Tuberculosis

How to send samples for Mycobacteria:

Obtaining multiple samples for TB culture is the gold standard for diagnosing TB.

• Pulmonary TB – 3 x good quality, early morning sputum samples for mycobacterial investigations are required. Labels can be printed from TRAK. If unable to produce sputum, then induced sputum or bronchoscopy should be considered in discussion with a specialist.
• Non-pulmonary TB – Tissue from the affected area should be sent for mycobacterial investigations (to Microbiology in saline or plain tube NOT in formulin) and histology (in formulin). Again seek advice from a specialist.

Further information about how to order these samples on TRAK can be found here on the Edinburgh and Lothians Laboratory Medicine website

Always offer HIV testing to patients with suspected or confirmed TB.

Local policies and guidelines for TB can be found here: Guidelines and Policies (scot.nhs.uk) (NB intranet only)

Contact details for the TB Nursing service:

• TBService@nhslothian.scot.nhs.uk
• Telephone number: 0131 242 1810 ext. 21810 or 21812

For infection prevention and control see How to get advice

Risk Factors for TB

• History of untreated or inadequately treated active TB infection
• Close contact with someone who has active pulmonary TB
• Co-morbid conditions:
  • HIV
  • Diabetes mellitus
  • End-stage chronic kidney disease receiving renal replacement therapy
  • Previous gastrectomy or jejunoileal bypass surgery
  • Occupational lung disease (e.g. silicosis)
  • Haematological malignancy
  • History of solid organ transplantation
• Immunosuppressive drugs:
  • High-dose immunosuppressants
  • Chemotherapy
  • Anti-TNF treatments
• Under-served groups:
  • People using homeless hostels, shelters and day centres
  • People in prison or detention centres
• History of excessive alcohol, injecting drug users and smokers.