J Korean Med Assoc.  2014 Jan;57(1):19-26. 10.5124/jkma.2014.57.1.19.

Diagnosis and treatment of pulmonary tuberculosis

• Ryu YJ

• KMID: 2194830
• DOI: http://doi.org/10.5124/jkma.2014.57.1.19

Abstract

Pulmonary tuberculosis is still serious, one of the great public health problems in Korea. Recently, the increase in the aged population, human immunodeficiency virus coinfection, and drug-resistant tuberculosis have reinforced the need for improved rapid diagnostics and better treatment strategies. The basic principles of care for persons with, or suspected of having, pulmonary tuberculosis are the same worldwide. The standard guidelines and recent advances in diagnosis and treatment are summarized in this article. Prompt, accurate diagnosis of pulmonary tuberculosis should be established using chest radiography, sputum microscopy, and culture in liquid and solid medium. The further evaluation of chest imaging, histopathological examination of biopsy samples, nucleic acid amplification tests, immunological evaluation, and new molecular diagnostic tests supplement earlier, improved diagnosis, especially in patients with smear-negative pulmonary tuberculosis. Standardized treatment regimens of proven efficacy should be used with appropriate patient education and treatment support. The response to treatment and the presence of side effects of antituberculosis drugs should be monitored regularly. In addition, essential public health responsibilities and public-private collaboration must be carried out for effective patient care and pulmonary tuberculosis control.

Keyword

Tuberculosis; pulmonary; Diagnosis; Therapeutics

MeSH Terms

Biopsy
Coinfection
Cooperative Behavior
Diagnosis*
HIV
Humans
Korea
Microscopy
Nucleic Acid Amplification Techniques
Pathology, Molecular
Patient Care
Patient Education as Topic
Public Health
Radiography
Sputum
Thorax
Tuberculosis
Tuberculosis, Multidrug-Resistant
Tuberculosis, Pulmonary*

Reference

1. Achkar JM, Sherpa T, Cohen HW, Holzman RS. Differences in clinical presentation among persons with pulmonary tuberculosis: a comparison of documented and undocumented foreign-born versus US-born persons. Clin Infect Dis. 2008; 47:1277–1283.

2. Brandli O. The clinical presentation of tuberculosis. Respiration. 1998; 65:97–105.

3. Park JS. Symptoms and factors associated with delayed diagnosis of pulmonary tuberculosis. Korean J Med. 2013; 84:221–228.

4. Kim HJ. Current status of tuberculosis in Korea. Korean J Med. 2012; 82:257–262.

5. World Health Organization. Early detection of tuberculosis: an overview of approaches, guidelines and tools [Internet]. Geneva: World Health Organization;2011. cited 2013 Dec 16. Available from: http://www.who.int/iris/handle/10665/70824.

6. Rathman G, Sillah J, Hill PC, Murray JF, Adegbola R, Corrah T, Lienhardt C, McAdam KP. Clinical and radiological presentation of 340 adults with smear-positive tuberculosis in The Gambia. Int J Tuberc Lung Dis. 2003; 7:942–947.

7. Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, Cunningham J, Urbanczik R, Perkins M, Aziz MA, Pai M. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis. 2006; 6:570–581.

8. Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med. 2000; 161(4 Pt 1):1376–1395.

9. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, Fujiwara P, Grzemska M, Hopewell PC, Iseman MD, Jasmer RM, Koppaka V, Menzies RI, O'Brien RJ, Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA. American Thoracic Society. Centers for Disease Control and Prevention and the Infectious Diseases Society. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003; 167:603–662.

10. Long R, Ellis E. Public Health Agency of Canada. Canada Lung Association. Canadian tuberculosis standards. 6th ed. Ottawa: Public Health Agency;2007.

11. British National Institute for Health and Clinical Excellence. Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London: NICE;2011.

12. Joint Committee for the Development of Korean Guidelines for Tuberculosis. Korea Centers for Disease Control and Prevention. Korean guidelines for tuberculosis. 1st ed. Cheongwon: Korea Centers for Disease Control and Prevention;2011.

13. Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, Cunningham J, Urbanczik R, Perkins M, Aziz MA, Pai M. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis. 2006; 6:570–581.

14. World Health Organization. Fluorescent light-emitting diode (LED) microscopy for diagnosis of tuberculosis policy [Internet]. Geneva: World Health Organization;2011. cited 2013 Dec 16. Available from: http://www.who.int/tb/publications/2011/led_microscopy_diagnosis_9789241501613/en/index.html.

15. Kanchana MV, Cheke D, Natyshak I, Connor B, Warner A, Martin T. Evaluation of the BACTEC MGIT 960 system for the recovery of mycobacteria. Diagn Microbiol Infect Dis. 2000; 37:31–36.

16. Greco S, Girardi E, Navarra A, Saltini C. Current evidence on diagnostic accuracy of commercially based nucleic acid amplification tests for the diagnosis of pulmonary tuberculosis. Thorax. 2006; 61:783–790.

17. Centers for Disease Control and Prevention (CDC). Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. MMWR Morb Mortal Wkly Rep. 2009; 58:7–10.

18. Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S, Krapp F, Allen J, Tahirli R, Blakemore R, Rustomjee R, Milovic A, Jones M, O'Brien SM, Persing DH, Ruesch-Gerdes S, Gotuzzo E, Rodrigues C, Alland D, Perkins MD. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010; 363:1005–1015.

19. World Health Organization. Policy statement: automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system [Internet]. Geneva: World Health Organization;2011. cited 2013 Dec 16. Available from: http://www.who.int/iris/handle/10665/44586.

20. Weyer K, Mirzayev F, Migliori GB, Van Gemert W, D'Ambrosio L, Zignol M, Floyd K, Centis R, Cirillo DM, Tortoli E, Gilpin C, de Dieu Iragena J, Falzon D, Raviglione M. Rapid molecular TB diagnosis: evidence, policy making and global implementation of Xpert MTB/RIF. Eur Respir J. 2013; 42:252–271.

21. Dewan PK, Grinsdale J, Kawamura LM. Low sensitivity of a whole-blood interferon-gamma release assay for detection of active tuberculosis. Clin Infect Dis. 2007; 44:69–73.

22. Tuberculosis Coalition for Technical Assistance. International Standards for Tuberculosis Care (ISTC). The Hague: Tuberculosis Coalition for Technical Assistance;2006.

23. Colebunders R, Bastian I. A review of the diagnosis and treatment of smear-negative pulmonary tuberculosis. Int J Tuberc Lung Dis. 2000; 4:97–107.

24. Siddiqi K, Lambert ML, Walley J. Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence. Lancet Infect Dis. 2003; 3:288–296.

25. Korea Centers for Disease Control and Prevention. Guidelines for the control of tuberculosis 2005. Seoul: Korea Centers for Disease Control and Prevention;2005.

26. World Health Organization. Guidelines for treatment of tuberculosis, fourth edition [Internet]. Geneva: World Health Organization;2010. cited 2013 Dec 16. Available from: http://www.who.int/tb/publications/2010/9789241547833/en/index.html.

27. Lee HS, Park KU, Park JO, Chang HE, Song J, Choe G. Rapid, sensitive, and specific detection of Mycobacterium tuberculosis complex by real-time PCR on paraffin-embedded human tissues. J Mol Diagn. 2011; 13:390–394.

28. Park JS, Kang YA, Kwon SY, Yoon HI, Chung JH, Lee CT, Lee JH. Nested PCR in lung tissue for diagnosis of pulmonary tuberculosis. Eur Respir J. 2010; 35:851–857.

29. Lee JJ, Chong PY, Lin CB, Hsu AH, Lee CC. High resolution chest CT in patients with pulmonary tuberculosis: characteristic findings before and after antituberculous therapy. Eur J Radiol. 2008; 67:100–104.