For more information, consult the Canadian Tuberculosis Standards, 7th edition, Chapter 3.
Delays in diagnosis of respiratory TB are common. Respiratory TB is often treated as a more common lower respiratory tract infection multiple times before TB is ruled in. A high index of suspicion is important to diagnose TB disease among those who have an epidemiologic risk factor for TB that presents with symptoms consistent with TB disease. For such clients, always consider testing with sputum samples and chest radiology.
Clinical presentation
The classic symptom of pulmonary TB disease:
Epidemiologic risk factor
Client is from or has spent time with populations with higher rates of TB:
History and Physical
Chronic health conditions, such as the following, are additional risks for developing TB disease
The most common physical finding in respiratory TB is a totally normal examination, even in relatively advanced cases.
How to test for TB:
Tests:
Tuberculin skin test (TST) should not be used for diagnosing active TB disease in adults – it is used for latent TB infection (LTBI) screening
Sputum collection:
All sputum testing is performed by Diagnostic Services Manitoba (DSM). The link to the DSM requisition is below.
DSM requisition
DSM Manual:
Ideally, patients should have 3 consecutive sputum samples collected for AFB smears at least one hour apart each (but even one sputum sample is better than none).
An on-the-spot sample of sputum should be requested of symptomatic clients who are able to spontaneously expectorate, and should be collected using proper infection control precautions.
On-the-spot sputum collection can safely be done in the community setting using proper infection control airborne precautions. See Infection Prevention Control fact sheet: I.P. & C. Considerations for Tuberculosis in Clinic Settings on collecting sputum on the spot below
WRHA Infection Prevention and Control:
The client can be instructed on how to collect sputum at home and should be provided with collection containers, link to patient information on sputum collection. Clients should be made aware to keep all samples collected at home in the refrigerator until they bring them to the clinic or laboratory.
Instructions to clients:
Home Isolation for Tuberculosis (TB)
Fact Sheets:
Consultation and Referrals
If concernced that a client has respiratory TB, consult Adult Chest Medicine or Pediatric Infectious Diseases at HSC by calling HSC paging: 204-787-2071.
If concerned that a client has nonrespiratoryTB, consult Adult Chest Medicine or Pediatric Infectious Diseases at HSC by calling HSC paging: 204-787-2071.
Outside of the Winnipeg Health Region, health-care providers can consult HSC Paging as above or:
In or near Brandon:
Infectious Diseases on-call (Dr. Bookatz) 204-578-4000 (pgr) or 204-727-6451 ext.2202 (office).
In or near Thompson: Dr. Shadi Mahmoud: cell: 204-939-6076
When cell phone unavailable, hospital number for the HMO on call # 204-677-2381.
What patients can expect
Tuberculosis treatment:
Public Health contact investigations
Other relevant links
WRHA Infection Prevention & Control
Prescription forms (Prescriptions should be provided by specialist TB care providers)
Manitoba Tuberculosis Protocol
Tuberculosis Testing Laboratory Reporting
Admission and Discharge Process for hospitalized TB patients