Don’t miss the signs of tuberculosis

Tuberculosis (TB) diagnosis is often delayed because it is uncommon and usually subacute in presentation. This can result in a more severe illness and a greater risk of transmission.

In Australia, 90 per cent of TB cases are found in people who were born overseas in a country where TB is common. More than 50 per cent of cases diagnosed arrived in Australia in the last five years. Most patients are young adults who are not especially unwell. Symptoms of pulmonary TB (representing less than 60 per cent of all cases) include a chronic cough that has lasted for more than three weeks. Sputum production is often not prominent, and haemoptysis is a late symptom.  Cough may be accompanied by night sweats, fatigue and unexplained weight/appetite loss. Cervical lymphadenopathy is the second most common presentation of TB.

If you suspect active pulmonary TB, collect sputum for acid fast bacilli (AFB) smear and culture. Order a chest X-ray, as a normal chest X-ray is unlikely in TB. If you suspect extra-pulmonary TB, send relevant microbiological specimens for AFBs.

Do not use Quantiferon TB Gold Plus (blood test) as a diagnostic test in a patient with TB symptoms as this is not a test for the diagnosis of active TB disease. It detects an immune response to TB, which can indicate latent TB infection.

TB is a notifiable disease. Information about these, including a link to the required form, is available on the “Notifiable Communicable Diseases and Related Conditions” HealthPathway.  If you do suspect or diagnose TB in your patient, contact the Western Australian Tuberculosis Control Program (WATBCP) for advice and support on (08) 9222 8500 or by emailing ACCADMIN@health.wa.gov.au

TB patients can be referred to WATBCP to confirm diagnosis, and for treatment and case management. Any tests, consultations and medications are provided at no cost to the patient. For more information, visit https://ww2.health.wa.gov.au/Articles/S_T/Tuberculosis

 

Maree Hose, Clinical Nurse Manager, Public Health, North Metropolitan Health Service

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