvimento do sistema nervoso central. [ Evidência ] Corticosteroids are not recommended in patients with disseminated TB without central nervous system involvement. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901421#Management	Disseminated tuberculosis	- Tratamento	18/07/2019 às 14:54
50	[ Indicador ] A tuberculose endobrônquica, estenose brônquica ou estenoses podem ser tratadas com: terapia com laser; criocirurgia; eletrocautério; coagulação por plasma de argônio. [ Evidência ] endobronchial tuberculosis - bronchial stenosis or strictures may be treated with - laser therapy - cryosurgery - electrocautery - argon plasma coagulation [ Referência ] http://www.dynamed.com/topics/dmp~AN~T916926#Overview	Endobronchial ablative therapies	- Tratamento	18/07/2019 às 15:19
51	[ Indicador ] A tuberculose extensivamente resistente a medicamentos é a forma da doença resistente a isoniazida, rifampicina, qualquer fluoroquinolona e pelo menos uma das três drogas injetáveis: amicacina, canamicina ou capreomicina. [ Evidência ] XDR TB is defined as TB caused by Mycobacterium tuberculosis resistant to isoniazid, rifampin, any fluoroquinolone, and at least 1 of 3 injectable second-line drugs (amikacin, kanamycin, or capreomycin). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Background	Extensively drug-resistant tuberculosis (XDR TB)	- Definição - Tuberculose resistente	18/07/2019 às 15:22
52	[ Indicador ] Os fatores de risco para a tuberculose resistente são: (1) tratamento prévio superior a um mês; (2) falha de um regime de tratamento da tuberculose contendo drogas de segunda linha, incluindo um agente injetável e uma fluoro quinolona; (3) contato próximo com paciente que tenha tuberculose resistente ou que seu regime de tratamento com medicamentos de segunda linha esteja falhando ou tenha falhado; (4) tratamento atrasado; (5) HIV; (6) nascimento estrangeiro; (7) idade mais jovem; (8) sexo feminino; e (9) prisão anterior. [ Evidência ] Risk factors for MDR and XDR TB: - prior TB treatment (> 1 month) - failure of a TB treatment regimen containing second-line drugs including an injectable agent and a fluoroquinolone - close contact with a patient with MDR TB, XDR TB, or with a patient whose treatment regimen including second-line drugs is failing or has failed - delayed treatment - HIV - foreign birth - younger age - female sex - previous imprisonment [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Background	Extensively drug-resistant tuberculosis (XDR TB)	- Fator de risco - HIV - Privação de liberdade - Sexo - Tuberculose resistente	18/07/2019 às 15:29
53	[ Indicador ] Como a apresentação clínica da tuberculose resistente não difere da tuberculose não resistente, o diagnóstico é confirmado com testes de cultura e suscetibilidade a medicamentos. [ Evidência ] Clinical presentation of XDR TB does not differ from that of drug-susceptible TB. XDR TB diagnosis is confirmed with culture and drug- -susceptibility testing. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Evaluation	Extensively drug-resistant tuberculosis (XDR TB)	- Diagnóstico - Tuberculose resistente	18/07/2019 às 15:32
54	[ Indicador ] É preciso suspeitar de tuberculose resistente antes de receber os resultados do teste de cultura se: os fatores de risco da tuberculose multi resistente estiverem presentes; persistirem baciloscopias positivas (exames de escarro) e/ou culturas; ou pouca/nenhuma melhora nos sintomas da tuberculose com o regime padrão de tratamento. [ Evidência ] XDR TB may be suspected prior to receipt of culture results if risk factors for multidrug-resistant (MDR) TB are present or there are persistently positive sputum smears and/or cultures or little/no improvement in signs and symptoms of TB, despite standard anti-TB treatment. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Evaluation	Extensively drug-resistant tuberculosis (XDR TB)	- Diagnóstico - Tuberculose resistente	18/07/2019 às 15:37
55	[ Indicador ] A tuberculose resistente deve ser tratada somente por especialistas nesse tipo da doença. Contudo, antes de receber os resultados dos testes de susceptibilidade aos medicamentos, o tratamento apropriado deve ser iniciado nos pacientes em quem há suspeita de tuberculose resistente. [ Evidência ] XDR TB should be managed by only those expert in the treatment of drug-resistant TB. Prior to receipt of drug-susceptibility testing results, empiric treatment for XDR TB should be started in those in whom XDR TB is suspected. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Tratamento - Tuberculose resistente	18/07/2019 às 15:42
56	[ Indicador ] O tratamento da tuberculose resistente é orientado pelos resultados dos testes de suscetibilidade às drogas da seguinte forma: sempre tentar usar 3 ou mais drogas não utilizadas anteriormente que tenham passado nos testes e considerar regimes com quatro a seis medicamentos, incluindo um injetável. [ Evidência ] Treatment is guided by drug-susceptibility testing results: - Always try to use ≥ 3 previously unused drugs that have demonstrated in vitro susceptibility and consider regimens with 4-6 medications, including an injectable (Strong recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Tratamento - Tuberculose resistente	18/07/2019 às 16:04
57	[ Indicador ] Para tratamento da tuberculose resistente, deve-se instituir terapia baseada em hospital diariamente ou terapia diretamente observada em casa. [ Evidência ] - Institute daily hospital-based or home-based directly observed therapy (DOT) (Strong recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Tratamento - Tuberculose resistente	18/07/2019 às 16:05
58	[ Indicador ] Qualquer paciente hospitalizado com suspeita de tuberculose deve ser colocado no isolamento de infecção pelo ar com medidas apropriadas de controle de infecção tanto para profissionais de saúde como visitantes. [ Evidência ] Any hospitalized patient with suspected TB or who has acid-fast bacilli (AFB) smear-positive sputum should be placed in airborne infection isolation with appropriate infection control measures for providers and visitors. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Tratamento	18/07/2019 às 16:08
59	[ Indicador ] O tratamento de pacientes com infecção latente por tuberculose que têm contato com outros pacientes com tuberculose multi resistente deve ser orientado, quando possível, pelos resultados de suscetibilidade à droga no paciente fonte. [ Evidência ] Treatment for latent TB infection in contacts of multidrug-resistant (MDR) TB patients should be guided by drug-susceptibility results in the source patient, when possible. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Management	Extensively drug-resistant tuberculosis (XDR TB)	- Tratamento - Tuberculose resistente	18/07/2019 às 16:11
60	[ Indicador ] Como a tuberculose multi resistente pode ter um período infeccioso prolongado se o tratamento for ineficaz, os pacientes devem ser reavaliados continuamente através de consulta especializada. [ Evidência ] - since multidrug-resistant TB (MDR TB) can have an extended infectious period if treatment is ineffective, continually reassess patients for recent contacts - seek expert consultation for treatment of persons exposed to patients with MDR TB [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Contact-investigation	Extensively drug-resistant tuberculosis (XDR TB)	- Prevenção - Tuberculose resistente	18/07/2019 às 16:18
61	[ Indicador ] O programa recomendado para controle da infecção por tuberculose consiste nas seguintes ações: (1) controles administrativos para reduzir o risco de exposição a pacientes que possam ter tuberculose; (2) atribuir responsabilidade pelo controle de infecção por tuberculose; (3) realizar uma avaliação de risco de tuberculose; (4) desenvolver e implementar um plano de controle de infecção por tuberculose por escrito para garantir detecção imediata de pessoas que suspeitaram ou confirmaram tuberculose, precauções com o ar e tratamento; (5) garantir a disponibilidade do processamento laboratorial, teste e relato de resultados recomendados ao médico solicitante; (6) implementar práticas de trabalho eficazes para o manejo de pacientes com tuberculose suspeita ou confirmada; (7) limpeza adequada e esterilização ou desinfecção de equipamentos que possam estar contaminados com tuberculose; (8) treinar e educar os profissionais de saúde sobre tuberculose, incluindo sintomas, transmissão e prevenção; (9) implementar programa de rastreio da tuberculose para avaliar os trabalhadores em risco de doença ou que possam estar expostos; (10) aplicar dados de controle de infecção relacionados ao ambiente e outros princípios de prevenção baseados na epidemiologia; (11) usar sinalização adequada defendendo a máscara para tosse e a higiene respiratória; (12) coordenar esforços com os departamentos de saúde locais e estaduais. [ Evidência ] implementation of infection control program recommended, consisting of - administrative controls to reduce risk for exposure to patients who might have tuberculosis (TB) - assign responsibility for TB infection control - conduct a TB risk assessment - develop and implement a written TB infection-control plan to ensure prompt detection of persons who have suspected or confirmed TB, airborne precautions, and treatment - ensure timely availability of recommended laboratory processing, testing, and reporting of results to the ordering physician - implement effective work practices for the management of patients with suspected or confirmed TB - proper cleaning and sterilization or disinfection of equipment that may be contaminated with M. tuberculosis - train and educate healthcare workers about TB including symptoms, transmission, and prevention - implement TB screening program to evaluated workers at risk for TB disease or who might be exposed to M. tuberculosis - apply setting-related infection-control data and other epidemiologic-based prevention principles - use appropriate signage advocating cough etiquette and respiratory hygiene - coordinate efforts with state and local health departments [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Infection-control	Extensively drug-resistant tuberculosis (XDR TB)	- Prevenção - Sistema de Saúde	18/07/2019 às 16:26
62	[ Indicador ] Controles ambientais devem ser realizados para evitar a disseminação de núcleos de gotículas infecciosas no ar: controles ambientais primários; ventilação de exaustão local (capuzes, barracas ou cabines) para controlar a origem da infecção; ventilação geral para diluir e remover o ar contaminado; controles ambientais secundários incluem filtragem de ar particulado de alta eficiência ou irradiação germicida ultravioleta para controlar o fluxo de ar, evitando a contaminação do ar em áreas adjacentes à fonte e limpando o ar. [ Evidência ] environmental controls to prevent spreading of infectious droplet nuclei in ambient air - primary environmental controls - local exhaust ventilation (hoods, tents, or booths) to control the source of infection - general ventilation to dilute and remove contaminated air - secondary environmental controls include high efficiency particulate air filtration or ultraviolet germicidal irradiation to control the airflow to prevent contamination of air in areas adjacent to the source and clean the air [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Infection-control	Extensively drug-resistant tuberculosis (XDR TB)	- Prevenção - Sistema de Saúde	18/07/2019 às 16:44
63	[ Indicador ] Controles de proteção respiratória devem ser realizado para reduzir o risco de exposição de profissionais de saúde a gotículas infecciosas expelidas no ar por pacientes com tuberculose: programa de proteção respiratória; treinar profissionais de saúde na proteção respiratória; treinar pacientes em procedimentos com máscara de tosse e higiene respiratória. [ Evidência ] respiratory protection controls to reduce risk for exposure of healthcare workers to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease - implement a respiratory protection program - train healthcare workers on respiratory protection - train patients on cough etiquette procedures and respiratory hygiene [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908130#Infection-control	Extensively drug-resistant tuberculosis (XDR TB)	- Prevenção - Profissional de saúde - Sistema de Saúde	18/07/2019 às 16:48
64	[ Indicador ] A tuberculose geniturinária é uma forma de tuberculose extrapulmonar que envolve qualquer parte do trato reprodutivo ou urinário masculino ou feminino. Ela é responsável por cerca de 5% a 6% dos casos de tuberculose extrapulmonar. [ Evidência ] Genitourinary tuberculosis (TB) is a form of extrapulmonary TB that involves any part of the male or female reproductive or urinary tracts. Genitourinary TB accounts for about 5%-6% of cases of extrapulmonary TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Background	Genitourinary tuberculosis	- Definição	19/07/2019 às 10:04
65	[ Indicador ] Os fatores de risco para tuberculose geniturinária incluem anomalias urogenitais congênitas, cistos renais, urolitíase, insuficiência renal e transplante renal. A infecção geralmente ocorre através da corrente sanguínea a partir da infecção pulmonar e, subsequentemente, se dissemina do rim para o ureter e para a bexiga. [ Evidência ] Specific risk factors for genitourinary TB include congenital urogenital anomalies, renal cysts, urolithiasis, renal failure, and renal transplantation. Genitourinary infection typically occurs by hematogenous dissemination from pulmonary infection and subsequently spreads from kidney to ureter to bladder. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Background	Genitourinary tuberculosis	- Fator de risco - Transmissão	19/07/2019 às 10:32
66	[ Indicador ] Os sintomas da tuberculose geniturinária podem ser similares a outras infecções do trato urinário e incluem disúria (desconforto, dor ou queimação ao urinar), frequência, urgência e hematúria (sangue na urina). Além disso, pode haver dor nas costas ou no flanco (região abdominal). Em todos os casos, os sintomas sistêmicos associados à tuberculose podem estar presentes como febre, perda de peso ou sudorese. [ Evidência ] When TB affects the urinary tract, symptoms may be similar to other urinary tract infections and include dysuria, frequency, urgency, and hematuria. With upper tract involvement, back or flank pain may be present. The finding of sterile pyuria, with or without proteinuria and hematuria, should also prompt investigation, particularly in patients with previous or current pulmonary tuberculosis. Also consider genitourinary TB in patients with a suspected urinary tract infection that does not respond to antibiotics (except fluoroquinolones). In all cases, systemic symptoms associated with TB including fever, weight loss, or sweating can be present. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Sintomas	19/07/2019 às 10:43
67	[ Indicador ] Piúria estéril (pus na urina), com ou sem proteinúria (excesso de proteína na urina) e hematúria (sangue na urina) podem ser sintomas de tuberculose geniturinária, particularmente em pacientes com tuberculose pulmonar prévia ou atual. Outro sinal é uma infecção do trato urinário que não responde aos antibióticos (exceto fluoro quinolonas). Além disso, a infertilidade pode ser o único sinal de desse tipo de tuberculose em homens e mulheres. [ Evidência ] The finding of sterile pyuria, with or without proteinuria and hematuria, should also prompt investigation, particularly in patients with previous or current pulmonary tuberculosis. Also consider genitourinary TB in patients with a suspected urinary tract infection that does not respond to antibiotics (except fluoroquinolones). Infertility may be the sole presenting sign of genital TB in both males and females. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Sexo - Sintomas	19/07/2019 às 10:52
68	[ Indicador ] Sinais adicionais da tuberculose geniturinária em mulheres incluem dor abdominal, irregularidade menstrual, corrimento vaginal anormal, sangramento pós-coito e a presença de aumento uterino ou uma massa anexial no exame físico. [ Evidência ] Additional signs of genital tract involvement in females include abdominal pain, menstrual irregularity, abnormal vaginal discharge, postcoital bleeding, and the presence of uterine enlargement or an adnexal mass on physical examination. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Sexo - Sintomas	19/07/2019 às 10:55
69	[ Indicador ] Sinais adicionais da tuberculose geniturinária em homens incluem epididimite (inflamação do tubo na parte de trás do testículo que armazena e transporta o esperma) ou orquite epididimária (nos testículos), prostatite (dor, inchaço ou inflamação nas glândulas da próstata), massa escrotal ou epididimal, secreção do seio escrotal ou diminuição do volume de sêmen. [ Evidência ] Additional signs of genital tract involvement in males include epididymitis or epididymo-orchitis, prostatitis, scrotal or epididymal mass, scrotal sinus discharge, or decreased semen volume. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Sexo - Sintomas	19/07/2019 às 11:00
70	[ Indicador ] O diagnóstico da tuberculose geniturinária inclui imagens do local de envolvimento suspeito. A abordagem varia com a anatomia e pode incluir urografia IV, tomografia computadorizada, ultrassonografia, cistoscopia, histeroscopia ou laparoscopia diagnóstica. [ Evidência ] The diagnostic evaluation should include imaging of the suspected site of involvement. The approach will vary with anatomy and may include IV urography, computed tomography, ultrasound, cystoscopy, hysteroscopy, or diagnostic laparoscopy. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Diagnóstico	19/07/2019 às 11:02
71	[ Indicador ] O diagnóstico definitivo da tuberculose geniturinária requer a detecção no local afetado (tipicamente urina com ou sem biópsia de tecido) por cultura ou teste de amplificação de ácido nucleico. [ Evidência ] Definitive diagnosis requires detection of Mycobacterium tuberculosis at the affected site (typically urine with or without tissue biopsy) by culture or nucleic acid amplification testing (NAAT). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Diagnóstico	19/07/2019 às 11:05
72	[ Indicador ] A tuberculose geniturinária pode ocorrer concomitantemente à tuberculose pulmonar. Revisão e radiografia de tórax devem ser realizadas em todos os pacientes, assim como teste para HIV devido às altas taxas de coinfecção. [ Evidência ] Note that genitourinary tuberculosis can occur concurrently with pulmonary TB, and a review of systems and a chest x-ray should be performed in all patients to rule out active pulmonary disease. Due to high rates of HIV co-infection, testing for HIV is also recommended. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Evaluation	Genitourinary tuberculosis	- Diagnóstico	19/07/2019 às 11:10
73	[ Indicador ] O tratamento da tuberculose geniturinária segue o regime padrão de multi drogas anti tuberculose: fase inicial intensiva com isoniazida, rifampicina, pirazinamida e etambutol por 2 meses; e fase de continuação com isoniazida e rifampicina por 4 meses. [ Evidência ] Treat patients with genitourinary TB caused by drug-susceptible organisms with the standard antituberculosis multidrug regimen (Strong recommendation): - initial intensive phase with isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months - continuation phase with isoniazid and rifampin is for 4 months [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Management	Genitourinary tuberculosis	- Tratamento	19/07/2019 às 11:18
74	[ Indicador ] Os pacientes em que há suspeita ou confirmação de tuberculose geniturinária resistente aos medicamentos devem ser tratados com base no perfil de suscetibilidade a drogas e em consulta com um especialista. [ Evidência ] Treat patients with suspected or confirmed drug-resistant organisms based on the drug susceptibility profile and in consultation with an expert. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Management	Genitourinary tuberculosis	- Tratamento - Tuberculose resistente	19/07/2019 às 11:20
75	[ Indicador ] Para a tuberculose geniturinária, a cirurgia deve ser considerada para pacientes com doença extensa ou uma infecção recorrente. As opções cirúrgicas incluem a excisão (extração) do tecido afetado como nefrectomia (remoção de rim) ou epididimectomia (remoção de duto que coleta e armazena os espermatozoides) e terapia reconstrutiva como enterocisto plastia (aumento da bexiga) e implante de stent. [ Evidência ] Consider surgery for patients with extensive disease or a recurrent infection. Surgical options include excision of affected tissue such as nephrectomy or epididymectomy, reconstructive therapy such as enterocystoplasty, and stenting. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909302#Management	Genitourinary tuberculosis	- Tratamento	19/07/2019 às 11:27
76	[ Indicador ] A hemoptise (sangue misturado com escarro) pode ser um sintoma de tuberculose. O teste de coagulação serve para saber a causa da hemoptise. O ensaio de liberação de interferon gama ou de Mantoux servem para identificar tuberculose caso haja essa suspeita. [ Evidência ] Diagnostic testing for cause of hemoptysis may include: - blood tests, including coagulation testing and interferon-gamma release assay or Mantoux screen if suspected tuberculosis [ Referência ] http://www.dynamed.com/topics/dmp~AN~T920582#Evaluation	Hemoptysis - approach to the patient	- Diagnóstico - Sintomas	19/07/2019 às 15:45
77	[ Indicador ] A embolização da artéria bronco vascular pode ser um tratamento eficaz para hemoptise (sangue no escarro) maciça secundária à tuberculose em adultos. [ Evidência ] bronchovascular artery embolization may be effective treatment for massive hemoptysis secondary to tuberculosis in adults (level 2 [mid-level] evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T920582#Tuberculosis	Hemoptysis - approach to the patient	- Adultos - Tratamento	19/07/2019 às 15:49
78	[ Indicador ] A embolização da artéria bronco vascular pode ser um tratamento eficaz para hemoptise com risco de vida secundário à tuberculose em pacientes com idade maior ou igual 16 anos. [ Evidência ] bronchovascular artery embolization may be effective treatment for life-threatening hemoptysis secondary to tuberculosis in patients ≥ 16 years old (level 2 [mid-level] evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T920582#Tuberculosis	Hemoptysis - approach to the patient	- Adultos - Tratamento	19/07/2019 às 15:52
79	[ Indicador ] A tuberculose resistente à isoniazida geralmente se refere a infecções resistentes somente à isoniazida. Ela também é chamada de tuberculose mono resistente à isoniazida. As taxas estimadas de resistência à isoniazida em todos os casos de TB foram de cerca de 50% na Europa Oriental e 14% fora da Europa Oriental de 1994 a 2009. [ Evidência ] Isoniazid-resistant tuberculosis (TB) generally refers to infections caused by Mycobacterium tuberculosis that are resistant to isoniazid only and it is also called isoniazid mono-resistant tuberculosis. The estimated rates of resistance to isoniazid among all TB cases was about 50% in Eastern Europe and 14% outside of Eastern Europe during 1994-2009. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T913244#Background	Isoniazid- -resistant tuberculosis	- Definição	19/07/2019 às 15:56
80	[ Indicador ] Os fatores de risco para tuberculose resistente à isoniazida incluem: falha do regime inicial de tratamento ou de retratamento; contato próximo com pessoas com tuberculose resistente aos medicamentos; recaída após tratamento aparentemente bem sucedido; e baixa adesão aos medicamentos para tuberculose. [ Evidência ] Risk factors include failure of initial or retreatment regimen, close contact with persons with known drug-resistant TB, relapse after apparently successful treatment, and poor adherence to TB medications. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T913244#Background	Isoniazid- -resistant tuberculosis	- Fator de risco	19/07/2019 às 15:58
81	[ Indicador ] A apresentação clínica da tuberculose mono resistente à isoniazida não difere significativamente da tuberculose comum. O diagnóstico preciso é realizado através de testes de cultura e sensibilidade ou testes de amplificação de ácidos nucleicos. [ Evidência ] Clinical presentation of isoniazid mono-resistant tuberculosis (TB) does not significantly differ from that of drug-susceptible TB. Determination of isoniazid mono-resistance can be determined through culture and susceptibility testing or nucleic acid amplification tests. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T913244#Evaluation	Isoniazid- -resistant tuberculosis	- Diagnóstico - Sintomas	19/07/2019 às 16:03
82	[ Indicador ] O tratamento recomendado para pacientes com tuberculose resistente à isoniazida inclui rifampicina, etambutol e pirazinamida por um período mínimo de 6 a 9 meses. Uma fluoro quinolona pode ser adicionada a esse esquema, especialmente para pacientes com doença extensa e/ou cavitária (lesão). [ Evidência ] The recommended regimen for patients with confirmed resistance to isoniazid alone includes rifampin, ethambutol, and pyrazinamide for a minimum of 6-9 months. A fluoroquinolone may be added to the above regimen, especially in patients with extensive and/or cavitary disease. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T913244#Management	Isoniazid- -resistant tuberculosis	- Tratamento	19/07/2019 às 16:06
83	[ Indicador ] A infecção por tuberculose latente acontece quando o paciente está infectado com a tuberculose, mas não apresenta a doença. Cerca de um quarto da população mundial tem esse tipo de infecção. Quando não tratada e não havendo infecção pelo HIV, de 5% a 10% dos pacientes desenvolvem a tuberculose ativa ao longo de suas vidas. [ Evidência ] LTBI is defined as infection with Mycobacterium tuberculosis in the absence of clinical disease and is detected by the presence of an immune response to M. tuberculosis antigens. About one-quarter of the world's population has LTBI. When untreated, in the absence of HIV infection, 5%-10% of patients with LTBI develop active TB over the course of their lifetimes. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Background	Latent tuberculosis infection (LTBI)	- Definição	22/07/2019 às 11:42
84	[ Indicador ] As seguintes populações têm maior risco de adquirir a infecção por tuberculose: contatos próximos de pessoas com tuberculose pulmonar ativa; lactentes, crianças e adolescentes expostos a adultos com maior risco de tuberculose latente ou ativa; pessoas nascidas em áreas ou que visitam áreas com alta prevalência de tuberculose; profissionais de saúde; moradores ou trabalhadores em ambientes congregados como prisões ou abrigos para pessoas em situação de rua; populações de baixa renda, medicamente desfavorecidas e pessoas que abusam de álcool ou drogas ilícitas. [ Evidência ] Populations at an increased risk for acquiring M. tuberculosis infection include: - close contacts of persons with known active pulmonary TB - infants, children, and adolescents exposed to adults at a higher risk for LTBI or active TB - persons born in areas or who visit areas with a high prevalence of TB - healthcare workers - residents or workers in congregate settings such as prisons or homeless shelters - the medically underserved, low-income populations, and persons who abuse alcohol or illicit drugs [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Background	Latent tuberculosis infection (LTBI)	- Baixa renda - Crianças - Fator de risco - Pessoas em situação de rua - Privação de liberdade - Profissional de saúde - Usuário de drogas	22/07/2019 às 11:48
85	[ Indicador ] As populações de risco devem ser testadas para infecção latente por tuberculose. As opções incluem o teste cutâneo tuberculínico e o teste de liberação de interferon gama (IGRA). O IGRA é preferível em pacientes com histórico de vacinação BCG ou quando é improvável que os pacientes retornem para obter os resultados do teste cutâneo. [ Evidência ] Testing for LTBI should be performed in at-risk populations. - Options for testing include the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs). - Use of IGRAs for testing is preferred in patients with a history of Bacille Calmette-Guérin (BCG) vaccination or when patients are unlikely to return to obtain TST results. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Evaluation	Latent tuberculosis infection (LTBI)	- Diagnóstico	22/07/2019 às 11:54
86	[ Indicador ] Os pacientes que obtiverem resultado positivo para infecção latente no teste cutâneo tuberculínico ou no teste de liberação de interferon gama, devem fazer uma revisão dos sintomas e uma radiografia de tórax para excluir a possibilidade de estarem com tuberculose ativa. [ Evidência ] For patients with a positive TST or IGRA, exclude active tuberculosis by a review of symptoms and a chest x-ray. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Evaluation	Latent tuberculosis infection (LTBI)	- Diagnóstico	22/07/2019 às 11:58
87	[ Indicador ] Uma opção de tratamento para infecção latente por tuberculose é a isoniazida em mono terapia. Deve ser administrada com vitamina B6 (piridoxina) por via oral em pacientes com risco de neuropatia e grávidas. A dosagem e o tempo de tratamento varia para adultos e crianças. Além disso, a incidência de tuberculose na região onde os pacientes vivem também influencia no tratamento. [ Evidência ] Isoniazid (INH) monotherapy - Should be given with vitamin B6 (pyridoxine) 25-50 mg/day orally in patients at risk for neuropathy and those who are pregnant - Centers for Disease Control and Prevention (CDC) dosing recommendations: - Adults 5 mg/kg or children 10-20 mg/kg (maximum 300 mg/day) orally once daily for 9 months - Adults 15 mg/kg or children 20-40 mg/kg (maximum 900 mg) orally twice weekly for 9 months - Adults 5 mg/kg (maximum 300 mg) orally once daily for 6 months (not recommended for children) - Adults 15 mg/kg (maximum 900 mg) orally twice weekly for 6 months (not recommended for children) - World Health Organization (WHO) dosing recommendations: - Adults 5 mg/kg or children 10 mg/kg (maximum 300 mg) orally once daily for 6 months - Once daily 9-month regimen may be considered in regions with low TB incidence [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Doença associada - Grávidas - Tratamento	22/07/2019 às 12:10
88	[ Indicador ] Uma opção de tratamento para infecção latente por tuberculose é a rifampicina em mono terapia. [ Evidência ] Rifampin (rifampicin) monotherapy in adults 10 mg/kg or children 15-20 mg/kg (maximum 600 mg/day) orally once daily for 4 months [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Tratamento	22/07/2019 às 12:14
89	[ Indicador ] Uma opção de tratamento para infecção latente por tuberculose é a isoniazida junto com rifapentina por via oral uma vez por semana durante 3 meses. As dosagens variam de acordo com a idade e o peso do paciente. [ Evidência ] Isoniazid plus rifapentine orally once weekly for 3 months For adults and children > 12 years of age: Isoniazid 15 mg/kg (maximum 900 mg) Rifapentine 300 mg for patients 10–14.0 kg 450 mg for patients 14.1–25.0 kg 600 mg for patients 25.1–32.0 kg 750 mg for patients 32.1–49.9 kg 900 mg for patients ≥ 50.0 kg For children 2-11 years of age: Isoniazid 25 mg/kg (maximum 900 mg) Rifapentine weight-based dosing same as above [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Tratamento	22/07/2019 às 12:17
90	[ Indicador ] O tratamento para pacientes com infecção latente por tuberculose e expostos à tuberculose multi resistente deve ser gerenciado por um especialista. [ Evidência ] Treatment for patients with known exposure to multidrug-resistant TB (MDR-TB) should be determined by the resistance pattern identified in the source case and managed by a specialist. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Tratamento - Tuberculose resistente	22/07/2019 às 12:20
91	[ Indicador ] A maioria dos tratamentos está associada à hepatotoxicidade (dano no fígado). Apesar do teste de função hepática não ser recomendado rotineiramente, ela deve ser monitorada em pacientes com doença hepática crônica, infecção por HIV, aqueles que usam álcool regularmente, durante a gravidez e o pós parto. [ Evidência ] Most regimens are associated with hepatotoxicity; liver function testing is not recommended routinely but should be monitored in patients with chronic liver disease, HIV infection, those who use alcohol regularly, and during pregnancy and postpartum. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114028#Management	Latent tuberculosis infection (LTBI)	- Doença associada - Efeitos colaterais - Grávidas - HIV - Tratamento - Usuário de drogas	22/07/2019 às 12:26
92	[ Indicador ] O HIV é o fator de risco mais importante para a tuberculose. As pessoas com HIV têm 20 a 30 vezes mais chances de desenvolver a tuberculose do que as pessoas HIV negativas. Cerca de 32% dos pacientes com tuberculose são coinfectados pelo HIV. As regiões endêmicas para o HIV também são endêmicas para a tuberculose. [ Evidência ] About 32% of patients with TB are co-infected with HIV. Regions endemic for HIV are also endemic for TB. HIV is the single most important risk factor for TB and persons with HIV are 20-30 times more likely to develop TB than HIV-negative persons. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Background	Latent tuberculosis infection in patients with HIV	- Fator de risco - HIV	22/07/2019 às 12:35
93	[ Indicador ] O HIV é o fator de risco mais importante para a tuberculose. As pessoas com HIV têm 20 a 30 vezes mais chances de desenvolver a tuberculose do que as pessoas HIV negativas. Cerca de 32% dos pacientes com tuberculose são coinfectados pelo HIV. Fatores de risco adicionais incluem residência em regiões endêmicas de tuberculose, contato próximo com pacientes com tuberculose, alojamento lotado (incluindo encarceramento), ventilação deficiente em ambientes de moradia ou trabalho, má nutrição e acesso limitado a cuidados de saúde de qualidade. [ Evidência ] About 32% of patients with TB are co-infected with HIV. HIV is the single most important risk factor for TB and persons with HIV are 20-30 times more likely to develop TB than HIV-negative persons. Additional risk factors include residence in TB-endemic regions, close contact with patients with TB, crowded housing (including incarceration), poor ventilation in living or working quarters, poor nutrition, and limited access to quality health care. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Background	Latent tuberculosis infection in patients with HIV	- Baixa renda - Fator de risco - HIV - Privação de liberdade	22/07/2019 às 12:38
94	[ Indicador ] Todas as pessoas com HIV devem realizar testes para infecção latente por tuberculose. As opções de testes incluem o teste cutâneo tuberculínico e os testes de liberação de interferon gama. No entanto, resultado negativo nesses teste não exclui definitivamente um diagnóstico de tuberculose. Todos os pacientes com infecção por HIV e suspeita de tuberculose ou com sintomas deve realizar radiografia de tórax e avaliação clínica para excluir a possibilidade de tuberculose ativa. [ Evidência ] Perform testing for latent tuberculosis infection (LTBI) in all persons with HIV. Options for testing include the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs). A negative TST or IGRA does not definitively exclude a diagnosis of tuberculosis (TB). In all patients with HIV infection and suspected LTBI or symptoms of TB, perform chest radiography and clinical evaluation promptly to rule out active TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Evaluation	Latent tuberculosis infection in patients with HIV	- Diagnóstico - HIV	22/07/2019 às 12:41
95	[ Indicador ] Os pacientes com HIV devem ser tratados para infecção latente por tuberculose latente quando: o teste de diagnóstico for positivo, não haver evidência de doença tuberculosa e não tiver histórico prévio de tratamento para tuberculose ativa ou latente; e há contato próximo de pessoas com tuberculose pulmonar infecciosa, independentemente do status da infecção latente. [ Evidência ] Treat patients with HIV for latent tuberculosis infection (LTBI) when: the patient has a positive diagnostic test for LTBI, no evidence of tuberculosis (TB) disease, and no prior history of treatment for active or latent TB (Strong recommendation) the patient is a close contact of persons with infectious pulmonary TB, regardless of LTBI status (Strong recommendation) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- HIV - Tratamento	22/07/2019 às 12:50
96	[ Indicador ] A tuberculose ativa (presença da doença) deve ser descartada antes de iniciar o tratamento para a tuberculose latente, pois o tratamento da doença ativa como se fosse latente pode levar ao desenvolvimento de tuberculose resistente a medicamentos. [ Evidência ] Rule out active TB prior to initiating treatment for LTBI, as treatment of active disease with regimens to treat LTBI can lead to development of drug-resistant TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- Tratamento - Tuberculose resistente	22/07/2019 às 12:54
97	[ Indicador ] Para pacientes com HIV expostos à tuberculose resistente a medicamentos, os medicamentos devem ser orientados em consulta com especialistas ou autoridades de saúde pública. [ Evidência ] For patients exposed to drug-resistant Mycobacterium tuberculosis, select anti-TB drugs after consultation with experts or public health authorities (Strong recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- HIV - Tratamento - Tuberculose resistente	22/07/2019 às 12:57
98	[ Indicador ] A terapia anti retroviral para pacientes com HIV deve ser adicionada ao tratamento da infecção latente por tuberculose para reduzir o risco do desenvolvimento da doença. Devido a interações medicamentosas, podem ser necessários ajustes nas doses dos medicamentos. [ Evidência ] Give ART in addition to LTBI treatment to reduce the risk of TB disease (Strong recommendation). Dose adjustments of antiretroviral drugs and/or TB drugs may be required due to drug-drug interactions. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- HIV - Tratamento	22/07/2019 às 12:59
99	[ Indicador ] Tratar a infecção latente por tuberculose diminui em 60% o risco de desenvolver a doença. [ Evidência ] Treatment for LTBI reduces the risk of developing active TB by about 60%. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Management	Latent tuberculosis infection in patients with HIV	- Prevenção - Tratamento	22/07/2019 às 13:02
100	[ Indicador ] Os pacientes com HIV que viajam ou trabalham em regiões endêmicas de tuberculose devem ser aconselhados sobre os riscos e para fazer testes de infecção latente por tuberculose quando retornarem. [ Evidência ] counsel patients with HIV who travel or work in TB-endemic regions about the risk of TB and testing for latent TB infection (LTBI) upon return [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Prevention-and-Screening	Latent tuberculosis infection in patients with HIV	- Prevenção	22/07/2019 às 13:05
101	[ Indicador ] O tratamento da infecção latente por tuberculose e a restauração da imunodeficiência é importante para prevenção de tuberculose em pacientes com infecção pelo HIV. A terapia preventiva com isoniazida está associada à redução da mortalidade em pacientes com HIV e da incidência de tuberculose em adultos com infecção pelo HIV (tratados com terapia anti retroviral). (nível 2 [nível médio] evidência) terapia empírica de TB pode não melhorar os desfechos em comparação com IPT em pacientes com doença avançada por HIV iniciando TARV em alta prevalência de HIV / TB (nível 2 [nível médio] evidência) [ Evidência ] Isoniazid preventative therapy (IPT) both treatment of LTBI and restoration of immunity with ART important for prevention of TB in patients with HIV infection efficacy of IPT in adults with HIV infection IPT associated with reduced mortality in patients with HIV in high TB prevalence setting (level 2 [mid-level] evidence) IPT appears to reduce incidence of TB in adults with HIV infection receiving ART (level 2 [mid-level] evidence) empiric TB therapy may not improve outcomes compared to IPT in patients with advanced HIV disease initiating ART in high HIV/TB prevalence setting (level 2 [mid-level] evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Isoniazid-preventative-therapy--IPT	Latent tuberculosis infection in patients with HIV	- Adultos - HIV - Prevenção - Tratamento	22/07/2019 às 13:22
102	[ Indicador ] A terapia preventiva com isoniazida para crianças com infecção pelo HIV está associada à redução de mortalidade e incidência de tuberculose se elas não recebem a terapia anti retroviral. A terapia pode não reduzir a mortalidade ou a tuberculose ativa em crianças com infecção pelo HIV que recebem a terapia anti retroviral. Além disso, ela pode não melhorar a sobrevida livre da tuberculose em bebês com ou sem infecção por HIV, imunizados com a vacina BCG. [ Evidência ] efficacy of IPT in children with HIV infection IPT may not reduce mortality or active TB in children with HIV infection receiving ART (level 2 [mid-level] evidence) IPT in children with HIV infection not receiving ART associated with reduced mortality and incidence of TB (level 2 [mid-level] evidence) IPT may not improve TB-disease-free survival in infants with or without HIV infection immunized with Bacille Calmette–Guerin (BCG) vaccine (level 2 [mid-level] evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909352#Isoniazid-preventative-therapy--IPT	Latent tuberculosis infection in patients with HIV	- Bebês - Crianças - HIV - Prevenção - Tratamento	22/07/2019 às 13:34
103	[ Indicador ] A tuberculose multi resistente é a forma da tuberculose resistente a pelo menos isoniazida e rifampicina. Estima-se que 460.000 casos de surgiram em 2017 globalmente. [ Evidência ] MDR TB is defined as TB caused by Mycobacterium tuberculosis resistant to at least isoniazid and rifampin. An estimated 460,000 cases of MDR TB emerged globally in 2017. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T907301#Background	Multidrug- -resistant tuberculosis (MDR TB)	- Definição - Tuberculose resistente	22/07/2019 às 15:49
104	[ Indicador ] Os fatores de risco da tuberculose multi resistente incluem: exposição a pessoas com esse tipo da doença; histórico de falha no tratamento ou recaída da tuberculose; baixa adesão ou não conclusão de medicamentos durante tratamento anterior; baciloscopia (exame de escarro) positiva após dois meses de terapia combinada; residência ou viagem para a área com alta prevalência de tuberculose resistente a medicamentos. [ Evidência ] Risk factors for MDR TB include: exposure to persons with MDR TB a history of TB with treatment failure or relapse poor adherence to or not completing anti-TB medications during previous TB treatment positive sputum smears after 2 months of standard anti-TB combination therapy residence in or travel to area with a high prevalence of drug resistance [ Referência ] http://www.dynamed.com/topics/dmp~AN~T907301#Background	Multidrug- -resistant tuberculosis (MDR TB)	- Fator de risco - Tuberculose resistente	22/07/2019 às 15:55
105	[ Indicador ] Os sinais da tuberculose multi resistente não diferem daqueles da tuberculose suscetível a drogas. O diagnóstico é tradicionalmente confirmado com testes de cultura e suscetibilidade a drogas. [ Evidência ] The clinical presentation of MDR TB does not differ from that of drug-susceptible TB. MDR TB diagnosis is traditionally confirmed with culture and drug-susceptibility testing. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T907301#Evaluation	Multidrug- -resistant tuberculosis (MDR TB)	- Diagnóstico - Tuberculose resistente	22/07/2019 às 15:58
106	[ Indicador ] Para a tuberculose multi resistente, a realização de testes moleculares pode identificar rapidamente a resistência à rifampicina e isoniazida e é preferível aos testes convencionais para o manejo inicial. Quando o teste molecular não é realizado, deve-se suspeitar desse tipo de tuberculose se um ou mais das seguintes condições estiver presente(s): fatores de risco; persistência de baciloscopias e exames de cultura positivos; e pouca melhora nos sintomas, ambas apesar da adesão ao tratamento padrão. [ Evidência ] The addition of molecular testing can rapidly identify resistance to rifampin and isoniazid and is preferred to conventional testing for initial management. When molecular testing is not performed, MDR TB may be suspected prior to receipt of drug susceptibility results if 1 or more of the following: risk factors for MDR TB are present there are persistently positive sputum smears and/or serial cultures despite adherence to standard anti-TB treatment there is little improvement in signs and symptoms of TB despite adherence to standard anti-TB treatment [ Referência ] http://www.dynamed.com/topics/dmp~AN~T907301#Evaluation	Multidrug- -resistant tuberculosis (MDR TB)	- Diagnóstico - Tuberculose resistente	22/07/2019 às 16:05
107	[ Indicador ] A tuberculose multi resistente deve ser administrada por especialistas com experiência no tratamento desse tipo de tuberculose. Antes de receber os resultados dos testes de sensibilidade às drogas, o tratamento deve ser iniciado para pacientes em que há suspeita de tuberculose multi resistente. O tratamento inicial inclui no mínimo 5 antibióticos. Ele dura pelo menos de 9 a 12 meses. Pode durar mais tempo dependendo dos resultados de suscetibilidade à drogas. [ Evidência ] MDR TB should be managed by experts with experience in the treatment of drug-resistant TB. Prior to receipt of drug-susceptibility testing results, empiric treatment for MDR TB should be started in those in whom MDR TB is suspected. Initial treatment includes ≥ 5 antibiotics. Duration is at least 9-12 months, and may be longer depending on drug susceptibility results. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T907301#Management	Multidrug- -resistant tuberculosis (MDR TB)	- Tratamento - Tuberculose resistente	22/07/2019 às 16:13
108	[ Indicador ] Nenhum dos potenciais tratamentos para pessoas infectadas com tuberculose multi resistente foi totalmente testado quanto à eficácia e estes tratamentos são frequentemente mal tolerados. [ Evidência ] none of the potential regimens for persons infected with MDR TB have been tested fully for efficacy, and these regimens are often poorly tolerated [ Referência ] http://www.dynamed.com/topics/dmp~AN~T907301#Contact-investigation	Multidrug- -resistant tuberculosis (MDR TB)	- Tratamento - Tuberculose resistente	22/07/2019 às 16:18
109	[ Indicador ] A tuberculose pericárdica é causada pela infecção e inflamação do pericárdio. Nos países com tuberculose endêmica, este tipo é a causa mais comum de pericardite (inchaço e irritação da membrana que envolve o coração). No entanto, representa apenas 4% dos pacientes com derrame pericárdico nos países desenvolvidos. [ Evidência ] Pericardial tuberculosis is caused by infection and inflammation of the pericardium by Mycobacterium tuberculosis. In tuberculosis (TB)- -endemic countries, pericardial TB is the most common cause of pericarditis, however it only accounts for 4% of patients with pericardial effusion in developed countries. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Background	Pericardial tuberculosis	- Definição	22/07/2019 às 16:25
110	[ Indicador ] A infecção do pericárdio pode ocorrer pela disseminação da tuberculose dos linfonodos mediastinais, peritraqueais e peribrônquicos, disseminação hematogênica (corrente sanguínea) durante a infecção primária ou disseminação direta de uma lesão tuberculosa no pulmão, pleura, caixa torácica, diafragma ou peritônio para o pericárdio. [ Evidência ] Infection of the pericardium can occur by M. tuberculosis spreading from mediastinal, peritracheal, and peribronchial lymph nodes, hematogenous spread during primary infection, or direct spread from a tuberculous lesion in lung, pleura, rib cage, diaphragm, or peritoneum to the pericardium. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Background	Pericardial tuberculosis	- Transmissão	22/07/2019 às 16:28
111	[ Indicador ] A tuberculose pericárdica geralmente apresenta sintomas sistêmicos inespecíficos, incluindo febre, sudorese noturna, fadiga, perda de peso, dor torácica e tosse. [ Evidência ] Pericardial tuberculosis (TB) typically presents with nonspecific systemic symptoms including fever, night sweats, fatigue, weight loss, chest pain, and cough. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Evaluation	Pericardial tuberculosis	- Sintomas	22/07/2019 às 16:54
112	[ Indicador ] A primeira etapa do diagnóstico da tuberculose pericárdica consiste em radiografia do tórax, que geralmente mostra uma sombra cardíaca aumentada e também pode mostrar alterações sugestivas de tuberculose pulmonar. Um ecocardiograma deve ser realizado em pacientes com suspeita de derrame pericárdico. [ Evidência ] Imaging is typically the first step in patient evaluation. Order a chest x-ray, which typically shows enlarged cardiac shadow and may also show changes suggestive of pulmonary TB. Echocardiography should be performed for patients suspected of having a pericardial effusion. Presence of fibrinous strands suggest an exudate, but are not specific for TB. Almost all patients have abnormal findings on electrocardiography in the form of ST-T wave changes, but none of these are specific for TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Evaluation	Pericardial tuberculosis	- Diagnóstico	22/07/2019 às 17:00
113	[ Indicador ] Todos os pacientes com suspeita de tuberculose pericárdica com derrame devem ser avaliados quanto aos sinais de tamponamento ou comprometimento cardíaco, pois constituem uma emergência médica. [ Evidência ] Assess all patients suspected of having pericardial TB with an effusion for signs of cardiac tamponade or compromise, as these constitute a medical emergency. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Evaluation	Pericardial tuberculosis	- Diagnóstico	22/07/2019 às 17:06
114	[ Indicador ] O diagnóstico da tuberculose pericárdica pode ser confirmado pelo exame de cultura a partir de amostras de fluido pericárdico, biópsia de espécimes, demonstração de bacilos ácido resistentes. Entretanto, devido ao baixo rendimento destes espécimes, um resultado negativo não exclui o diagnóstico de tuberculose pericárdica. Achar granulomas e bacilos ácido resistentes na biópsia pericárdica também fornece um diagnóstico definitivo. [ Evidência ] Diagnosis can be confirmed by culturingMycobacterium tuberculosis from pericardial fluid or biopsy specimens or demonstration of acid- -fast bacilli, but because yield is low from these specimens, a negative result does not rule out the diagnosis of pericardial TB. Finding of granulomas and acid-fast bacilli on pericardial biopsy also provides definitive diagnosis. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Evaluation	Pericardial tuberculosis	- Diagnóstico	22/07/2019 às 17:10
115	[ Indicador ] A terapia diretamente observada é preferível à terapia autoadministrada para o tratamento de rotina de pacientes com todas as formas de tuberculose. [ Evidência ] Directly observed therapy (DOT) is preferred over self-administered therapy (SAT) for routine treatment of patients with all forms of tuberculosis (Weak recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Management	Pericardial tuberculosis	- Tratamento	22/07/2019 às 17:13
116	[ Indicador ] Para a tuberculose pericárdica, corticosteroides adjuvantes são recomendados durante as primeiras onze semanas de tratamento em pacientes sem infecção por HIV, embora as recomendações variem para pacientes com infecção por HIV. [ Evidência ] Use adjunctive corticosteroids during the first 11 weeks of treatment in patients without HIV infection (Strong recommendation), although recommendations vary for patients with HIV infection. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Management	Pericardial tuberculosis	- HIV - Tratamento	22/07/2019 às 17:16
117	[ Indicador ] Pacientes com tuberculose pericárdica, instáveis com tamponamento cardíaco, necessitam de drenagem imediata do líquido pericárdico por pericardiocentese ou cirurgia. [ Evidência ] Unstable patients with cardiac tamponade require immediate drainage of pericardial fluid by needle pericardiocentesis or surgery. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Management	Pericardial tuberculosis	- Tratamento	22/07/2019 às 17:19
118	[ Indicador ] A pericardiectomia cirúrgica (remoção de parte do pericárdio) deve ser considerada em pacientes com pericardite tuberculosa constritiva que não melhoram ou se deterioram após o período de 4 a 8 semanas de terapia anti tuberculose. [ Evidência ] Consider surgical pericardiectomy in patients with constrictive tuberculous pericarditis who do not improve or deteriorate after 4-8 weeks of anti-TB therapy. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T910018#Management	Pericardial tuberculosis	- Tratamento	22/07/2019 às 17:22
119	[ Indicador ] A tuberculose pleural refere-se a um derrame pleural que resulta da infecção da pleura (membrana do pulmão) combinado com uma resposta de hipersensibilidade retardada a essa infecção. É uma das formas mais comuns de tuberculose extrapulmonar em todo o mundo. [ Evidência ] Pleural tuberculosis refers to a pleural effusion that results from infection of the pleura with Mycobacterium tuberculosis combined with a delayed hypersensitivity response to that infection. It is one of the most common forms of extrapulmonary tuberculosis (TB) worldwide. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Background	Pleural tuberculosis	- Definição	22/07/2019 às 17:28
120	[ Indicador ] A tuberculose pleural pode resultar de infecção primária ou de reativação da infecção latente. A infecção concomitante por tuberculose do parênquima pulmonar é comum e está presente em cerca de 20% a 50% dos pacientes. [ Evidência ] Pleural TB may result from primary infection or from reactivation of latent TB infection. Concurrent TB infection of the lung parenchyma is common, and present in about 20%-50% of patients. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Background	Pleural tuberculosis	- Transmissão	22/07/2019 às 17:30
121	[ Indicador ] Os sintomas da tuberculose pleural aguda incluem febre, tosse e dor torácica pleurítica. É preciso suspeitar de tuberculose pleural em um paciente com derrame pleural na radiografia de tórax e uma história de exposição a alguém com tuberculose ou história de viver ou viajar para uma área onde a tuberculose é endêmica. A maioria dos derrames são unilaterais e de tamanho pequeno a moderado. [ Evidência ] Symptoms associated with acute pleural tuberculosis (TB) include fever, cough, and pleuritic chest pain. With long-standing infection, draining empyema (empyema necessitans) can develop. Suspect pleural TB in a patient with a pleural effusion on chest x-ray and a history of exposure to someone with TB or history of living in or travelling to an area where TB is endemic. Note that most effusions are unilateral and small to moderate in size. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnóstico - Sintomas	22/07/2019 às 17:34
122	[ Indicador ] Imagens adicionais como a tomografia computadorizada podem ajudar a detectar complicações como infecção concomitante a tuberculose pleural, por exemplo a infeção por tuberculose do parênquima pulmonar. [ Evidência ] Additional imaging, such as a computed tomography (CT) scan, may help detect complications such as loculations or concurrent TB infection of the lung parenchyma. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnóstico	22/07/2019 às 17:36
123	[ Indicador ] O diagnóstico definitivo da tuberculose pleural requer demonstração da tuberculose em escarro, líquido pleural por cultura ou teste de amplificação de ácido nucleico. A biópsia pleural pode ser necessária quando o organismo não pode ser detectado na análise do escarro ou do líquido pleural. [ Evidência ] Definitive diagnosis requires demonstration of Mycobacterium tuberculosis in either sputum or pleural fluid by culture or nucleic acid amplification testing. Pleural biopsy may be needed when the organism cannot be detected in sputum or pleural fluid analysis. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnóstico	22/07/2019 às 17:39
124	[ Indicador ] Em regiões com altas taxas de tuberculose, onde os recursos são limitados, o diagnóstico tuberculose pleural pode ser inferido pela detecção de um derrame linfocítico exsudativo. [ Evidência ] In regions with high rates of TB where resources are limited, diagnosis can be inferred by detecting an exudative lymphocytic effusion with high ADA levels. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnóstico	22/07/2019 às 17:42
125	[ Indicador ] Pacientes diagnosticados com tuberculose pleural ou com suspeita também devem ser testados para infecção por HIV devido a altas taxas de coinfecção e/ou co endemicidade. [ Evidência ] In all cases, patients with known or suspected pleural TB should also be tested for HIV infection due to high rates of coinfection and/or co- -endemicity. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Evaluation	Pleural tuberculosis	- Diagnóstico - HIV	22/07/2019 às 17:43
126	[ Indicador ] O tratamento recomendado para pacientes com tuberculose pleural causada por organismos não resistentes inclui: fase inicial de 2 meses com isoniazida, rifampicina, pirazinamida e etambutol; e fase de continuação de 4 meses com isoniazida e rifampicina. [ Evidência ] The recommended regimen for patients with pleural TB caused by drug-susceptible organisms includes (Strong recommendation): a 2-month initial phase with isoniazid, rifampin, pyrazinamide, and ethambutol PLUS a 4-month continuation phase with isoniazid and rifampin [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Management	Pleural tuberculosis	- Tratamento	22/07/2019 às 17:46
127	[ Indicador ] Para a tuberculose pleural, a drenagem dos derrames pleurais não é rotineiramente recomendada, mas pode ser considerada para pacientes com um grande derrame causando dificuldade na respiração ou para pacientes com empiema (acúmulo de pus). [ Evidência ] Drainage of pleural effusions is not routinely recommended but can be considered for patients with a large effusion causing difficulty in breathing or in patients with empyema. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Management	Pleural tuberculosis	- Tratamento	22/07/2019 às 17:49
128	[ Indicador ] Após o início do tratamento anti tuberculose, pode ocorrer piora do paciente devido a um aumento no tamanho de um derrame pleural ou desenvolvimento de novas lesões. Na maioria dos casos, as reações são resolvidas sem terapia adicional. [ Evidência ] Be aware that paradoxical worsening after initiation of antituberculosis treatment can occur and may be characterized by an increase in size of a pleural effusion or development of new lesions. Paradoxical reactions resolve without additional therapy in most cases. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T909686#Management	Pleural tuberculosis	- Efeitos colaterais	22/07/2019 às 17:53
129	[ Indicador ] A pleurite é a inflamação da pleura parietal que resulta em dor torácica súbita e intensa na inspiração e na expiração. Essa dor combinada com mal estar, perda de peso, febre, ou sudorese noturna pode indicar tuberculose. [ Evidência ] inflammation of parietal pleura resulting in sudden and intense chest pain on inhalation and exhalation(1) ask about symptoms that may appear in combination with pain malaise may indicate malignancy(3) pleural effusion(1) tuberculosis(1) rheumatoid arthritis(1) weight loss may indicate malignancy(3) pleural effusion(1) tuberculosis(1) rheumatoid arthritis(1) fever may indicate(1) pneumonia tuberculosis familial Mediterranean fever systemic lupus erythematosus medication-induced pleuritis (Clin Chest Med 2004 Mar;25(1):141) other infection night sweats may indicate malignancy(3) pleural effusion (including malignant pleural effusion)(1) tuberculosis(1) rheumatoid arthritis(1) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T922350#Description http://www.dynamed.com/topics/dmp~AN~T922350#History-of--present-illness--HPI	Pleuritis - approach to the patient	- Sintomas	22/07/2019 às 19:06
130	[ Indicador ] A tuberculose pulmonar refere-se à síndrome clínica associada à infecção do sistema respiratório causada pela micobactéria tuberculose. Em 2017, Organização Mundial de Saúde estima que 10 milhões de pessoas desenvolveram tuberculose e 1,6 milhões morreram da doença. [ Evidência ] Pulmonary tuberculosis (TB) refers to the clinical syndrome associated with infection of the respiratory system caused by Mycobacterium tuberculosis. The World Health Organization estimates that in 2017, 10 million people developed TB and 1.6 million died from the disease, with 9,093 cases reported in the United States. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Background	Pulmonary tuberculosis	- Definição	23/07/2019 às 10:45
131	[ Indicador ] O tuberculose é transmitida pelo ar de uma pessoa para outra quando as bactérias são expelidas na forma de aerossol por uma pessoa com tuberculose pulmonar. [ Evidência ] M. tuberculosis is spread through the air from one person to another when bacteria are aerosolized from a person with pulmonary TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Background	Pulmonary tuberculosis	- Transmissão	23/07/2019 às 10:48
132	[ Indicador ] Os fatores de risco da tuberculose pulmonar são: (1) contato próximo de uma pessoa com tuberculose infecciosa; (2) crianças menores de 5 anos com teste cutâneo tuberculínico positivo; (3) pessoas que imigraram de regiões do mundo com altas taxas de tuberculose; (4) grupos com altas taxas de transmissão de tuberculose, incluindo pessoas com infecção por HIV, usuários de drogas injetáveis e pessoas em situação de rua; (5) trabalhar ou residir com pessoas com alto risco de tuberculose em instalações ou instituições; (6) condições médicas que enfraquecem o sistema imunológico como o tratamento com medicamentos imunossupressores, diabetes, malignidade, transplante de órgãos, silicose, transtorno de abuso de substâncias, doença renal grave ou baixo peso corporal. [ Evidência ] Risk factors for developing TB include: Close contacts of a person with infectious TB disease. Children < 5 years old who have a positive tuberculin skin test. Persons who have immigrated from regions of the world with high rates of TB. Groups with high rates of TB transmission including persons with HIV infection, injection drug users, and homeless persons. Working or residing with people at high risk for TB in facilities or institutions. Medical conditions that weaken the immune system such as HIV infection, treatment with immunosuppressive medications, diabetes, malignancy, organ transplantation, silicosis, substance abuse disorder, severe kidney disease, or low body weight. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Background	Pulmonary tuberculosis	- Doença associada - Fator de risco - HIV - Pessoas em situação de rua - Usuário de drogas	23/07/2019 às 11:04
133	[ Indicador ] A tuberculose pulmonar tem sintomas sugestivos como febre, fadiga, perda de peso, sudorese noturna, tosse ou hemoptise (sangue no escarro). [ Evidência ] Suspect pulmonary tuberculosis (TB) in patients with suggestive symptoms including fever, fatigue, weight loss, night sweats, cough, or hemoptysis. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Evaluation	Pulmonary tuberculosis	- Sintomas	23/07/2019 às 11:07
134	[ Indicador ] O diagnóstico da tuberculose pulmonar é confirmado com a identificação da micobactéria na amostra respiratória de pacientes com sintomas clínicos compatíveis. Os testes utilizados para diagnóstico bacteriológico incluem baciloscopia (exame de escarro), teste de amplificação de ácido nucleico e teste de cultura mico bacteriana líquida e sólida (padrão ouro para diagnóstico). Frequentemente, o diagnóstico é complementado com anormalidades radiológicas do tórax e evidência da resposta imune pelo teste cutâneo tuberculínico e/ou pelo teste de liberação de interferon gama, embora esses testes também sejam positivos em pacientes com tuberculose previamente tratada ou infecção tuberculosa latente. [ Evidência ] Identification of Mycobacterium tuberculosis in respiratory specimen confirms diagnosis of pulmonary TB in patients with compatible clinical symptoms. Tests used for bacteriologic diagnosis include: Acid fast bacillus (AFB) smear microscopy, though this test is not specific to M. tuberculosis. Nucleic acid amplification testing (NAAT). Liquid and solid mycobacterial culture (gold standard for diagnosis). Diagnosis often supplemented with additional evidence such as: Chest x-ray abnormalities. Evidence of immune response by tuberculin skin test (TST) and/or interferon gamma release assay (IGRA), though these tests will also be positive in patients with previously treated TB or latent TB infection. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Evaluation	Pulmonary tuberculosis	- Diagnóstico	23/07/2019 às 11:15
135	[ Indicador ] O tratamento recomendado para a tuberculose pulmonar recém diagnosticada e suscetível a todos os medicamentos de primeira linha é: fase inicial de dois meses com isoniazida, rifampicina, pirazinamida e etambutol; e fase de continuação de 4 meses com isoniazida mais rifampina. [ Evidência ] The recommended empiric treatment for newly diagnosed pulmonary TB caused by Mycobacterium tuberculosis susceptible to all first-line drugs is a 2-month initial or intensive phase followed by a 4-month continuation phase (Strong recommendation). The 2-month initial phase consists of isoniazid, rifampin, pyrazinamide, plus ethambutol. The 4-month continuation phase consists of isoniazid plus rifampin. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Management	Pulmonary tuberculosis	- Tratamento	23/07/2019 às 11:21
136	[ Indicador ] O tratamento da tuberculose pulmonar com isoniazida deve ser suplementado com piridoxina em pacientes com deficiência nutricional, diabetes, infecção por HIV, insuficiência renal, alcoolismo, em mulheres grávidas e lactantes e em crianças para prevenir efeitos colaterais. [ Evidência ] Supplement isoniazid treatment with pyridoxine 25 mg/day in patients with nutritional deficiency, diabetes, HIV infection, renal failure, or alcoholism, in pregnant and breastfeeding women, and in children to prevent adverse events. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Management	Pulmonary tuberculosis	- Crianças - Doença associada - Efeitos colaterais - Grávidas - HIV - Tratamento	23/07/2019 às 11:25
137	[ Indicador ] Para tuberculose pulmonar, se existirem cavidades em radiografia de tórax inicial e se uma cultura de amostra obtida em 2 meses de tratamento permanecer positiva, deve ser considerada a extensão da fase de continuação para 7 meses (9 meses no total). [ Evidência ] If cavities are present on an initial chest radiograph and if a culture of a specimen obtained at 2 months remains positive, consider extending the continuation phase to 7 months (9 months total). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Management	Pulmonary tuberculosis	- Tratamento	23/07/2019 às 11:30
138	[ Indicador ] A profilaxia com isoniazida pode reduzir o risco de tuberculose em pacientes com transplante renal. [ Evidência ] isoniazid prophylaxis may reduce risk of tuberculosis in patients having kidney transplant (level 2 [mid-level] evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T116300#Treatment-of-latent-tuberculosis-infection	Pulmonary tuberculosis	- Prevenção	23/07/2019 às 11:35
139	[ Indicador ] Os principais fatores de risco para a aquisição da tuberculose em crianças incluem nascimento ou residência em área endêmica e exposição a adultos com tuberculose ativa e exposição ao fumo passivo. Além disso, os fatores associados ao aumento do risco de desenvolvimento da doença incluem aquisição recente de infecção, idade mais jovem, comprometimento da imunidade (particularmente infecção pelo HIV) e comorbidades crônicas como diabetes mellitus. [ Evidência ] Major risk factors for acquisition of infection include birth or residence in an endemic area, exposure to adults with active TB, and exposure to second hand smoke. Factors associated with increased risk of progressing from latent infection to active disease include recent acquisition of infection, younger age, immunocompromise, particularly HIV infection, and chronic comorbidities such as diabetes mellitus. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Background	Tuberculosis in children	- Bebês - Crianças - Doença associada - Fator de risco - HIV	23/07/2019 às 11:41
140	[ Indicador ] A apresentação clínica mais comum da tuberculose em crianças é a doença parenquimatosa pulmonar com linfadenopatia intratorácica associada. [ Evidência ] The most common clinical presentation of tuberculosis in children is pulmonary parenchymal disease with associated intrathoracic lymphadenopathy. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Background	Tuberculosis in children	- Crianças - Sintomas	23/07/2019 às 11:47
141	[ Indicador ] A tuberculose extra pulmonar é mais comum em crianças do que em adultos, manifestando-se mais frequentemente como linfadenite tuberculosa ou doença pleural. São menos comuns as formas extra pulmonares no pericárdio, sistema nervoso central, esquelética e miliar. [ Evidência ] Extrapulmonary disease is also more common in children than in adults, most often manifesting as tuberculous lymphadenitis or pleural disease. Less common extrapulmonary manifestations include pericardial, central nervous system, skeletal, and miliary disease. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Background	Tuberculosis in children	- Crianças - Diagnóstico - Sintomas	23/07/2019 às 11:48
142	[ Indicador ] A tuberculose congênita é muito rara, mas é relatada. Pode apresentar febre, desconforto respiratório, hepato/esplenomegalia (aumento do fígado/baço) ou sintomas inespecíficos como má alimentação ou letargia. [ Evidência ] Congenital TB is very rare, but reported, and may present with fever, respiratory distress, hepato/splenomegaly, or with nonspecific symptoms such as poor feeding or lethargy. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Background	Tuberculosis in children	- Bebês - Sintomas	23/07/2019 às 11:56
144	[ Indicador ] Crianças nascidas em áreas endêmicas ou exposta a um adulto com tuberculose, devem ser investigadas se apresentam tosse e/ou febre, perda de peso ou deficit de crescimento, linfadenopatia (aumento dos nódulos linfáticos), hepato/esplenomegalia (aumento do fígado/baço), meningite, ascite ou outros sintomas sugestivos. [ Evidência ] Consider the diagnosis of tuberculosis (TB) in children born in endemic areas or with known exposure to an adult with active TB, presenting with cough and/or fever, weight loss or failure to thrive, lymphadenopathy, hepato- or splenomegaly, meningitis or ascites, or other suggestive signs and symptoms. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation	Tuberculosis in children	- Bebês - Crianças - Sintomas	23/07/2019 às 12:00
145	[ Indicador ] Crianças com suspeita de infecção por tuberculose devem fazer teste cutâneo tuberculínico ou teste de liberação de interferon gama. O teste cutâneo é preferido para crianças menores de 5 anos. O segundo teste é preferido para crianças a partir de 5 anos que tenham histórico da vacina BCG. Contudo, qualquer teste é aceitável em crianças maiores de 5 anos que não têm histórico da vacina. Crianças com resultado positivo devem fazer um exame físico completo, incluindo uma avaliação neurológica cuidadosa e uma radiografia de tórax. Caso o resultado seja negativo, é considerada uma avaliação adicional nas crianças que permanecem em risco de adquirir tuberculose, pois resultado negativo não exclui a doença ativa. [ Evidência ] Screen children with suspected latent or active infection using either a tuberculin skin test (TST) or interferon gamma release assay (IGRA). TST is preferred in children < 5 years old, but IGRA is preferred in children ≥ 5 years old with history of bacille Calmette-Guérin (BCG) vaccination. Either test is acceptable in children > 5 years old who lack a history of BCG vaccination. In children who screen positive, perform a thorough physical examination, including a careful neurologic assessment and a chest x-ray. In children who screen negative, consider additional evaluation in those who remain at increased risk for TB, as a negative result does not rule out active disease. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation	Tuberculosis in children	- Crianças - Diagnóstico	23/07/2019 às 12:06
146	[ Indicador ] Na ausência de confirmação bacteriana, o diagnóstico da tuberculose pode ser feito clinicamente com base em fatores de risco, sintomas e/ ou características da radiografia de tórax. [ Evidência ] In the absence of bacterial confirmation, the diagnosis can be made clinically based on risk factors, signs and symptoms and/or characteristic chest x-ray findings. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation	Tuberculosis in children	- Crianças - Diagnóstico	23/07/2019 às 13:17
147	[ Indicador ] Devido à associação entre infecção por HIV e tuberculose, o teste de HIV deve ser realizado em todas as crianças com suspeita ou confirmação de tuberculose. [ Evidência ] Due to the association between HIV infection and TB, consider HIV testing in all children with suspected or confirmed TB. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Evaluation	Tuberculosis in children	- Crianças - HIV	23/07/2019 às 13:18
148	[ Indicador ] O diagnóstico de tuberculose em crianças geralmente representa uma transmissão recente. Portanto, é necessário investigar o caso de origem. [ Evidência ] The diagnosis in children often represents a recent transmission and should trigger a source case investigation. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Management	Tuberculosis in children	- Crianças - Diagnóstico - Tratamento	23/07/2019 às 13:22
149	[ Indicador ] Em crianças, o tratamento recomendado para tuberculose pulmonar não resistente a todos os medicamentos de primeira linha é uma fase inicial de 2 meses, seguida de uma fase de continuação de 4 meses. A fase inicial inclui isoniazida, rifampicina, pirazinamida e etambutol. A fase de continuação incluiu isoniazida e rifampicina. [ Evidência ] American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America (ATS/CDC/IDSA)- recommended empiric treatment for tuberculosis in children with pulmonary tuberculosis caused by Mycobacterium tuberculosis known or suspected to be susceptible to all first-line drugs is a 2-month initial phase followed by a 4-month continuation phase (Strong recommendation). The 2-month initial phase includes: isoniazid 5 mg/kg/day (maximum 300 mg/day, 10 mg/kg/day in children) orally, IV, or intramuscularly rifampin 10 mg/kg/day (maximum 600 mg/day, 15 mg/kg/day in children) orally or IV pyrazinamide 25 mg/kg/day (maximum 2 g/day, 15-30 mg/kg/day in children) orally ethambutol 15 mg/ kg/day (maximum 1.6 g/day, 20 mg/kg/day in children) orally The 4-month continuation phase includes: isoniazid 5 mg/kg/day (maximum 300 mg/ day, 10 mg/kg/day in children) orally, IV, or intramuscularly rifampin 10 mg/kg/day (maximum 600 mg/day, 15 mg/kg/day in children) orally or IV [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Management	Tuberculosis in children	- Crianças - Tratamento	23/07/2019 às 13:29
150	[ Indicador ] A fase de continuação do tratamento da tuberculose em crianças deve ser estendida se houver cavitação na radiografia de tórax inicial, culturas de escarro com resultado positivo após 2 meses de terapia, meningite tuberculosa ou tuberculose esquelética. [ Evidência ] Extend the continuation phase for patients with cavitation on initial chest radiograph and positive sputum cultures after 2 months of therapy, tuberculous meningitis, or skeletal tuberculosis. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Management	Tuberculosis in children	- Crianças - Tratamento	23/07/2019 às 13:31
151	[ Indicador ] São recomendados corticosteroides adjuvantes para todas as crianças com meningite tuberculosa e/ou acometimento das vias aéreas por linfadenopatia (linfonodos aumentados). Também podem ser considerados para crianças com doença pleural, pericárdica, abdominal ou miliar grave. [ Evidência ] Adjunctive corticosteroids are recommended for all children with tuberculous meningitis, airway impingement from lymphadenopathy, and can be considered for those with pleural, pericardial, abdominal, or severe miliary disease. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Management	Tuberculosis in children	- Crianças - Doença associada - Tratamento	23/07/2019 às 13:35
152	[ Indicador ] É recomendada terapia preventiva para crianças com infecção latente por tuberculose. Ela consiste em uso da isoniazida por 6 meses para crianças menores de 5 anos com contato próximo de pessoas com tuberculose, mas não apresentam a doença. [ Evidência ] both the World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend preventative therapy for children with latent tuberculosis infection (LTBI)(6, 8) WHO recommends isoniazid preventative therapy (10 mg/kg/day, maximum 300 mg/day) for 6 months to children aged < 5 years who are household or close contacts of people with tuberculosis but do not have active disease (WHO Strong recommendation, High-quality evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Crianças - Prevenção	23/07/2019 às 13:43
153	[ Indicador ] A terapia preventiva com isoniazida é considerada para todos os bebês e crianças com tuberculose latente que não tenham a doença ativa ou histórico de tratamento prévio para tuberculose. [ Evidência ] consider isoniazid preventative therapy for all infants and children with latent tuberculosis infection who have no evidence of active disease or history of previous tuberculosis treatment [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Bebês - Crianças - Prevenção	23/07/2019 às 13:45
154	[ Indicador ] A terapia preventiva deve ser iniciada em todas as crianças menores de 4 anos com imunidade diminuída que estão expostas a pacientes com tuberculose contagiosa, independentemente dos resultados dos testes de diagnóstico. [ Evidência ] initiate preventative therapy in all children < 4 years old with impaired immunity exposed to patients with contagious tuberculosis regardless of diagnostic testing results [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Bebês - Crianças - Prevenção	23/07/2019 às 13:48
155	[ Indicador ] A terapia preventiva para crianças com infecção latente por tuberculose inclui isoniazida durante 9 meses. Existem regimes alternativos com doses e durações diferentes de acordo com a idade da criança. Além disso, a rifampicina pode ser incluída para um regime de duração de 3 meses. Para crianças que foram iniciadas em terapia e não tiveram doença ativa, são considerados suficientes 2 meses de rifampicina e pirazinamida administrados como parte do regime de quatro medicamentos. Se a origem da infecção for tuberculose resistente à isoniazida, mas suscetível à rifampicina, deve ser administrada rifampicina diariamente por 4 meses (alguns especialistas recomendam 6 meses em crianças com maiores de 12 anos). [ Evidência ] regimens for children with latent tuberculosis infection isoniazid 10 mg/kg/day (maximum 300 mg/day) for 9 months preferred consider isoniazid 20-30 mg/kg/dose (maximum 900 mg/dose) twice weekly as directly observed therapy for 9 months if adherence to daily therapy cannot not assured alternative regimens isoniazid 15 mg/kg (maximum 900 mg) plus rifampin 300-900 mg weekly for 12 weeks may be used in children ≥ 12 years old can be considered in children < 12 years old if low likelihood of completion of other therapies (note regimen unstudied in this age group) should not be used in children < 2 years old isoniazid 10 mg/kg/day (maximum 300 mg/day) plus rifampin 10-15 mg/kg/day (maximum 600 mg) for 3 months for children who have been started on empiric therapy and subsequently found not to have active disease, 2 months of daily rifampin and pyrazinamide given as part of the empiric 4-drug regimen considered sufficient for treatment of LTBI if source of infection found to have isoniazid-resistant, rifampin- -susceptible tuberculosis, give rifampin daily for 4 months (some experts recommend 6 months in children < 12 years old) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Bebês - Crianças - Prevenção	23/07/2019 às 13:59
156	[ Indicador ] Crianças com teste cutâneo de tuberculina ou teste de liberação de interferon gama negativos devem ser retestadas 8 a 10 semanas após a última exposição à fonte da infecção. A terapia preventiva pode ser descontinuada em pacientes imunocompetentes que continuam com resultado negativo nos testes. O regime completo de tratamento preventivo deve ser continuado em pacientes imunocomprometidos nos quais a infecção latente não pêde ser excluída. [ Evidência ] retest children with negative tuberculin skin test (TST) or interferon gamma release assay (IGRA) 8-10 weeks after last exposure to source of infection therapy can be discontinued in immunocompetent patients who continue to have negative TST or IGRA continue full treatment regimen in patients with immunocompromised in whom LTBI cannot be excluded [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Crianças - Prevenção	23/07/2019 às 14:03
157	[ Indicador ] A rifapentina e a isoniazida diretamente observadas uma vez por semana durante 3 meses parecem tão eficazes quanto a isoniazida uma vez ao dia por 9 meses na prevenção da tuberculose em crianças com infecção latente. [ Evidência ] directly observed rifapentine plus isoniazid once weekly for 3 months appears as effective as isoniazid once daily for 9 months in preventing tuberculosis in children with LTBI (level 2 [mid-level] evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Crianças - Prevenção	23/07/2019 às 14:06
158	[ Indicador ] A rifampicina de 4 meses pode ser tão eficaz quanto a isoniazida de 9 meses em crianças com infecção latente por tuberculose. [ Evidência ] 4-month rifampin may be as effective as 9-month isoniazid in children with LTBI (level 2 [mid-level] evidence) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Prevention-of-active-disease	Tuberculosis in children	- Crianças - Prevenção	23/07/2019 às 14:09
159	[ Indicador ] Tuberculose em crianças raramente é contagiosa. Entretanto, crianças com características de tuberculose do tipo adulto podem ser potencialmente contagiosas, sendo as características clínicas: presença de tosse, tosse produtiva, drenagem da pele/lesão dos tecidos moles, falta de tratamento adequado para a tuberculose ou somente ter sido iniciado com medicação por curta duração e instrumentação de via aérea. As características radiográficas são: lesões cavitárias, envolvimento apical e laríngeo. Além disso, podem ser contagiosas se tiverem baciloscopia positiva. [ Evidência ] children with tuberculosis (TB) rarely contagious ( Tuberculosis (Edinb) 2011 Dec;91 Suppl 1:S11) children with features of adult-type TB may potentially be contagious, including clinical symptoms presence of cough productive cough draining skin/soft tissue lesion lack of appropriate treatment for TB, or only having been started on TB medications for short duration airway instrumentation radiographic features cavitary lesions apical involvement laryngeal involvement positive acid-fast sputum smear [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Isolation-of-children-with-active-tuberculosis	Tuberculosis in children	- Crianças - Transmissão	23/07/2019 às 14:16
160	[ Indicador ] Se a mãe ou contato doméstico tiver resultado positivo no teste cutâneo tuberculínico ou no ensaio de liberação de interferon gama, mas radiografia torácica estiver normal, as recomendações são: não é necessário separar a mãe do bebê; nenhuma avaliação especial ou terapia necessária para o bebê; outros familiares devem ser avaliados para tuberculose, pois o teste positivo pode representar um caso não reconhecido de tuberculose contagiosa; e mãe pode amamentar o bebê. [ Evidência ] if mother (or household contact) has positive tuberculin skin test or IGRA and normal chest x-ray(8) no separation of mother and infant required no special evaluation or therapy required for infant other household members should be evaluated for tuberculosis as positive test may represent unrecognized case of contagious tuberculosis mother can breastfeed infant [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis	Tuberculosis in children	- Amamentação - Bebês - Prevenção	23/07/2019 às 14:21
161	[ Indicador ] Se a mãe ou familiar apresentar sintomas clínicos ou resultados anormais no raio-X compatíveis com a tuberculose, as seguintes medidas devem ser tomadas: avaliar bebê por tuberculose congênita; separar a mãe ou familiar da criança até ser realizada uma avaliação completa; quando a criança receber isoniazida, a separação não é necessária, exceto se a mãe ou familiar tiver suspeita de infecção por tuberculose resistente a medicamentos ou tem baixa adesão à terapia e a terapia diretamente observada não é possível; mulheres com infecção suscetível a drogas que foram tratadas adequadamente por mais de 2 semanas podem amamentar. Se a tuberculose congênita for excluída, a isoniazida deve ser utilizada de 3 a 4 meses e o teste cutâneo realizado em seguida. Se o teste der negativo e a mãe ou familiar tiver boa adesão ao tratamento, a isoniazida pode ser interrompida. Se o teste der positivo, a tuberculose deve ser investigada novamente. Caso não seja detectada, a isoniazida deve ser continuada por 9 meses e a criança avaliada mensalmente durante o tratamento. [ Evidência ] if mother (or household contact) has clinical signs and symptoms or abnormal findings on x-ray consistent with tuberculosis disease(8) immediately report to local health department evaluate infant for congenital tuberculosis separate mother (or household contact) from infant until full evaluation can be done, and if tuberculosis suspected, until mother found not to have tuberculosis mother and child both receive appropriate therapy mother understands and is willing to adhere to infection-control measures once infant receives isoniazid, separation not required unless mother (or household contact) has suspected drug resistant tuberculosis infection has poor adherence to therapy and directly observed therapy not possible women with drug- -susceptible infection treated appropriately for ≥ 2 weeks may breastfeed if congenital tuberculosis excluded, give isoniazid for 3-4 months and perform skin test if skin test is positive reassess for tuberculosis disease if tuberculosis disease excluded, continue isoniazid for total of 9 months evaluate infants for signs of tuberculosis monthly during treatment if skin test is negative, and mother has good treatment adherence, discontinue isoniazid [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis	Tuberculosis in children	- Bebês - Crianças - Prevenção	23/07/2019 às 14:35
162	[ Indicador ] Se a mãe ou familiar tiver resultado positivo no teste cutâneo tuberculínico ou no ensaio de liberação de interferon gama e resultados anormais na radiografia torácica, mas nenhuma evidência de doença tuberculosa, as seguintes medidas devem ser tomadas: a criança pode ser considerada de baixo risco de doença e a separação não é necessária; a mãe deve ser tratada por infecção latente por tuberculose; outros familiares devem ser avaliados. [ Evidência ] if mother (or household contact) has positive skin test or IGRA and abnormal findings on chest x-ray but no evidence of tuberculosis disease(8) infant can be assumed to be at low risk of disease, and separation not necessary treat mother for latent tuberculosis infection evaluate other household members [ Referência ] http://www.dynamed.com/topics/dmp~AN~T908867#Management-of-infant-born-to-mother-with-tuberculosis	Tuberculosis in children	- Bebês - Crianças - Prevenção	23/07/2019 às 14:39
163	[ Indicador ] A linfadenite tuberculosa é a forma mais comum de tuberculose extra pulmonar, ocorrendo em cerca de 35% dos pacientes com tuberculose extra pulmonar. Linfadenite tuberculosa pode ocorrer na presença de doença em outros locais anatômicos. [ Evidência ] Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis (TB), occurring in about 35% of patients with extrapulmonary TB. Tuberculous lymphadenitis may occur in the presence of disease in other anatomical sites. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901422#Background	Tuberculous lymphadenitis	- Definição - Doença associada	23/07/2019 às 14:42
164	[ Indicador ] Os fatores de risco para tuberculose linfadenite incluem sexo feminino, pico de idade de 30 a 40 anos, residência em países endêmicos, particularmente no sudeste da Ásia e na África, e imuno comprometimento, incluindo a infecção pelo HIV. [ Evidência ] Risk factors include female sex, peak age 30-40 years, residence in endemic countries, particularly in Southeast Asia and Africa, and immunocompromise, including HIV infection. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901422#Background	Tuberculous lymphadenitis	- Fator de risco - HIV - Sexo	23/07/2019 às 14:43
165	[ Indicador ] O diagnóstico definitivo da tuberculose linfadenite é feito pela cultura ou identificação molecular da micobactéria da tuberculose no tecido de um linfonodo afetado. O método preferido para coletar amostrar para biópsia é a punção aspirativa por agulha fina, pois é mais seguro e menos invasivo que a biópsia excisional. Contudo, os diagnósticos comumente usados incluem teste microbiológico, citologia e testes de amplificação de ácidos nucleicos. A radiografia de tórax deve ser realizada para determinar a presença de tuberculose pulmonar. [ Evidência ] Definitive diagnosis is made by culture or molecular identification of Mycobacterium tuberculosis in tissue from an affected lymph node. Fine needle aspiration is the preferred method of collecting biopsy samples, as it is safer and less invasive than excisional biopsy. Commonly used diagnostics include: microbiologic testing cytology nucleic acid amplification tests Chest x-ray should be performed to determine the presence of pulmonary tuberculosis. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901422#Evaluation	Tuberculous lymphadenitis	- Diagnóstico	23/07/2019 às 14:46
166	[ Indicador ] A duração total do tratamento da tuberculose linfadenite é de 6 meses. A fase inicial é de 2 meses e inclui isoniazida, rifampicina, pirazinamida e etambutol. A fase de continuação é de 4 meses e inclui isoniazida e rifampicina. [ Evidência ] Treatment recommendations derived from the American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America (ATS/CDC/IDSA) and World Health Organization (WHO) (Strong recommendation): The total length of therapy is 6 months. The 2-month initial phase includes: isoniazid orally, IV, or intramuscularly 5 mg/kg/day (maximum 300 mg/day, 10 mg/kg/day in children) rifampin orally or IV 10 mg/kg/day (maximum 600 mg/day, 15 mg/kg/day in children) pyrazinamide orally 25 mg/kg/day (maximum 2 g/day, 15-30 mg/kg/day in children) ethambutol orally 15 mg/kg/day (maximum 1.6 g/day, 20 mg/kg/day in children) The 4-month continuation phase includes: isoniazid orally, IV, or intramuscularly 5 mg/kg/day (maximum 300 mg/day, 10 mg/kg/day in children) rifampin orally or IV 10 mg/kg/day (maximum 600 mg/day, 15 mg/kg/day in children) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901422#Management	Tuberculous lymphadenitis	- Tratamento	23/07/2019 às 14:48
167	[ Indicador ] A excisão (extração) dos linfonodos afetados é geralmente reservada para casos incomuns ou falha do tratamento. [ Evidência ] Excision of affected lymph nodes is generally reserved for unusual cases or treatment failure. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901422#Management	Tuberculous lymphadenitis	- Tratamento	23/07/2019 às 14:50
168	[ Indicador ] Durante o tratamento, deve ser feito monitoramento de toxicidades de drogas, reação de melhoria paradoxal e síndrome inflamatória de reconstituição imune. [ Evidência ] During treatment, monitor for drug toxicities, a paradoxical upgrading reaction, and immune reconstitution inflammatory syndrome [ Referência ] http://www.dynamed.com/topics/dmp~AN~T901422#Management	Tuberculous lymphadenitis	- Tratamento	23/07/2019 às 14:51
169	[ Indicador ] A meningite tuberculosa (também denominada tuberculose meníngea) é causada pela infecção do sistema nervoso central. É a forma mais grave de tuberculose, com alta morbidade e mortalidade, e complicações neurológicas são comuns quando o diagnóstico ou o tratamento são tardios. [ Evidência ] Tuberculous meningitis (also called meningeal tuberculosis) is caused by infection of the central nervous system with Mycobacterium tuberculosis. It is the most severe form of tuberculosis, with high morbidity and mortality, and neurologic complications are common with delayed diagnosis or treatment. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Background	Tuberculous meningitis	- Definição	23/07/2019 às 14:57
170	[ Indicador ] As populações com maior risco de contrair meningite tuberculosa incluem crianças e pessoas com infecção pelo HIV. [ Evidência ] Those at highest risk for tuberculous meningitis include children and persons with HIV infection. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Background	Tuberculous meningitis	- Crianças - Fator de risco - HIV	23/07/2019 às 14:58
171	[ Indicador ] A propagação da tuberculose para o sistema nervoso central ocorre pela disseminação hematogênica (corrente sanguínea) de organismos para o cérebro. [ Evidência ] Spread to the central nervous system occurs by hematogenous dissemination of organisms to the brain. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Background	Tuberculous meningitis	- Transmissão	23/07/2019 às 14:59
172	[ Indicador ] A meningite tuberculosa é difícil de diagnosticar e requer muita suspeita. A apresentação clínica inicial pode ser inespecífica e semelhante a outros tipos de meningite. O diagnóstico deve ser considerado quando um paciente apresentar sinais e sintomas consistentes combinados com fatores de risco para tuberculose. [ Evidência ] Tuberculous meningitis is difficult to diagnose and a high index of suspicion is required. Diagnosis should be considered when a patient presents with consistent signs and symptoms combined with risk factors for tuberculosis (TB). Early clinical presentation may be nonspecific, and similar to other types of meningitis. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Diagnóstico - Sintomas	23/07/2019 às 15:02
173	[ Indicador ] Os sintomas da tuberculose meníngea em crianças podem incluir irritação meníngea, baixo ganho de peso ou perda de peso, consciência alterada e febre. Frequentemente, os sintomas se apresentam dentro de 3 meses da tuberculose pulmonar primária. A tuberculose meníngea está intimamente associada à tuberculose disseminada (miliar), com progressão mais rápida dos sintomas e complicações neurológicas em comparação aos adultos. [ Evidência ] Symptoms in children may include meningeal irritation, poor weight gain or weight loss, altered consciousness, and fever. It often presents within 3 months of primary pulmonary TB. It is closely associated with disseminated TB with more rapid progression of symptoms and neurological complications compared to adults. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Crianças - Sintomas	23/07/2019 às 15:04
174	[ Indicador ] Os sintomas da tuberculose meníngea em adultos incluem rigidez do pescoço, dor de cabeça, febre e vômitos. [ Evidência ] Symptoms in adults include stiff neck, headache, fever, and vomiting. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Sintomas	23/07/2019 às 15:05
175	[ Indicador ] Cerca de um terço dos pacientes com meningite tuberculosa têm neuropatias cranianas com acometimento do sexto nervo mais comum. [ Evidência ] About one-third of patients with tuberculous meningitis have cranial neuropathies, with involvement of the sixth nerve most common. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Sintomas	23/07/2019 às 15:06
176	[ Indicador ] Pacientes com HIV tipicamente apresentam uma apresentação clínica semelhante de meningite tuberculosa em pacientes sem HIV. [ Evidência ] Patients with HIV typically have a similar clinical presentation of tuberculous meningitis as patients without HIV. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- HIV - Sintomas	23/07/2019 às 15:07
177	[ Indicador ] Para realização do diagnóstico da tuberculose meníngea, um exame neurológico cuidadoso deve ser realizado em busca de défices motores, paralisias de nervos cranianos e fotofobia. O diagnóstico é tipicamente baseado na detecção de micobactérias no líquido cefalorraquidiano por microscopia, cultura de micobactérias ou um teste de amplificação de ácido nucleico. Anormalidades nas imagens podem incluir realce da cisterna basal, alargamento do espaço subaracnoideo, hidrocefalia, alterações nos nervos cranianos e anormalidades na radiografia de tórax. [ Evidência ] A careful neurologic exam should be performed looking for motor deficits, cranial nerve palsies, and photophobia. Diagnosis is typically based on detection of mycobacteria in cerebrospinal fluid (CSF) by smear microscopy, mycobacterial culture, or a nucleic acid amplification test. Abnormalities on imaging may include basal cistern enhancement, widening of subarachnoid space, hydrocephalus, changes to cranial nerves, and abnormalities on chest x-ray. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Evaluation	Tuberculous meningitis	- Diagnóstico	23/07/2019 às 15:10
178	[ Indicador ] O tratamento imediato para tuberculose meníngea é muito importante. Devido à natureza da doença, ao tempo necessário para os resultados da cultura e à morbidade e mortalidade, o tratamento inicial é necessário na maioria dos casos. [ Evidência ] Prompt treatment is very important. Because of the paucibacillary nature of tuberculous meningitis, time required for culture results, and morbidity and mortality that may delay treatment of tuberculous meningitis, initial empiric treatment is necessary in most instances. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Management	Tuberculous meningitis	- Tratamento	23/07/2019 às 15:17
179	[ Indicador ] O tratamento da tuberculose meníngea baseia-se no regime anti tuberculose padrão, mas com uma fase de continuação mais longa: fase inicial com isoniazida, rifampicina, pirazinamida e etambutol por 2 meses; fase de continuação com isoniazida mais rifampicina por 7 a 10 meses. [ Evidência ] Treatment is based on the standard antituberculosis regimen but with a longer continuation phase, including: initiation phase of isoniazid, rifampin, pyrazinamide, ethambutol for 2 months (Strong recommendation) continuation phase of isoniazid plus rifampin for 7-10 months (Weak recommendation) [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Management	Tuberculous meningitis	- Tratamento	23/07/2019 às 15:18
180	[ Indicador ] Embora seu papel permaneça controverso, os corticosteroides adjuvantes são fortemente recomendados no contexto da meningite tuberculosa. [ Evidência ] Although their role remains controversial, adjunctive corticosteroids are recommended in the context of tuberculous meningitis (Strong recommendation). [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Management	Tuberculous meningitis	- Tratamento	23/07/2019 às 15:19
181	[ Indicador ] Para a tuberculose meníngea, a cirurgia pode ser indicada em pacientes com hidrocefalia, abscesso cerebral tuberculoso ou tuberculose vertebral com paraparesia. [ Evidência ] Surgery may be indicated in patients with hydrocephalus, tuberculous cerebral abscess, or vertebral tuberculosis with paraparesis. [ Referência ] http://www.dynamed.com/topics/dmp~AN~T114554#Management	Tuberculous meningitis	- Tratamento	23/07/2019 às 15:20

Centro Brasileiro de Estudos de Saúde Av. Brasil, 4036, sala 802, 21040-361 Rio de Janeiro - RJ Brasil, Tel. 55 21-3882-9140, Fax.55 21-2260-3782 - Rio de Janeiro - RJ - Brazil
E-mail: revista@saudeemdebate.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Conflict of interests: non-existent