TB Case Finding in

Hospitals

OBJECTIVES
1. Identify presumptive Tuberculosis
2. Assess and examine presumptive
TB case
3. Decide if a patient have TB
4. Refer patient to a hospital TB
clinic/desk

2 APPROACHES TO CASE FINDING

1. Passive case finding identifying TB among
the symptomatic patients who are screened for
disease activity upon consultation at the hospital
or health facility.
2. intensified case finding - actively seeking
out TB among individuals belonging to special or
define population. Example: High risk groups like
patient with HIV, DM, End stage Renal Disease,
cancer, connective tissue diseases, Autoimmune
Diseases, Silicosis, patients who underwent
gastrectomy or solid organ transplantation and
patient on prolong systemic steroids.

STEP1-IDENTIFY PRESUMPTIVE TB PATIENTS

Areas:

OPD

ER
WARDS
RADIOLOGY/X-RAY DEPT.
PHARMACY
SOCIAL SERVICE
LABORATORY
PRIVATE DOCTORS WITHIN THE
HOSPITAL

TB-

PRESUMPTIVE
any person whether adult or child with signs and or
symptoms suggestive of TB whether Pulmonary or Extra
Pulmonary or those with chest x-ray findings suggestive of active
TB.
1. Adults (15 y/o and above) who has any of the ff:
a. Cough of atleast 2 weeks duration with or without the
following symptoms:
Significant

and unintentional weight loss

Fever
Bloody

sputum (hemoptysis)
Chest/black pains not referable to any musculoskeletal
disorders
Easy fatigability or malaise
Night sweats
Shortness of breath or DOB

b. Unexplained cough of any duration in:

Close

contact of a known active TB case

High risk clinical groups
High risk population (elderly, urban poor, inmates and other
congregate settings.)

2. Children (below 15 y/o0, who has any of the ff:

a. Atleast 3 of the ff clinical criteria:
Coughing/wheezing

of 2 weeks or more, especially if

unexplained
Unexplained fever of 2 weeks or more after common causes
such as malaria or pneumonia have been r/o.
Loss of weight /failure to gain weight/weight faltering/loss of
appetite
Failure to respond to 2 weeks of appropriate antibiotic txt for
lower RTI
Failure to regain previous state of health 2 weeks after a
viral infection or exanthema. Ex. Measles
Fatigue, reduce playfulness, or lethargy

b. Any of the above signs and symptoms (clinical criteria)

in a child who has a close contact of known active TB case
3. A patient with chest x-ray findings suggestive of TB with or
without symptoms, regardless of age.

PRESUMPTIVE EXTRA-PULMONARY TB-

may

have Any of
the following:
Gibbus, especially of recent onset (resulting
from vertebral TB)
Non-painful enlarged cervical lymphadenopathy
with or without fistula formation.
Neck stiffness or nuchal rigidity and or
drowsiness suggestive of meningitis that is not
responding to antibiotic treatment
Pleural effusion
Pericardial effusion
Distended abdomen (ex. Big liver and spleen)
with ascites
Non-painful enlarged joint
Signs or tuberculin hypersensitivity

PRESUMPTIVE DRUG RESITANT-TB(DRTB)

any person 9whether adult or child) who belongs
to any of the DRTB high risks groups, such as: re
treatment cases, new TB cases that are contacts
of confirmed DRTB cases or non-converter of
Category 1 and people living with HIV with signs
and symptoms of TB.

STEP II- ASSESMENT OF

PRESUMPTIVE TB PATIENT
1. Medical History and Physical Examination
a. Signs and symptoms of the disease-805 of TB cases
affect the lung
b. History of exposure from active TB cases of
presumptive TB (including MDR-TB) within the family
or household and workplace ( present and past
exposure)
c. Presence of clinical or other high-risk factors.
d. History of previous anti-TB treatment and its
details.
e. Physical examination- lungs and other organ
affected like larynx, lymph nodes, brain , kidney,
bones and joints.

2. Diagnostic test (provided by the NTP)

a. Direct Sputum Smear Microscopy- serves as
one of the bases for categorizing TB cases
according to standard case definition.
- use to monitor progress of patient with
TB
while they are on treatment and
confirm cure at
the end of treatment
- primary diagnostic method adopted by
the
NTP among such individuals because:
1. It provides a definitive diagnosis of active TB.
2. Procedure is simple
3. Economical
4. Microscopy could be put up even in remote
areas

Contraindication for collecting sputum for DSSM is

massive hemoptysis.
All presumptive TB patient should undergo DSSM
except the following situation:
Mentally incapacitated as decided by specialist
or medical institution
Debilitated or bedridden
Children unable to expectorate
Patients unable to produce sputum despite
sputum induction
b. TB Culture and Drug Susceptibility Test (DST)
a routine diagnostic test for Drug resistant TB
cases under the NTP.
- Used for TB prevalence surveys, drug
resistance surveillance, research and other
special cases.

c. Rapid Molecular Diagnostic Test : Xpert MTB /RIF

- Is a fully automated diagnostic molecular test that

detects TB and Rifampicin Drug resistant.
- Provides accurate result in less than 2 hours so
that patient can be given proper treatment on the
same day.
- Used for TB diagnosis among :
1. Presumptive DRTB
2. Person living with HIV (PLHIV) with signs and
symptoms
and TB
3. Smear negative adults with chest x-ray findings
suggestive of TB
4. Smear negative children
d. Other Tests
1.Tuberculin Skin Testing (TST) - Basic Screening Tool for
TB
infection among children using PPD solution/Mantoux
Test.
2. Chest x-ray used to compliment bacteriologic
testing in making a diagnosis


STEP III DECIDE IF PATIENT HAVE TB
Classification of TB based on anatomical site
a. Pulmonary TB (PTB) involves the lung parenchyma.
b. Extra Pulmonary TB (EPTB) involves larynx, pleura, lymph
nodes, abdomen, GUT, skin, joints and bones, meninges
Classification of TB based on bacteriological status
a. Bacteriology confirmed a TB patient from whom a
biological specimen is positive by smear microscopy, culture
or rapid diagnostic test (Xpert MTB/RIF).
b. Clinically diagnosed patient who does not fulfill the criteria
for bacteriological confirmation but has been diagnosed with
active TB by a clinician or other medical practitioner who has
decided to give the patient a full course of TB treatment. It
includes cases diagnosed on the basis of x-ray abnormalities
or suggestive histology and extra pulmonary cases without
laboratory confirmation.

STEP IV REFER
PATIENT TO
HOSPITAL TB CLINIC
(INTERNAL
REFERRAL)

TB CASE HOLDING AND

REFERRAL TO DOTS CENTER

Objectives:

1. Identify patients TB disease registration

group
2. Assign Correct Treatment Regimen
3. Initiate Treatment and registration in the
Hospital and DOTS Facility
4.Refer Patient to a DOTS facility (External
Referral System)
5. Monitor patients treatment