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Minerva Pneumologica 2015 June;54(2):85-101


lingua: Inglese

Overview of pulmonary, pleural and mediastinal investigations in active tuberculosis

Jha A. 1, Kon O. M. 2

1 Centre for Respiratory Infection (CRI), National Heart and Lung Institute (NHLI), Imperial College London, London, UK; 2 Department of Respiratory Medicine, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK


Tuberculosis (TB) in Europe remains an important source of morbidity and with a notification rate of up to 85 per 100,000 of the population in some European Union (EU) countries, the need for accurate and early diagnosis is crucial. Spontaneous sputum sampling for obtaining cultures remains the commonest method for diagnosing pulmonary tuberculosis, whilst the introduction of the Gene Xpert MTB/RIF test may offer a more rapid and sensitive option to the traditional smear due to its ability to simultaneously diagnose Mycobacterium tuberculosis and identify Rifampicin resistant strains with great accuracy. Standard and high resolution computed tomography (HRCT), as well as positron emission tomography (PET) scanning are becoming important tools for smear negative cases or those with complex presentations. The difficulties of diagnosing pleural TB have been improved with the advent of specific and non-specific immune markers such as adenosine deaminase (ADA) and interferon gamma (IFN-γ), as well as by the ability to obtain highly accurate biopsies with thoracoscopy. Mediastinal and hilar lymphadenitis is a common presentation of the disease and endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a safe and highly sensitive procedure which is rapidly establishing itself as a first line tool in the diagnosis of intrathoracic TB. In this review we outline the host and environmental factors that contribute to the propagation of pulmonary tuberculosis. We summarize and assess the gold standard techniques for identifying active thoracic TB and review cutting-edge methods to diagnose the disease.

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