Latest Chest Guidelines for Cough Due to TB and Other Chronic Infections

1. For patients with cough in high TB prevalence countries, particularly in high risk groups (eg, inmates, people living with HIV [PLWHIV], or close contacts of pulmonary TB), we suggest that individuals with cough be evaluated for pulmonary TB because of the implications of active pulmonary TB both to the individual and to public health are of great importance (Ungraded Consensus-Based Statement).

Remarks: Evaluation for pulmonary TB should be undertaken even though most individuals with cough will not have pulmonary TB.

2. For patients with a cough in high TB prevalence countries or settings, we suggest that they are screened for TB regardless of cough duration (Grade 2C).

Remarks: We found low-quality evidence that the prevalence of pulmonary TB was similar whether patients in such settings were screened after cough duration of ≥ 1, 2, 3, or 4 weeks.

3. For patients with cough and at risk of pulmonary TB but at low risk of drug-resistant TB living in high TB prevalence countries, we suggest that XpertMTB/RIF testing, when available, replace sputum microscopy for initial diagnostic testing, but chest x-rays should also be done on pulmonary TB suspects when feasible and where resources allow (Ungraded Consensus-Based Statement).

4. For patients with cough suspected to have pulmonary TB and at high risk of drug-resistant TB (eg, those with a prior history of treatment for pulmonary TB, contacts of drug-resistant TB cases and/or living in countries with a high drug-resistant TB prevalence), we suggest that XpertMTB/RIF assay, where available, replace sputum microscopy but sputum mycobacterial cultures, drug susceptibility testing, and chest x-rays should be performed when feasible and where resources allow (Ungraded Consensus-Based Statement).

5. For patients with a cough with or without fever, night sweats, hemoptysis, and/or weight loss, and who are at risk of pulmonary TB in high TB prevalence countries, we suggest that they should have a chest x-ray if resources allow (Ungraded Consensus-Based Statement).

6. For PLWHIV with a cough who also complain of fever, night sweats, hemoptysis, and/or weight loss (WHO-endorsed symptoms) and are at risk for TB, we suggest screening for pulmonary TB because the presence of these symptoms increases the likelihood that the affected individual has pulmonary TB(Grade 2C).

Remarks: All of the included studies were limited to PLWHIV.

7. For patients with a cough in high TB prevalence populations, we suggest the addition of active case finding (ACF) to passive case finding (PCF) because it may improve outcomes in patients with pulmonary TB (Ungraded Consensus-Based Statement).

8. For patients with a cough in high TB prevalence populations, we suggest the addition of ACF to PCF because it may reduce transmission (Ungraded Consensus-Based Statement).

9. For patients with a cough suspected to have pulmonary TB, we suggest that available financial modeling algorithms be used to estimate costs associated with different screening strategies because cost-effectiveness studies have not yet been performed (Ungraded Consensus-Based Statement).

10. For patients with a chronic cough in low-income countries, we suggest that strategies for pulmonary TB diagnosis should focus on improved case detection rather than diagnostic testing (Ungraded Consensus-Based Statement).

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DOI: 10.1016/j.chest.2017.11.018