Tuberculosis is a bacterial infection spread through the air, usually affecting the lungs, and it can stay silent for years as latent infection before becoming active disease. Active lung TB is contagious, so early isolation and a full course of combined antibiotics are the keys to cure and to stopping spread.
Key symptoms
- Cough lasting more than 2 to 3 weeks, sometimes with blood
- Fever and drenching night sweats
- Weight loss and poor appetite
- Fatigue and chest pain
- Risk factors: HIV, recent migration from a high-burden country, incarceration, homelessness, close contact
What you find on exam
- Thin, tired patient with fever
- Often normal lung exam; sometimes crackles in the upper lobes
- Enlarged lymph nodes, mostly in the neck
- Oxygen saturation and signs of spread to other organs
Tests
- Chest X-ray: upper lobe infiltrates or cavities
- Three sputum samples for acid-fast smear, culture and nucleic acid amplification test
- Interferon gamma release assay or tuberculin skin test to detect infection
- HIV test, liver function tests at baseline
Treatment basics
- Airborne isolation in a negative pressure room; staff wear fitted N95 respirators
- Active TB: rifampin, isoniazid, pyrazinamide and ethambutol for 2 months, then rifampin and isoniazid
- Directly observed therapy and pyridoxine with isoniazid
- Latent TB: shorter regimens such as weekly isoniazid with rifapentine for 3 months
- Report to public health and trace contacts
Red flags
- Large amounts of coughed blood
- Confusion, headache or neck stiffness (TB meningitis)
- Jaundice or vomiting on treatment (drug liver injury)
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Related guides
Sources: CDC, Guideline for Isolation Precautions (2007) and PPE sequence; NCSBN 2026 NCLEX-RN Test Plan; NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.