Tuberculosis

Tuberculosis

Practical guide for clinicians, nurses, laboratory technicians and medical auxiliaries

© Médecins Sans Frontières, 2017

All rights reserved for all countries. No reproduction, translation and adaptation may be done without the prior permission of the Copyright owner.

Médecins Sans Frontières and Partners in Health. Tuberculosis: Practical guide for clinicians, nurses, laboratory technicians and medical auxiliaries. 2017 Edition.
ISBN 978-2-37585-018-3

Table of contents

• Authors/Contributors
• Introduction
• Abbreviations and acronyms
• Chapter 1: Introduction and epidemiology
  • 1.1 Characteristics of Mycobacterium tuberculosis bacillus
  • 1.2 Transmission
  • 1.3 Evolution of TB infection and disease in humans
  • 1.4 Prognosis
  • 1.5 Factors modifying TB epidemiology
  • 1.6 Epidemiological indicators
  • 1.7 Estimation of the burden of TB worldwide
  • 1.8 Drug-resistant TB worldwide
  • References Chapter 1
• Chapter 2: Clinical presentation
  • 2.1 Pulmonary tuberculosis (PTB)
  • 2.2 Extrapulmonary tuberculosis (EPTB)
  • 2.3 Disseminated or miliary tuberculosis
  • 2.4 Clinical presentation in HIV-infected patients
  • 2.5 Summary of clinical presentations of tuberculosis
  • References Chapter 2
• Chapter 3: Diagnostic investigations
  • 3.1 Sputum smear microscopy
  • 3.2 Culture
  • 3.3 Phenotypic drug susceptibility tests (DST)
  • 3.4 Molecular techniques
  • 3.5 Summary of bacteriological examinations
  • 3.6 Indications for DST
  • 3.7 Radiology
  • 3.8 Tuberculin skin test (TST)
  • 3.9 Interferon gamma release assays (IGRAs)
  • 3.10 Biopsies, laboratory tests on body fluids and other biological tests
  • References Chapter 3
• Chapter 4: Diagnostic algorithms for pulmonary tuberculosis (PTB) in adults and adolescents
  • 4.1 Guiding principles for the use of the algorithms
  • 4.2 Adult and adolescent algorithms
  • References Chapter 4
• Chapter 5: Diagnosis of tuberculosis in children
  • 5.1 Background
  • 5.2 Characteristics of tuberculosis in children
  • 5.3 Diagnostic approach
  • 5.4 Key elements of the diagnosis
  • 5.5 Collecting sputum specimens in children
  • 5.6 Paediatric diagnostic algorithms
  • References Chapter 5
• Chapter 6: Intensive case finding in HIV-infected individuals
  • 6.1 Routine screening
  • 6.2 Purposes of screening
  • References Chapter 6
• Chapter 7: Case definitions for registration
  • 7.1 Definition of a tuberculosis case
  • 7.2 History of prior anti-TB treatment
  • 7.3 Anatomical site of the disease
  • 7.4 Bacteriological status
  • 7.5 HIV status
  • 7.6 Other co-morbidities
  • 7.7 Summary of patient registration
  • References Chapter 7
• Chapter 8: Anti-TB drugs and treatment regimens
  • 8.1 Introduction
  • 8.2 Anti-TB drug formulations
  • 8.3 Quality-assured anti-TB drugs
  • 8.4 Dosing of anti-TB drugs
  • 8.5 Cross resistance
  • References Chapter 8
• Chapter 9: Treatment of drug-susceptible tuberculosis
  • 9.1 Standard first-line treatment regimens
  • 9.2 Special situations
  • 9.3 Adjunctive corticosteroid therapy
  • 9.4 Follow-up for patients treated with first-line regimens
  • 9.5 Management of adverse effects in patients on first-line regimens
  • 9.6 Management of treatment interruption in patients on first-line regimens
  • References Chapter 9
• Chapter 10: Treatment of multidrug-resistant TB (MDR-TB)
  • 10.1 Design of therapeutic regimens in MDR-TB
  • 10.2 Selection of anti-TB drugs in MDR-TB regimens
  • 10.3 Building a treatment regimen for MDR-TB
  • 10.4 Duration of MDR-TB regimens
  • 10.5 Follow-up for patients treated for MDR-TB
  • 10.6 Management of adverse effects in patients on second-line regimens
  • 10.7 Surgery as an adjunctive treatment measure
  • 10.8 Management of patients whose treatment failed and palliative care
  • 10.9 Special situations
  • 10.10 Treatment of extensively drug-resistant TB (XDR-TB)
  • References Chapter 10
• Chapter 11: Treatment of mono- and poly-drug resistant tuberculosis (PDR-TB)
  • 11.1 Treatment schemes
  • 11.2 Treatment algorithms for PDR-TB
  • References Chapter 11
• Chapter 12: Co-management and treatment of HIV in TB disease
  • 12.1 HIV testing and counselling for patients known or suspected to have TB
  • 12.2 Prophylaxis against opportunistic infections
  • 12.3 Anti-TB regimens in HIV patients
  • 12.4 Concomitant treatment TB and HIV
  • 12.5 Drug interactions
  • 12.6 Overlapping toxicities with anti-TB drugs and antiretrovirals
  • 12.7 Immune reconstitution inflammatory syndrome (IRIS)
  • 12.8 HIV-infected children with TB
  • 12.9 HIV-infected pregnant women with TB
  • 12.10 HIV-infected patients with DR-TB
  • References Chapter 12
• Chapter 13: Adherence to treatment
  • 13.1 Treatment delivery and accompaniment
  • 13.2 Factors that influence adherence
  • 13.3 Patient support
  • 13.4 Additional patient support for patients on DR-TB treatment
  • References Chapter 13
• Chapter 14: Tuberculosis infection control
  • 14.1 Introduction
  • 14.2 Implementation of TB IC strategies
  • 14.3 Administrative controls
  • 14.4 Environmental controls
  • 14.5 Personal protective measures
  • 14.6 Hospital hygiene
  • 14.7 Patients’ homes
  • References Chapter 14
• Chapter 15: Follow-up of staff exposed to tuberculosis
  • 15.1 Initial assessment
  • 15.2 BCG vaccination
  • 15.3 Follow-up
  • References Chapter 15
• Chapter 16: Chemoprophylaxis
  • 16.1 Isoniazid preventive therapy (IPT)
  • 16.2 Benefit and limitations of IPT
  • 16.3 IPT in children
  • 16.4 IPT in HIV-infected individuals
  • 16.5 Chemoprophylaxis and drug-resistant tuberculosis
  • References Chapter 16
• Chapter 17: Monitoring and evaluation
  • 17.1 Introduction
  • 17.2 Definitions of treatment outcomes
  • 17.3 Recording tools
  • 17.4 Reporting
  • 17.5 Programme assessment
  • References Chapter 17
• Appendices
  • Appendix 1. Sputum specimen: collection, storage and shipment
  • Appendix 2. Sputum smear process
  • Appendix 3. Xpert MTB/RIF
  • Appendix 4. Fine needle aspirate cytology (FNAC)
  • Appendix 5. Protein estimation
  • Appendix 6. Adenosine desaminase assay (ADA)
  • Appendix 7. Ventilated work station (VWS) and bio-safety cabinet (BSC)
  • Appendix 8. Daily dose of anti-TB drugs using FDCs
  • Appendix 9. Anti-TB drug sheets and patient instructions
  • Appendix 10. Management of common adverse effects in adults on DR-TB regimens
  • Appendix 11. Compassionate use
  • Appendix 12. Dose adjustments in renal insufficiency
  • Appendix 13. Potential overlapping toxicities of ARVs and anti-TB drugs
  • Appendix 14. Informing the patient
  • Appendix 15. Treatment supporters for patients under second line therapy
  • Appendix 16. Basic TB infection control risk assessment tool
  • Appendix 17. Air change per hour (ACH) measurement recommendations
  • Appendix 18. Advantages and disadvantages of ventilation techniques
  • Appendix 19. Upper room ultraviolet germicidal irradiation (UVGI) system
  • Appendix 20. Respirators
  • Appendix 21. Face or surgical masks
  • Appendix 22. BCG vaccine
  • Appendix 23. Treatment card for patients on first-line anti-TB therapy
  • Appendix 24. Tuberculosis register for patients on first-line anti-TB therapy
  • Appendix 25. Treatment card for patients on second-line anti-TB therapy
  • Appendix 26. Tuberculosis register for patients on second-line anti-TB therapy
  • Appendix 27. Request form for microscopy and Xpert MTB/RIF
  • Appendix 28. Request form for sputum culture, LPA and DST
  • Appendix 29. Sputum smear microscopy register
  • Appendix 30. Xpert MTB/RIF register
  • Appendix 31. Drug-o-gram
  • Appendix 32. Quaterly report
  • Appendix 33. Report on detection and enrolment of TB cases with rifampicin and multidrug-resistance
  • Appendix 34. Report of final outcomes of drug-resistant tuberculosis
  • Appendix 35. Check-list for the evaluation of a TB service
  • References Appendices
• Weight-based anti-TB drugs daily dosing in patients ≥ 30 kg
• In the same collection