13.5.1 How to identify a person with suspected TB
First, remember that you need to inform the general public about the signs and symptoms of TB and to tell them about where TB screening can be done.
How to suspect pulmonary TB
You can identify a TB suspect with pulmonary TB by asking two simple questions:
Remember that any person with a persistent cough of two or more weeks is a TB suspect and should be screened for TB.
- Do you have a persistent cough?
- How long have you had the cough?
You may also come in contact with persons who have extra-pulmonary TB, in which case you can use Table 13.2 as a guide on how to proceed. What is important for you to appreciate is that while a patient with EPTB is likely to have general symptoms such as weight loss, fever, night sweats, their specific symptoms will depend on which organ has been affected by the TB bacteria.
Any person suspected of extra pulmonary TB should be referred to a medical doctor or clinician for diagnosis. If the patient is also coughing, sputum must be examined.
| Organ affected | Symptoms |
|---|---|
| Vertebral spine | Back pain, swelling on spine |
| Bone | Long-lasting bone infection |
| Joints | Painful joint swelling, usually affecting one joint |
| Kidney and urinary tract | Painful urination, blood in urine, frequent urination, lower back pain |
| Upper respiratory tract (larynx) | Hoarseness of voice, pain on swallowing |
| Pleural membrane of lungs | Chest pain, difficulty in breathing, fever |
| Meninges of the brain (meningitis) | Headache, fever, neck stiffness, vomiting, irritability, convulsions |
| Lymph node | Swelling of the node, draining pus. Long-lasting ulcer despite antibiotic treatment, draining pus |
How to suspect TB in children
What about diagnosis of TB in children? This is often quite difficult because sputum is not so easy to obtain. What is more, the symptoms are not as clear cut as in adults. They include:
- Low grade fever not responding to malaria treatment
- Night sweats
- Persistent cough for three weeks or more
- Loss of weight, loss of appetite
- Failure to thrive
- Lymph node swellings
Any child suspected of having TB should be referred to a Medical Officer/Clinician for diagnosis. The tuberculin test is a skin test to see if there is a reaction to extracts of TB bacteria. - Joint or bone swellings
- Deformity of the spine
- Listlessness
- Neck stiffness, headache, vomiting (TB meningitis).
Diagnosis in children rests largely on the results of clinical history, family contact history, X-ray examination and tuberculin test. A medical officer experienced in TB should make the decision whether to treat or not to treat.
13.5 Case finding