Tuberculosis

The answer first

Tuberculosis is three clinical problems wearing one name, and almost every exam question and every hard ward decision is really asking which of the three you are dealing with ^[3]:

1. Infection or disease? A person with immune sensitisation to M. tuberculosis — a positive IGRA or tuberculin skin test — who has no symptoms, no radiological activity and no detectable organisms is latently infected: well, non-infectious, and a candidate for preventive therapy. The same person with a chronic cough, apical infiltrates and bacilli in sputum has active disease: infectious, notifiable, and needing four drugs. No blood test can tell these two states apart — only clinical assessment plus microbiology can ^{[3] [19]}.
2. Drug-susceptible or resistant? Every confirmed case starts with a molecular test that simultaneously detects M. tuberculosis and rifampicin resistance, because the regimen chosen on day one determines whether you cure the patient or amplify resistance ^{[6] [1]}.
3. Individual patient or public-health event? Active pulmonary TB obliges you to notify, isolate while infectious, and trace contacts. The consultation is not finished when the prescription is written ^[1].

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References23ShowHide

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2. [2]Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children Clin Infect Dis, 2017.PMID 28052967
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