+ cough + night sweats + fatigue +travel/exposure history
Presentation concerning for possible Pulmonary Tuberculosis.

AFB Culture [other non-sterile, PHL sputum induced], M. tuberculosis PCR with Rifampin Resistance (sputum or expectorated or induced), HIV antigen/antibody screen (blood)

• • Presentation
    • Symptoms
      • Weight loss (>1 month), Cough (>2 weeks), Fever (>2 weeks), Night sweats (>1 month), Malaise (>1 month), Hemoptysis
    • Risk factors
      • History of homelessness, History of incarceration, Born outside the U.S., Prior active TB disease, HIV infection, History of TB exposure, History of (+) tuberculin skin test**A positive tuberculin skin test alone does not necessitate collection of sputum for active TB disease
  •  Workup:
    • Special Orders
      • The first specimen should be collected in the ED and should be induced by inhalation of an aerosol (e.g., warm, sterile, 3%–5% hypertonic saline).
      • Further sputum collection (a total of 3 samples q8 hours recommended) can be collected by Public Health (if discharged) or on the ward (if admitted).
      • HIV tests should be followed up as an outpatient but will not be performed STAT
    • Radiographic findings
      • Cavitary lesion(s), Apical or upper lobe infiltrates
  • Discharge Instructions
    • DO NOT receive visitors at home, visit others, or go to work until evaluated by Public Health
      DO NOT care for children ≤ 5 years old
      Avoid public areas/ public transportation.
      If you are employed DO NOT go to work
      Cover your mouth and nose when coughing
      Wear a surgical mask when spending time in a shared space (should be provided to patient upon discharge)
      Patients will be contacted regarding any positive TB or HIV results