Diagnosis

The diagnosis of tuberculosis can present a challenge to emergency physicians. In the past, physicians mainly considered the diagnosis when presented with a young or older patient with reactivation disease. With the increased incidence of tuberculosis and the appearance of multidrug-resistant strains, one must consider the diagnosis in anyone with respiratory complaints or any extrapulmonary symptoms. The variable clinical presentation along with the time required to culture the organism makes emergent diagnosis difficult. A heightened awareness of the disease along with potential new rapid diagnostic tests can ensure that these patients are not returned to the community without proper therapy.

All prehospital and emergency department personnel must be trained to suspect tuberculosis, institute appropriate precautions, and notify health care providers of their suspicions. Triage workers should ask appropriate questions to detect potential cases. Patients with suspected tuberculosis should be placed in separate waiting areas, wear surgical masks, and be instructed to cover the mouth and nose when coughing. Any immunocompromised patient with respiratory symptoms should be isolated until tuberculosis can be excluded. Prompt evaluation will ensure a minimal amount of time spent in the ambulatory care setting and a minimal risk of exposure to health care providers and other patients.13,14

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