Mycobacterium tuberculosis - Tuberculosis

Mycobacterium tuberculosis is the bacteria that causes tuberculosis (TB), an infection that usually affects the lungs and can be fatal without proper treatment. Nontuberculosis mycobacteria (NTM) can also be pathogenic agents in humans. Screening for latent TB involves either the interferon-gamma release assay or the tuberculin skin test (TST). Diagnostic tests for active infection include acid-fast bacilli (AFB) smear and nucleic acid amplification testing (NAAT), with culture providing definitive diagnosis.

Tabs Content

Clinical Overview

Diagnosis

TB

Indications for Testing

Cough, fever, weight loss, fatigue, night sweats, pain with breathing in at-risk patients

Laboratory Testing

CDC TB testing and diagnosis recommendations
- Diagnosing latent TB infection and TB disease
- Latent TB infection: a guide for primary healthcare providers
Concentrated AFB smear
- Traditional standard diagnosis method (sputum)
- Not as sensitive as culture – requires ~10⁴ bacilli/mL sputum for detection
Culture
- Culture provides definitive diagnosis
- Susceptibility testing is mandatory
- Most sensitive test for detection of mycobacteria – gold standard
- Slow – 2-8 weeks
- Should be performed on specimen from any site suspected for mycobacteria infection
NAAT
- Less sensitive than culture
Adenosine deaminase (ADA)
- Adjunctive test – use in evaluating suspected extrapulmonary TB involving body cavities or cerebrospinal fluid (CSF)
- Reported sensitivity and specificity vary
  - Meta-analysis derived summary receiver operator curves from pleural fluid – sensitivity 92%; specificity 92%
- Not specific for TB
- AFB culture should always be performed concurrently on fluid
Latent TB
- Refer to Screening section

Imaging Studies

Chest x-ray confirmation is required – may have been performed prior to TB testing

NTM (Atypical)

Indications for Testing

Clinical setting suspicious for disease

Laboratory Testing

Concentrated AFB smear
- Traditional standard screening method (sputum)
- Not as sensitive as culture – requires ~10⁴ bacilli/mL sputum for detection
- Not specific for atypical TB
Mycobacterial culture
- Most sensitive test for detection of mycobacteria – gold standard
- Slow – 2-8 weeks
- Should be performed on specimen from any site suspected for mycobacteria infection
- Positive culture from site of suspected disease required to make a diagnosis of disseminated disease
NAAT
- Emerging recommended method for rapid, sensitive, and specific detection of atypical TB
- Less sensitive than culture

Imaging Studies

Chest x-ray – cavities, frank parenchymal infiltrates (upper lobes more common), bronchiectasis, pulmonary nodules
- Does not distinguish between TB and NTM
Computed tomography (CT) – may give better global picture of disease present

Differential Diagnosis

Cavitary disease
- Actinomycosis, nocardiosis
- Staphylococcal disease
- Streptococcus pneumoniae
- Gram-negative pneumonia
- Anaerobic pneumonia
Miliary disease
- Mycoplasma pneumoniae
- Pneumocystis jirovecii
- Yeasts
  - Histoplasmosis
  - Coccidioides
  - Blastomyces
- Influenza virus
- Respiratory viruses
Constitutional disease
- Malnutrition
- HIV

Screening

Screen for latent TB in populations at increased risk (Infectious Diseases Society of America [IDSA], 2016; American Academy of Family Physicians [AAFP], 2016; Centers for Disease Control and Prevention [CDC], 2013; U.S. Preventive Services Task Force [USPSTF], 2016)
Interferon-gamma release assay (eg, QuantiFERON Gold)
- Recommended over TST in individuals 5 years and older and who have low or moderate risk of disease progression (IDSA, 2016)
- Should not be used in patients with active disease symptoms; test cannot differentiate latent TB from active infection
- Preferable for persons who have received a bacillus Calmette-Guérin (BCG) vaccination or persons who may be unlikely to return for TST interpretation
- May be used instead of purified protein derivative (PPD)
- Should not be used in children younger than 5 years
TST
- Targeted tuberculin testing for latent TB infection for foreign-born persons entering the U.S. within the past 5 years
- Should not be used in patients with active disease symptoms; test cannot differentiate latent TB from active infection
- False positives occur in patients previously vaccinated with BCG or exposed to NTM
- False negatives
  - Immunocompromised state
  - Severe illness
- Requires patients return 48-72 hours after administration of test for interpretation of results

Monitoring

Sputum culture
- Follow-up treatment with repeat cultures of sputum
- Positive 3-month cultures may be predictive of relapse

Background

TB

Epidemiology

Incidence and prevalence
- ~3/100,000 reported in the U.S. (CDC, 2014)
- 8-9 million new cases annually worldwide
  - 3-4 million cases are infectious pulmonary disease (smear positive)
Age – incidence increases with age; peak is 35-44 years in the U.S.
Sex
- <25 years – M:F, equal
- >25 years – M>F, 1.5-2:1
Ethnicity – in U.S., more frequent in foreign-born individuals

Organism

Mycobacterium is a genus of the order Actinomycetales (Mycobacteriaceae family)
M. tuberculosis – rod-shaped aerobic bacterium with acid-fast staining properties
M. tuberculosis complex (MTB) – transmission via inhaled droplet nuclei
- Includes M. tuberculosis, M. bovis, M. africanum, M. microti, and others

Risk Factors

Risk of infection (greatest risk)
- Homeless, shelter dwelling
- Incarceration
- Alcoholism, intravenous drug abuse
- Military (foreign deployment)
- Foreign born
- Immunocompromised (eg, HIV, transplant drugs, chemotherapy, chronic steroid treatment)
Risk of developing active disease once infected
- Comorbidity present (eg, HIV, immunosuppression, chronic renal failure, diabetes mellitus)
- Recent tuberculosis infection (<1 year)
- Malnutrition, alcoholism
- Fibrotic lesions present on chest x-ray

Clinical Presentation

Primary disease
- Ranges from mild, self-limited illness to severe disseminated disease
Postprimary disease
- Reactivation of latent infection
- Moderate to severe; progressive and often fatal
Extrapulmonary TB
- Gastrointestinal disease
- Genitourinary
- Lymphadenitis
- Meningitis, central nervous system (CNS) tuberculoma
- Miliary
- Pericarditis
- Pleural disease
- Skeletal (Pott disease)
TB in patients with HIV
- Extrapulmonary disease is common
- Atypical chest x-ray findings
- Delays in diagnosis and treatment are common
- Increased risk of latent disease reactivation or rapid progression of newly acquired infection

NTM (Atypical)

Epidemiology

Age – usually isolated
Transmission routes vary – cutaneous, inhalation, parenteral routes
- Organisms are widely distributed in water and soil and by animals; person-to-person transmission has not been reported

Organisms

Free-living organisms; more than 125 species of NTM
Nontuberculous organisms
- M. avium complex, M. kansasii, M. fortuitum, M. abscessus, M. chelonae, M. marinum, M. haemophilum
Rare new organisms
- M. nebraskense, M. parmense, M. saskatchewanense, M. arupense, M. caprae, M. colombiense, M. florentium, M. montefiorense
Pathogenicity and clinical significance vary with species and host; asymptomatic infections are common

Clinical Presentation

Cutaneous – M. fortuitum, M. abscessus, M. chelonae, M. marinum, M. haemophilum
- Nodular or ulcerating chronic lesions that fail to respond to standard antimicrobial therapy
- Lymphadenitis - M. avium complex, especially in children
Pulmonary – M. avium complex, M. kansasii, M. abscessus
- Chronic cough usually present
- Immunocompromised hosts
- Increased in elderly and patients with underlying pulmonary disease
- Bronchiectatic, nodular, or cavitary disease
Disseminated
- Weight loss, fever, fatigue, lymphadenopathy, hepatosplenomegaly, gastrointestinal complaints
- Usually immunocompromised patients (advanced HIV, transplant)
Other (in-dwelling catheters, skeletal)

Pediatrics

Epidemiology

High-incidence countries where children have contact with TB-positive adults – 30-40% risk for TB in child

Clinical Presentation

Much higher rate of progression to active disease
Cough typical in infants; fever common in adolescents
25-35% have extrapulmonary presentation
- Three typical forms
  - Cervical adenitis
  - Miliary disease – most common in <2-3 years or immunocompromised
  - CNS disease – meningitis typically develops 3-6 months after primary infection; 50% are <2 years
- Risk highest in infants, adolescents, immunocompromised children
Reactivation disease most common in adolescents
Congenital
- Infants born to mothers who have disseminated disease
- Failure to thrive in first 3 months (most common symptom)
- Other – hepatomegaly, peripheral lymphadenopathy, respiratory distress

Indications for Testing

Clinical suspicion for disease

Laboratory Testing

Concentrated AFB smear
- Not as sensitive as culture; positive in 10-15%
- Difficult to obtain sputum in children; may need to use early morning gastric aspiration
Culture
- Yield positive in 20-30%
- Best specimen is early morning gastric aspirate
- Gastric lavage has better yield than pulmonary lavage – three samples best on sequential mornings
  - Requires hospitalization and fasting
- Single hypertonic saline-induced sputum specimen may produce some bacteriologic yield as gastric aspirate
- Highest yield in cavitary disease
NAAT – may be useful if AFB smear is negative and there is clinical suspicion of TB
QuantiFERON Gold
- Unable to distinguish between active and latent disease
- Better than TST
- Cannot be used in children <5 years (highest yield of indeterminate results)
TST
- Test of choice in children <5 years
- Rarely positive in congenital disease

Imaging Studies

Chest x-ray
- Enlarged perihilar and peritracheal nodes most common in children <5 years
- Effusions unusual in children 3-5 years
- Adult disease at age 8-10 years with apical segment involvement

Differential Diagnosis

Pneumonia – bacterial, viral
Malnutrition
HIV

ARUP Lab Tests

Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Acid-Fast Bacillus (AFB) Culture and AFB Stain 0060152
Method: Stain/Culture/Identification/Susceptibility

Recommended Use

Gold standard test for diagnosing the presence of mycobacteria organisms

Specimen from any suspected site, including sputum, CSF, tissue, urine, and other body fluid or gastric aspirate

Susceptibility will be performed on organisms isolated from a sterile source and isolates of M. chelonae, M. abscesses, M. fortuitum complex, M. immunogenum, M. mucogenicum; susceptibility testing will be performed by request only on M. kansaii and M. marinum; susceptibility testing of M. gordonae is inappropriate

For drug susceptibilities, refer to antimicrobial susceptibility, AFB/mycobacteria test

Limitations

Mycobacteria are slow growing organisms; culture requires several weeks

Mycobacterium tuberculosis Complex Detection and Rifampin Resistance by PCR 2010775
Method: Qualitative Polymerase Chain Reaction

Recommended Use

Panel includes polymerase chain reaction (PCR) testing to detect M. tuberculosis isolates and determine possible resistance to rifampin treatment

Test may be ordered for client-processed specimens; refer to specimen requirements

QuantiFERON-TB Gold Plus, 1-Tube 3000400
Method: Cell Culture/Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Recommended Use

Aid in the detection of latent disease among persons at increased risk for TB

Positive predictive value is less in low-risk populations

Test may be used in persons who have received BCG vaccine

QuantiFERON-TB Gold Plus, 4-Tube 3000399
Method: Cell Culture/Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Recommended Use

Aid in the detection of latent disease among persons at increased risk for TB

Positive predictive value is less in low-risk populations

Test may be used in persons who have received BCG vaccine

Acid-Fast Bacillus (AFB) Identification 0060999
Method: Identification. Methods may include biochemical, mass spectrometry, nucleic acid probe, polymerase chain reaction, or sequencing.

Recommended Use

Identify mycobacterial isolates, including requests for speciation within the M. tuberculosis complex

Acid-Fast Bacillus (AFB) Culture and AFB Stain with Reflex to Mycobacterium tuberculosis Complex Detection and Rifampin Resistance by PCR 0060738
Method: Stain/Culture

Recommended Use

Comprehensive panel includes AFB culture and stain

Positive smears reflex to PCR amplification of MTBC species and rifampin resistance

Limitations

Available for respiratory specimens only

Blood Culture, Acid-Fast Bacillus (AFB) 0060060
Method: Continuous Monitoring Blood Culture/Identification

Recommended Use

Order for AFB culture of blood or bone marrow specimen

Acid-Fast Bacillus (AFB) Identification with Reflex to Susceptibility 0060997
Method: Identification/Susceptibility. Methods may include biochemical, mass spectrometry, nucleic acid probe, polymerase chain reaction, or sequencing.

Recommended Use

Order for M. tuberculosis complex speciation and susceptibility testing

Reflex pattern – if a significant organism is identified, then appropriate susceptibility panel will be added

Limitations

Susceptibility testing may not be performed on all isolates (varies by species)

Antimicrobial Susceptibility, AFB/Mycobacteria 0060217
Method: Macrobroth Dilution/Microbroth Dilution

Recommended Use

Order for susceptibility of clinically significant isolates of M. tuberculosis complex, M. kansasii, M. avium-intracellulare complex, M. fortuitum complex, M. abscessus complex, M. chelonae, M. immunogenum, and any isolate from a significant source

Antimicrobial Susceptibility, AFB/Mycobacterium tuberculosis Primary Panel 0060347
Method: Broth Macrodilution

Recommended Use

Order when phenotypic drug susceptibility testing is required for M. tuberculosis treatment

For genotypic (DNA sequencing) resistance testing, refer to TB drug resistance by sequencing test

Mycobacterium tuberculosis Drug Resistance by Sequencing 2011713
Method: Polymerase Chain Reaction/Sequencing

Recommended Use

Order for rapid identification of mutations associated with drug resistance for M. tuberculosis treatment

For phenotypic drug susceptibility testing, refer to the antimicrobial susceptibility, AFB/TB primary panel

Medical Reviewers

Barker, Adam, PhD, Medical Director, Microbiology, Reagent Laboratory, and R&D Special Operations; Director, ARUP Institute for Clinical & Experimental Pathology®; Assistant Professor of Clinical Pathology, University of Utah

References

Guidelines

Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K, IGRA Expert Committee, Centers for Disease Control and Prevention (CDC). Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010. MMWR Recomm Rep. 2010; 59(RR-5): 1-25. PubMed
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. Am J Respir Crit Care Med. 2000; 161(4 Pt 1): 1376-95. PubMed
US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Bauman L, Davidson KW, Epling JW, Garcia FA, Herzstein J, Kemper AR, Krist AH, Kurth AE, Landefeld S, Mangione CM, Phillips WR, Phipps MG, Pignone MP. Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016; 316(9): 962-9. PubMed
Clinical Preventive Service Recommendation: Tuberculosis Infection, Asymptomatic Adults. American Academy of Family Physicians. [Accessed: Jun 2018]
Taylor Z, Nolan CM, Blumberg HM, American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America. Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR Recomm Rep. 2005; 54(RR-12): 1-81. PubMed
Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, Chaisson LH, Chaisson RE, Daley CL, Grzemska M, Higashi JM, Ho CS, Hopewell PC, Keshavjee SA, Lienhardt C, Menzies R, Merrifield C, Narita M, O'Brien R, Peloquin CA, Raftery A, Saukkonen J, Schaaf S, Sotgiu G, Starke JR, Migliori GB, Vernon A. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis. 2016; 63(7): e147-e195. PubMed

General References

Balasingham SV, Davidsen T, Szpinda I, Frye SA, Tønjum T. Molecular diagnostics in tuberculosis: basis and implications for therapy. Mol Diagn Ther. 2009; 13(3): 137-51. PubMed

Cruz AT, Starke JR. Pediatric tuberculosis. Pediatr Rev. 2010; 31(1): 13-25; quiz 25-6. PubMed

Deangelis TM, Miller A. Diagnosis of multiple sclerosis. Handb Clin Neurol. 2014; 122: 317-42. PubMed

Diel R, Goletti D, Ferrara G, Bothamley G, Cirillo D, Kampmann B, Lange C, Losi M, Markova R, Migliori GB, Nienhaus A, Ruhwald M, Wagner D, Zellweger JP, Huitric E, Sandgren A, Manissero D. Interferon-γ release assays for the diagnosis of latent Mycobacterium tuberculosis infection: a systematic review and meta-analysis. Eur Respir J. 2011; 37(1): 88-99. PubMed

El-Sadr WM, Tsiouris SJ. HIV-associated tuberculosis: diagnostic and treatment challenges. Semin Respir Crit Care Med. 2008; 29(5): 525-31. PubMed

Glassroth J. Pulmonary disease due to nontuberculous mycobacteria. Chest. 2008; 133(1): 243-51. PubMed

Kahwati LC, Feltner C, Halpern M, Woodell CL, Boland E, Amick HR, Weber RP, Jonas DE. Primary Care Screening and Treatment for Latent Tuberculosis Infection in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016; 316(9): 970-83. PubMed

Lawn SD. Diagnosis of pulmonary tuberculosis. Curr Opin Pulm Med. 2013; 19(3): 280-8. PubMed

Miranda C, Tomford W, Gordon SM. Interferon-gamma-release assays: Better than tuberculin skin testing? Cleve Clin J Med. 2010; 77(9): 606-11. PubMed

Schlossberg D. Acute tuberculosis. Infect Dis Clin North Am. 2010; 24(1): 139-46. PubMed

Shingadia D. The diagnosis of tuberculosis. Pediatr Infect Dis J. 2012; 31(3): 302-5. PubMed

Sia IG, Wieland ML. Current concepts in the management of tuberculosis. Mayo Clin Proc. 2011; 86(4): 348-61. PubMed

Zar HJ, Connell TG, Nicol M. Diagnosis of pulmonary tuberculosis in children: new advances. Expert Rev Anti Infect Ther. 2010; 8(3): 277-88. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology^®

Aldous WK, Pounder JI, Cloud JL, Woods GL. Comparison of six methods of extracting Mycobacterium tuberculosis DNA from processed sputum for testing by quantitative real-time PCR. J Clin Microbiol. 2005; 43(5): 2471-3. PubMed

Anderson BL, Welch RJ, Litwin CM. Assessment of three commercially available serologic assays for detection of antibodies to Mycobacterium tuberculosis and identification of active tuberculosis. Clin Vaccine Immunol. 2008; 15(11): 1644-9. PubMed

Cloud JL, Carroll KC, Cohen S, Anderson CM, Woods GL. Interpretive criteria for use of AccuProbe for identification of Mycobacterium avium complex directly from 7H9 broth cultures. J Clin Microbiol. 2005; 43(7): 3474-8. PubMed

Cloud JL, Hoggan K, Belousov E, Cohen S, Brown-Elliott BA, Mann L, Wilson R, Aldous W, Wallace RJ, Woods GL. Use of the MGB Eclipse system and SmartCycler PCR for differentiation of Mycobacterium chelonae and M. abscessus. J Clin Microbiol. 2005; 43(8): 4205-7. PubMed

Cloud JL, Meyer JJ, Pounder JI, Jost KC, Sweeney A, Carroll KC, Woods GL. Mycobacterium arupense sp. nov., a non-chromogenic bacterium isolated from clinical specimens. Int J Syst Evol Microbiol. 2006; 56(Pt 6): 1413-8. PubMed

Cloud JL, Neal H, Rosenberry R, Turenne CY, Jama M, Hillyard DR, Carroll KC. Identification of Mycobacterium spp. by using a commercial 16S ribosomal DNA sequencing kit and additional sequencing libraries. J Clin Microbiol. 2002; 40(2): 400-6. PubMed

Cloud JL, Shutt C, Aldous W, Woods G. Evaluation of a modified gen-probe amplified direct test for detection of Mycobacterium tuberculosis complex organisms in cerebrospinal fluid. J Clin Microbiol. 2004; 42(11): 5341-4. PubMed

Cooksey RC, de Waard JH, Yakrus MA, Toney SR, Da Mata O, Nowicki S, Sohner K, Koch E, Petti CA, Morey RE, Srinivasan A. Mycobacterium cosmeticum, Ohio and Venezuela. Emerg Infect Dis. 2007; 13(8): 1267-9. PubMed

Jazrawi A, Jones M, Kfoury AG, Fisher PW, Gilbert EM, Bader F, Pombo D, Hanson KE, Stehlik J. Tuberculosis in a solid-organ transplant recipient: modern-day implications. J Heart Lung Transplant. 2009; 28(2): 191-3. PubMed

Lozier BK, Haven TR, Astill ME, Hill HR. Detection of acetylcholine receptor modulating antibodies by flow cytometry. Am J Clin Pathol. 2015; 143(2): 186-92; quiz 305. PubMed

Lu J, Grenache DG. Development of a rapid, microplate-based kinetic assay for measuring adenosine deaminase activity in body fluids. Clin Chim Acta. 2012; 413(19-20): 1637-40. PubMed

Neal H, Cloud JL, Pounder JI, Page SR, Woods GL. Sequence variant for internal transcribed spacer region of Mycobacterium abscessus. J Clin Microbiol. 2005; 43(12): 6214. PubMed

Odell ID, Cloud JL, Seipp M, Wittwer CT. Rapid species identification within the Mycobacterium chelonae-abscessus group by high-resolution melting analysis of hsp65 PCR products. Am J Clin Pathol. 2005; 123(1): 96-101. PubMed

Pounder JI, Aldous WK, Woods GL. Comparison of real-time polymerase chain reaction using the Smart Cycler and the Gen-Probe amplified Mycobacterium tuberculosis direct test for detection of M. tuberculosis complex in clinical specimens. Diagn Microbiol Infect Dis. 2006; 54(3): 217-22. PubMed

Simmon KE, Low YY, Brown-Elliott BA, Wallace RJ, Petti CA. Phylogenetic analysis of Mycobacterium aurum and Mycobacterium neoaurum with redescription of M. aurum culture collection strains. Int J Syst Evol Microbiol. 2009; 59(Pt 6): 1371-5. PubMed

Simmon KE, Pounder JI, Greene JN, Walsh F, Anderson CM, Cohen S, Petti CA. Identification of an emerging pathogen, Mycobacterium massiliense, by rpoB sequencing of clinical isolates collected in the United States. J Clin Microbiol. 2007; 45(6): 1978-80. PubMed

Taggart EW, Hill HR, Ruegner RG, Litwin CM. Evaluation of an in vitro assay for interferon gamma production in response to the Mycobacterium tuberculosis-synthesized peptide antigens ESAT-6 and CFP-10 and the PPD skin test. Am J Clin Pathol. 2006; 125(3): 467-73. PubMed

Taggart EW, Hill HR, Ruegner RG, Martins TB, Litwin CM. Evaluation of an in vitro assay for gamma interferon production in response to Mycobacterium tuberculosis infections. Clin Diagn Lab Immunol. 2004; 11(6): 1089-93. PubMed

Wallace RJ, Brown-Elliott BA, Brown J, Steigerwalt AG, Hall L, Woods G, Cloud J, Mann L, Wilson R, Crist C, Jost KC, Byrer DE, Tang J, Cooper J, Stamenova E, Campbell B, Wolfe J, Turenne C. Polyphasic characterization reveals that the human pathogen Mycobacterium peregrinum type II belongs to the bovine pathogen species Mycobacterium senegalense. J Clin Microbiol. 2005; 43(12): 5925-35. PubMed

Last Update: August 2018


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	Mycobacterium tuberculosis - Tuberculosis. ARUP Consult^©. Retrieved October 15, 2018, from: https://arupconsult.com/content/mycobacterium-tuberculosis

Mycobacterium tuberculosis - Tuberculosis

Diagnosis

TB

Indications for Testing

Laboratory Testing

Imaging Studies

NTM (Atypical)

Indications for Testing

Laboratory Testing

Imaging Studies

Differential Diagnosis

Screening

Monitoring

Background

TB

Epidemiology

Organism

Risk Factors

Clinical Presentation

NTM (Atypical)

Epidemiology

Organisms

Clinical Presentation

Pediatrics

Epidemiology

Clinical Presentation

Indications for Testing

Laboratory Testing

Imaging Studies

Differential Diagnosis

ARUP Lab Tests

Medical Reviewers

References

Guidelines

General References

References from the ARUP Institute for Clinical and Experimental Pathology®

References from the ARUP Institute for Clinical and Experimental Pathology^®