4.1 Guiding principles for the use of the algorithms

The aim of algorithms is to assist the diagnostic process and minimize incorrect diagnosis. The following algorithms are for adults and adolescents. For diagnostic algorithms for children < 10 years, see Chapter 5.

4.1.1 Clinical assessment

See reference 1

– An assessment for danger signs is the first part of the clinical assessment. The adult or adolescent is classified as seriously ill if one or more of the following danger signs are present:
• Respiratory rate > 30/minute;
• Fever > 39°C;
• Pulse rate > 120/minute;
• Unable to walk unaided.

– In cases where there is no bacteriological confirmation of TB, the clinical (and radiological) assessment should determine if the patient needs broad-spectrum antibiotics and/or anti-TB drugs.

– HIV testing should be routinely offered to all individuals suspected of having TB. If testing is refused or unavailable, it might be assumed that a certain patient is likely to be HIVpositive (according to context and/or clinical presentation). In this event, follow the algorithm for HIV-infected patients.

4.1.2 Clinical response

For patients who are treated empirically for bacterial pneumonia or pneumocystosis (PCP), a “non-response to antibiotics” increases the likelihood of TB. The converse is not necessarily true, such that a response to antibiotics does not automatically exclude TB in a person suspected of having TB, particularly if respiratory symptoms persist after treatment. Pneumonia or PCP may occur in patients with underlying TB.

Antibiotic treatment is appropriate for HIV-infected patients with cough because bacterial infections are common both with and without TB. All seriously ill patients being started on anti-TB treatment should also be treated empirically, with broad-spectrum antibiotics for bacterial pneumonia because benefits outweigh the risks1.