Pulmonary and extrapulmonary tuberculosis — Rapid

Synopsis

Recognise tuberculosis across lung, lymph node, meninges, spine, pleura, pericardium and other organs; secure culture and resistance evidence; start site-specific multidrug and adjunctive treatment; and coordinate infection control, notification and completion through a specialist TB service.

Pulmonary TB creates transmission risk; extrapulmonary TB may present through lymph nodes, pleura, meninges, spine, abdomen, genitourinary tract, pericardium or disseminated organ disease.
Use epidemiology as probability, not a gate: exposure, residence in a high-incidence setting, immune suppression, homelessness, detention and previous treatment matter, but disease can occur without a disclosed classic risk.
For suspected pulmonary TB, NICE recommends multiple deep-cough sputum specimens for smear and culture, preferably three with one early-morning sample; add rapid molecular identification and resistance testing.

Key red flags

Potentially infectious pulmonary TB

Weeks of cough, weight loss, fever, night sweats or haemoptysis accompany upper-zone, nodular or cavitary change, especially with exposure or epidemiological risk.

Investigation priorities

Chest radiograph followed by targeted CTFirst step

Find pulmonary disease, cavitation, nodes, miliary spread and a safe route to sample.

Management branches

Pulmonary suspicionProtect, sample and report

Symptoms and imaging make pulmonary or laryngeal tuberculosis credible.

Place the patient in the locally approved airborne pathway, minimise unnecessary movement and involve infection prevention and the specialist TB team.
Send multiple respiratory samples for smear, molecular testing and culture plus baseline safety tests; begin treatment before culture when the clinical diagnosis is strong or illness is life threatening.

Key medicines

Rifampicin, isoniazid, pyrazinamide and ethambutol intensive phaseUse specialist daily weight bands approximating rifampicin 10 mg/kg, isoniazid 5 mg/kg, pyrazinamide 25 mg/kg and ethambutol 15 mg/kg for 2 months.

Rifampicin and isoniazid continuation phaseGive rifampicin 10 mg/kg up to 600 mg and isoniazid 5 mg/kg up to 300 mg orally once daily for the site-specific continuation period.

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