CHEST Guidelines-Cough-Due-to-TB-and-Other-Chronic-Infections_2017

Cough-Due-to-TB-and-Other-Chronic-Infections_2017_

Pdf Summary

This CHEST guideline report addresses the issue of cough caused by tuberculosis (TB) and other chronic respiratory infections, providing insights on screening and diagnostic strategies. Cough is a prevalent symptom in TB and can be a predictor for screening. The guideline emphasizes the importance of early identification and screening to prevent disease progression and transmission, especially in high TB prevalence areas.

Key findings from the report are:

1. <strong>Screening Duration and Strategy:</strong> While a cough lasting more than two weeks is commonly used as an indicator for TB screening, the evidence does not strongly support that this duration is superior to shorter or longer periods. However, screening individuals irrespective of cough duration in high-prevalence areas can lead to earlier diagnosis, although increasing costs.

2. <strong>People Living with HIV (PLWHIV):</strong> For PLWHIV, incorporating additional symptoms like fever, night sweats, hemoptysis, and weight loss increases the diagnostic sensitivity for TB. Despite this increased sensitivity, the negative predictive value can help stratify risk and prioritize testing in resource-limited settings. However, these strategies may not be reliable in asymptomatic, pregnant PLWHIV.

3. <strong>Diagnostic Tools and Cost-Effectiveness:</strong> The Xpert MTB/RIF test, which is cost-effective and more efficient than clinical diagnosis, is recommended for initial TB testing. Passive case finding (PCF), complemented by active case finding (ACF), may increase early detection and potentially reduce transmission in high burden communities.

4. <strong>Cough Resolution and Other Chronic Infections:</strong> The report highlights that data are insufficient to determine cough resolution rates linked to pulmonary TB treatment strictly. Furthermore, there are no definitive cough features that differentiate MAC lung disease or those caused by other mycobacteria, fungi, or paragonimiasis effectively.

5. <strong>Recommendations:</strong> The report suggests various guidelines for screening and testing different population groups, particularly focusing on high-risk groups such as prisoners, PLWHIV, close contacts of TB patients, and pregnant women. In these settings, comprehensive diagnostic strategies, including chest x-rays and Xpert MTB/RIF assays, are recommended when feasible.

Overall, the guideline underscores the complexity of cough as a symptom for TB and encourages an integrated diagnostic approach, supporting early case finding and treatment initiation to curb TB spread, especially in regions with limited healthcare resources.

Keywords

tuberculosis

chronic respiratory infections

cough screening

diagnostic strategies

high TB prevalence

people living with HIV

Xpert MTB/RIF test

active case finding

pulmonary TB treatment

integrated diagnostic approach