Tuberculosis – Diagnosis and Treatment

Diagnosis

Checking for TB

Healthcare providers use several methods to find out if someone has tuberculosis (TB) or has been exposed to Mycobacterium tuberculosis.

Screening usually starts when a person has symptoms, has been in contact with someone with active TB, or is at higher risk for TB disease. Professionals decide whether a skin or blood-based method is best.

Skin Reaction Test

The tuberculin skin test is a common way to look for infection. A healthcare worker injects a small amount of testing fluid under the skin of the lower arm.

They check the site after 2–3 days. Swelling, measured with a ruler, shows whether the result is positive.

A positive reaction means the immune system has met TB bacteria before, either from latent TB infection, active TB, or from having the BCG vaccine.

A negative test shows no reaction, but someone could still have TB, especially if their immune system is weak.

Blood-Based Analysis

Blood testing for TB, like the interferon-gamma release assay (IGRA), uses a sample to find immune system cells that respond to M. tuberculosis.

These tests give a positive or negative result within a few days. A positive result can mean latent TB infection or active TB disease.

A negative blood test usually rules out TB, but a person’s health can affect the results.

Chest Imaging

Doctors use chest X-rays if they suspect active pulmonary tuberculosis. They look for changes or spots in the lungs that are typical for TB.

X-rays cannot tell the difference between active and inactive disease. Abnormal images may lead to further testing.

Test	What It Shows
Chest X-ray	Lung damage or active lung disease
CT Scan (in special cases)	Details for hard-to-see TB

Examining Mucus Samples

Doctors test sputum (mucus coughed up from the lungs) when pulmonary TB is possible.

They look at the sample under a microscope and place it in a special culture dish to see if M. tuberculosis grows.

Results show if someone has TB, and further lab tests show if the bacteria are drug-resistant.

Sputum testing helps diagnose active, contagious TB disease.

• Microscope Test: Finds bacteria quickly, but may also see similar bacteria.
• Culture Test: Confirms TB, but takes longer (weeks).
• Drug-Resistance Test: Shows which medicines will work.

When a person, especially a child, cannot produce sputum, doctors may use gastric aspiration.

This involves collecting stomach contents in the morning to test for swallowed TB bacteria. The sample is examined in the same way as sputum to check for infection.

Additional Tests

Doctors sometimes use other lab tests to confirm tuberculosis or find it outside the lungs.

These can include:

• Breath analysis
• Sampling fluid around the lungs or spinal cord
• Testing urine for TB in the kidneys
• Special procedures to gather sputum

Doctors use these tests for extrapulmonary TB or when main tests are unclear.

Common symptoms seen during procedures can include:

• Chest pain
• Night sweats
• Fatigue
• Weight loss

Treatment

Finishing Every Dose Is Essential

Patients need to take all prescribed tuberculosis (TB) medicines without missing a dose for successful treatment.

Completing the full course destroys all TB bacteria and lowers the risk of drug-resistant disease. If patients skip doses or stop early, the bacteria can become resistant to antibiotics, making future treatments harder and longer.

A healthcare worker may use directly observed therapy (DOT) for those at risk of missing doses. In DOT, a healthcare worker visits regularly—often at home—to watch as the person takes their medicine.

This helps ensure every dose is taken. Some public health departments offer checklists or printable forms to help patients manage their treatment on their own.

Main Medications Used to Fight Tuberculosis

Treatment depends on whether a person has latent or active TB and if drug resistance is present.

The following table lists common TB medicines and when they may be used:

Medicine Name	Used For	Notes
Isoniazid	Latent, Active	Often part of standard combo
Rifampin	Latent, Active	Key first-line drug
Rifabutin	Active	Used if side effects occur
Rifapentine	Latent	Can be once weekly
Pyrazinamide	Active	Used first two months
Ethambutol	Active	Prevents drug resistance

People with latent TB usually need one or two of these medicines for three or four months.

Those with active TB need several at once for four to nine months. Drug-resistant TB requires alternative or additional antibiotics and longer treatments.

Understanding Medication Risks and Side Effects

Most patients finish their medicines without major problems, but side effects can happen. Mild effects might go away over time.

Anyone experiencing problems should tell their healthcare professional right away. Sometimes, a medicine may need to be stopped or replaced.

Possible side effects include:

• Upset stomach, vomiting, loss of appetite
• Severe diarrhea
• Light-colored stools, dark urine
• Yellowish skin or eyes (jaundice)
• Visual changes, dizziness, or loss of balance
• Tingling in the hands or feet
• Easy bruising, nosebleeds, or bleeding gums
• Unexplained tiredness, sadness, depression, or rash
• Joint pain or unexplained weight loss

Patients should tell their healthcare team about all medicines, supplements, and herbal remedies they take. Some products may interact with TB medications or increase side effect risks.

Coping and support

Staying on tuberculosis treatment can be difficult, especially for those with HIV or who have weak immune systems.

People may feel anger or frustration.

Helpful steps include:

• Talking with a therapist or support group
• Creating a daily routine
• Learning about risk factors and ways to lower exposure to TB

These actions support mental health and can help with treatment.

Getting Ready for Your Visit

Steps You Can Take Before Seeing a Health Care Provider

Being prepared for a health appointment helps you get the most from your visit. When scheduling, ask if you need to fast or stop any medications before the appointment.

Bring a list with the following details:

• Symptoms: Write down all symptoms, even minor ones. Include the dates they started and if they have changed.
• Personal History: Note recent life events, such as travel abroad or big changes at home, especially if you visited or lived in countries where tuberculosis is common.
• Medications: List all prescriptions, over-the-counter drugs, vitamins, and supplements with dosages.
• Questions: Prepare questions for the health care provider. Here are some to consider:

Question to Ask	Why Ask?
What could be causing my symptoms?	Helps identify possible conditions
Will I need any tests?	Learn if further checks are needed
What treatment options are available?	Understand possible therapies
What if the treatment is not successful?	Plan for next steps
How long will treatment last?	Set expectations
How often are follow-ups needed?	Prepare for ongoing care
How do I handle my other health problems with this?	Manage multiple conditions safely

Tip: Keep a small notebook or use a phone app to track new symptoms, medication changes, or questions before your visit. These notes help remind you of details during your appointment.

Personal Information to Prepare:

• Any previous history with tuberculosis or positive TB test results
• Vaccination history for tuberculosis
• Work environment and possible exposure risks
• Regular habits related to alcohol or drug use

Types of Questions Your Specialist Might Ask

A healthcare provider will ask about your medical background and status. Being ready to answer helps speed up the process and ensures nothing is missed.

Here’s what they may ask:

• What symptoms are you experiencing?
• When did these symptoms begin and how have they changed?
• Do you have or have you ever had HIV or AIDS?
• Have you had any known contact with someone diagnosed with active tuberculosis?
• Where were you born?
• Have you lived, worked, or traveled in countries where tuberculosis is common?
• Were you given the tuberculosis vaccine as a child?
• Did you ever receive treatment for tuberculosis in the past, and if so, what kind and how long did it last?
• What is your job or daily work environment?
• How much alcohol do you drink, if any?
• Do you use drugs, including injectable drugs?
• Are there any supplements, herbal remedies, or other non-prescription products you use regularly?

Sample Question Table:

Topic	Sample Provider Question
Medical history	Have you ever had tuberculosis before?
Exposure	Have you had contact with anyone with TB?
Lifestyle	Do you drink alcohol? Use drugs?
Medication/supplement use	What do you take regularly?
Travel and work	Where have you traveled or worked recently?

Note: Answer honestly and give as much detail as possible.

This helps the healthcare provider understand your situation and offer the best care. They may refer you to a specialist in infectious diseases for further evaluation and treatment.

Bringing a trusted family member or friend can help, especially if you feel worried or have a lot of information to remember. They can listen, take notes, or help you remember what was discussed.

Make sure your health care provider has your up-to-date contact information in case they need to follow up with you about test results or appointments.