Cough Due to TB and Other Chronic Infections

Publication Date: February 1, 2018
Last Updated: March 14, 2022

Recommendations

1. For patients with cough in high TB prevalence countries, particularly in high risk groups (eg, inmates, people living with HIV [PLWHIV], or close contacts of pulmonary TB), we suggest that individuals with cough be evaluated for pulmonary TB because of the implications of active pulmonary TB both to the individual and to public health are of great importance. (U-CBS)
Remarks: Evaluation for pulmonary TB should be undertaken even though most individuals with cough will not have pulmonary TB.
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2. For patients with cough in high TB prevalence countries or settings, we suggest that they be screened for TB regardless of cough duration. (2C)
Remarks: We found low-quality evidence that the prevalence of pulmonary TB was similar whether patients in such settings were screened after cough durations of ≥ 1, 2, 3, or 4 weeks.
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3. For patients with cough and at risk of pulmonary TB but at low risk of drug-resistant TB living in high TB prevalence countries, we suggest that XpertMTB/RIF testing, when available, replace sputum microscopy for initial diagnostic testing, but chest x-rays should also be done on pulmonary TB suspects when feasible and where resources allow. (U-CBS)
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4. For patients with cough suspected to have pulmonary TB and at high risk of drug-resistant TB (eg, those with a prior history of treatment for pulmonary TB, contacts of drug-resistant TB cases and/or living in countries with a high drug-resistant TB prevalence), we suggest that XpertMTB/RIF assay, where available, replace sputum microscopy but sputum mycobacterial cultures, drug susceptibility testing and chest x-rays should be performed when feasible and where resources allow. (U-CBS)
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5. For patients with cough with or without fever, night sweats, hemoptysis, and/or weight loss, and who are at risk of pulmonary TB in high TB prevalence countries, we suggest that they should have a chest x-ray if resources allow. (U-CBS)
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6. For PLWHIV with cough who also complain of fever, night sweats, hemoptysis, and/or weight loss (WHO-endorsed symptoms) and are at risk for TB, we suggest screening for pulmonary TB because the presence of these symptoms increases the likelihood that the affected individual has pulmonary TB. (2C)
Remarks: All of the included studies were limited to PLWHIV.
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7. For patients with cough in high TB prevalence populations, we suggest the addition of active case finding (ACF) to passive case finding (PCF) because it may improve outcomes in patients with pulmonary TB. (U-CBS)
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8. For patients with cough in high TB prevalence populations, we suggest the addition of ACF to PCF because it may reduce transmission. (U-CBS)
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9. For patients with cough suspected to have pulmonary TB, we suggest that available financial modeling algorithms be used to estimate costs associated with different screening strategies because cost-effectiveness studies have not yet been performed. (U-CBS)
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10. For patients with chronic cough in low income countries, we suggest that strategies for pulmonary TB diagnosis should focus on improved case detection rather than diagnostic testing. (U-CBS)
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Recommendation Grading

Overview

Title

Cough Due to TB and Other Chronic Infections

Authoring Organization

Publication Month/Year

February 1, 2018

Last Updated Month/Year

January 22, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Cough is common in pulmonary TB and other chronic respiratory infections. Identifying features that predict whether pulmonary TB is the cause would help target appropriate individuals for rapid and cost-effective screening, potentially limiting disease progression and preventing transmission to others.

Target Patient Population

Patients with cough due to TB or other respiratory infections

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Long term care, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D014376 - Tuberculosis, D003371 - Cough, D014397 - Tuberculosis, Pulmonary

Keywords

Mycobacterium tuberculosis, pulmonary infections, infections, cough

Methodology

Number of Source Documents
118
Literature Search Start Date
January 1, 1984
Literature Search End Date
March 1, 2017