TB/HIV: a clinical manual - libdoc.who.int - World Health Organization

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CONTENTSForeword to second edition. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Foreword to first edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Preface to second edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Glossary and abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Background information on tuberculosisand human immunodeficiency virus . . . . . . . . . . . . 231.1 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231.1.1 Basic facts about TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231.1.2 Pathogenesis of TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251.2 Human immunodeficiency virus . . . . . . . . . . . . . . . . . . . . 271.2.1 Introduction: HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . 271.2.2 HIV/AIDS epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . 281.2.3 HIV transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281.2.4 Prevention of HIV transmission in health units . . . . . . . . 291.2.5 Immunopathogenesis of HIV infection . . . . . . . . . . . . . . 301.2.6 Natural history of HIV infection . . . . . . . . . . . . . . . . . . . 311.2.7 Clinical staging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321.2.8 Epidemiological surveillance of AIDS . . . . . . . . . . . . . . . . 351.3 HIV-related TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361.3.1 Epidemiology of coinfection of HIV and M tuberculosis. . . 361.3.2 HIV infection and risk of TB. . . . . . . . . . . . . . . . . . . . . . . 371.3.3 TB in the course of HIV progression . . . . . . . . . . . . . . . . 371.3.4 Consequence of HIV/M tuberculosis coinfection . . . . . . . . 371.3.5 Impact of HIV on TB control . . . . . . . . . . . . . . . . . . . . . . 371.3.6 Patterns of HIV-related TB . . . . . . . . . . . . . . . . . . . . . . . . 381.3.7 Impact of TB on HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 An expanded framework for effectivetuberculosis control. . . . . . . . . . . . . . . . . . . . . . . . . . . 412.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412.2 Components of expanded TB control framework . . . . . . 412.2.1 Goals of TB control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422.2.2 Targets for TB control (cure and case detection). . . . . . . 422.2.3 TB control policy package (the DOTS strategy) . . . . . . . 43TB/HIV:A CLINICAL MANUAL3
2.2.4 Key operations for DOTS implementation. . . . . . . . . . . . 442.2.5 Indicators to measure NTP progress in TB control . . . . . 452.3 Directly observed treatment . . . . . . . . . . . . . . . . . . . . . 452.4 TB/HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462.5 DOTS-Plus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 Diagnosis of pulmonary tuberculosis in adults . . . . 493.1 Diagnostic approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493.2 Clinical features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503.3 Diagnostic sputum smear microscopy . . . . . . . . . . . . . . . 513.4 Differential diagnosis of pulmonary TB. . . . . . . . . . . . . . . 543.5 Chest X-ray in diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . 553.6 Radiographic abnormalities seen in pulmonary TB . . . . . . 553.7 Differential diagnosis of chest X-ray findings . . . . . . . . . . 563.8 The place of mycobacterial culture in the diagnosis of TB 573.9 Sepsis and concomitant TB . . . . . . . . . . . . . . . . . . . . . . . 573.10 Distinguishing other HIV-related pulmonary diseasesfrom pulmonary TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 584 Diagnosis of pulmonary tuberculosis in children . . 614.1 Epidemiology of childhood TB . . . . . . . . . . . . . . . . . . . . . 614.2 How does TB in children differ from TB in adults? . . . . . 624.3 Approach to diagnosis of TB . . . . . . . . . . . . . . . . . . . . . . 634.4 Score system for diagnosis of TB in children . . . . . . . . . . 664.5 Tuberculin skin test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 674.6 The decision to start TB treatment in children . . . . . . . . 684.7 Impact of HIV on the diagnosis of TB in children . . . . . . . 694.8 Differential diagnosis of pulmonary TB inHIV-infected children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704.9 Management of child contacts of infectious adults . . . . . . 715 Diagnosis of extrapulmonary tuberculosis inadults and children . . . . . . . . . . . . . . . . . . . . . . . . . . . 755.1 Diagnostic approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755.2 Tuberculous lymphadenopathy . . . . . . . . . . . . . . . . . . . . . 755.3 Miliary (disseminated) TB. . . . . . . . . . . . . . . . . . . . . . . . . 785.4 Tuberculous serous effusions (pleural, pericardial, ascites) 795.5 Tuberculous meningitis. . . . . . . . . . . . . . . . . . . . . . . . . . . 845.6 Other forms of extrapulmonary TB . . . . . . . . . . . . . . . . . 875.7 Further information on spinal, gastrointestinaland hepatic TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 884 CONTENTS
Page 1 and 2: WHO/HTM/TB/2004.329TB HIVA CLINICAL
Page 3: WHO Library Cataloguing-in-Publicat
Page 7 and 8: 9.4 TB treatment regimens: question
Page 9 and 10: 12.7 Neurological problems in adult
Page 12 and 13: FOREWORD TO SECOND EDITIONWHO is co
Page 14 and 15: PREFACE TO SECOND EDITIONRecognitio
Page 16 and 17: GLOSSARY AND ABBREVIATIONSThis glos
Page 18 and 19: HIV-negativeHIV-positiveHIV-related
Page 20: RNARTISCCscrofulasensitivity testse
Page 24 and 25: BACKGROUND INFORMATION ONTUBERCULOS
Page 26 and 27: dead, 25% will be healthy (self-cur
Page 28 and 29: smear; upper lobe involvement; usua
Page 30 and 31: About one-third of children born to
Page 32 and 33: important cells in the cell-mediate
Page 34 and 35: AdultsWHO clinical staging system f
Page 36 and 37: 1.2.8 Epidemiological surveillance
Page 38 and 39: 1.3.2 HIV infection and risk of TBH
Page 40 and 41: HIV-related TB in childrenAs in adu
Page 42 and 43: AN EXPANDED FRAMEWORK FOR EFFECTIVE
Page 44 and 45: 2.2.3 TB control policy package (th
Page 46 and 47: º Undertake economic analysis and
Page 48 and 49: 2.5 DOTS-PLUSHigh levels of multidr
Page 50 and 51: DIAGNOSIS OF PULMONARY TUBERCULOSIS
Page 52 and 53: 3.3 DIAGNOSTIC SPUTUM SMEAR MICROSC
Page 54 and 55:
Sensitivity of sputum smear microsc
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PRACTICAL POINTIf the patient is br
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cavitationunilateral infiltrationbi
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Clinical and CXR features of PCP an
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DIAGNOSIS OF PULMONARY TUBERCULOSIS
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disease to other parts of the body,
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(3) Respiratory symptoms such as co
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º evidence of wasting (i.e. under
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In the past, some doctors have advo
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productive of copious purulent and
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distinguishing TB-infected from non
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DIAGNOSIS OF EXTRAPULMONARYTUBERCUL
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Practical approach to investigation
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Clinical differentiation of miliary
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malignancy, post-pneumonic effusion
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Therapeutic pericardiocentesis is n
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Clinical featuresThe patient may pr
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5.6 OTHER FORMS OF EXTRAPULMONARY T
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SUGGESTIONS FOR FURTHER READINGCrof
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PRACTICAL POINTFull blood count (FB
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countries for staging and monitorin
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provides support. Counselling is a
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SUGGESTIONS FOR FURTHER READINGUNAI
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Lesscommonextensive fungal skin, na
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positive. These include the poor ou
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STANDARDIZED TUBERCULOSIS CASEDEFIN
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Pulmonary TB - sputum smear-negativ
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The table below shows the severe an
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First-line Mode of Potency Recommen
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growing bacilli and the killing of
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Recommended treatment regimens for
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9.4 TB TREATMENT REGIMENS: QUESTION
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9.5 USE OF ANTI-TB DRUGS IN SPECIAL
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PRACTICAL POINTRecording treatment
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indicators are treatment completion
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SCCAmong TB patients who complete S
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SIDE-EFFECTS OF ANTI-TUBERCULOSIS D
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PRACTICAL POINTRifampicin reduces t
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10.7.1 Treatment regimen includes t
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not a severe reaction) to isoniazid
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ANTIRETROVIRAL THERAPY FOR THETREAT
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eplication and functioning of HIV.
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18 HIV antibody º WHO Paediatric S
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Name of drug Formulations Pharmacok
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Stavudine Maximum dose: Needs to be
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Efavirenz 25 to 33 kg: 350 mg(EFZ)
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11.7 CHOICE OF ART REGIMENWHO recom
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Recommended first-line ARV combinat
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11.10 INTERACTIONS BETWEEN ARV DRUG
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SUGGESTIONS FOR FURTHER READINGBart
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worldwide. There has also been rece
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chlamydia doxycycline 100 mg orally
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º Fungal infectionsInfection Local
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Ichthyosis(dry scalyskin)PsoriasisE
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sputuminductionusing 3-5%hypertonic
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Where available, barium swallow sho
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Isospora bellitrimethoprim 80 mg/su
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Always check a blood film for malar
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It is unlikely, but possible, that
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a variety of neurological problems
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section 12.4 on skin problems), a b
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ChildrenIn children with known or s
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PathogenPneumocystis cariniiDrug re
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COORDINATED CARE IN DIFFERENT SETTI
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º access to voluntary counselling
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13.5.3 Secondary careMeasures appli
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Secondary care As for primary As pe
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SUGGESTIONS FOR FURTHER READINGGilk
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PRACTICAL POINTIn wards, outpatient
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14.3.2 BCG protection against TB in
Page 201 and 202:
) Aimed at decreasing risk of a rec
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to exclude active TB and to ensure
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SUGGESTIONS FOR FURTHER READINGHarr
Page 207 and 208:
Childrenapproach to TB diagnosis .
Page 209 and 210:
Kaposi sarcoma . . . . . . . . . .3
Page 211 and 212:
Target groups for preventive treatm
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