Tuberculosis: The Daily PANCE Blueprint

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Tuberculosis: The Daily PANCE Blueprint

A 41-year-old man who recently emigrated from a high-prevalence country presents with 6 weeks of productive cough, drenching night sweats, weight loss, and blood-streaked sputum. A chest radiograph shows a right upper-lobe cavitary infiltrate. Which of the following is the most appropriate initial diagnostic test?

A. Tuberculin skin test (PPD)
B. Chest CT
C. Bronchoscopy
D. Sputum acid-fast bacilli smear, culture, and nucleic acid amplification test
E. Interferon-gamma release assay (IGRA)

Answer and topic summary

The answer is D. Sputum acid-fast bacilli smear, culture, and nucleic acid amplification test.

Chronic cough, night sweats, weight loss, hemoptysis, and an upper-lobe cavitary lesion are classic active pulmonary tuberculosis. The initial test for suspected ACTIVE disease is sputum collection for acid-fast bacilli smear, mycobacterial culture (the gold standard), and a nucleic acid amplification test (which also gives rapid rifampin-resistance data). The PPD and IGRA detect infection/exposure (latent TB) and cannot distinguish active disease, and they may be falsely negative in active TB. Place the patient in an airborne-isolation room.

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Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ Mycobacterial Disease ⇒ Tuberculosis

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