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Tuberculosis diagnosis treatment sign and symptoms

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"Tuberculosis"[MeSH Terms] AND treatment

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WHO tuberculosis diagnosis treatment symptoms guidelines 2025

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https://www.who.int/health-topics/tuberculosis

Tuberculosis (TB)

TB is an infection caused by Mycobacterium tuberculosis. It usually affects the lungs and spreads through the air when a person with untreated infectious lung TB coughs, speaks, or sings. It can also affect lymph nodes, brain coverings, spine, kidneys, abdomen, and other organs.

Signs and symptoms of active TB

Symptoms often develop gradually over weeks to months:
  • Persistent cough, often 2 weeks or longer
  • Coughing up sputum, sometimes blood
  • Fever, often low-grade
  • Night sweats
  • Weight loss and poor appetite
  • Tiredness, weakness, fatigue
  • Chest pain or breathlessness
Pulmonary TB commonly causes fever, night sweats, productive cough, hemoptysis, anorexia, and weight loss. Textbook of Family Medicine, p. 298.
Possible extrapulmonary symptoms depend on the site:
  • Swollen lymph nodes
  • Severe headache, neck stiffness, confusion: possible TB meningitis
  • Back pain or weakness in the legs: possible spinal TB
  • Abdominal pain/swelling
  • Blood in urine or urinary symptoms
Some people, especially those with HIV or weakened immunity, can have atypical symptoms or even a normal chest X-ray.

Latent TB infection versus active TB disease

FeatureLatent TB infectionActive TB disease
TB bacteriaPresent but inactiveMultiplying and causing illness
SymptomsNoneOften cough, fever, night sweats, weight loss
Infectious?NoLung/laryngeal TB can be infectious
TestsSkin or blood test may be positiveRequires microbiological and clinical evaluation
TreatmentPreventive treatmentMulti-drug treatment
A positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA) indicates TB infection but does not by itself prove active disease. Active TB must be excluded first. Textbook of Family Medicine, p. 298.

Diagnosis

If TB is suspected, seek medical assessment promptly. Tests may include:
  1. Sputum testing
    • Rapid molecular test, such as Xpert MTB/RIF or similar, to identify TB DNA and often rifampicin resistance
    • Sputum smear microscopy for acid-fast bacilli
    • Culture, which confirms TB and permits full drug-susceptibility testing
  2. Chest X-ray
    • Can show upper-lung infiltrates or cavities in reactivation TB, but cannot alone confirm TB.
  3. Testing for drug resistance
    • Essential before and during treatment when resistance is suspected.
  4. TST or IGRA blood test
    • Mainly used to identify TB infection, especially when there are no symptoms.
  5. Tests for extrapulmonary TB
    • Fluid or tissue from the affected site may require molecular testing, culture, or biopsy.
WHO recommends rapid molecular tests as the initial test for people with symptoms of TB, with sputum testing for suspected lung disease and body-fluid or tissue testing for non-lung TB. See the WHO TB diagnosis guidance.

Treatment

Drug-susceptible active TB

The usual treatment is a combination of four antibiotics initially:
  • Isoniazid
  • Rifampicin or rifampin
  • Pyrazinamide
  • Ethambutol
A common standard regimen is:
  • First 2 months: all four drugs
  • Then about 4 months: isoniazid plus rifampicin
This is often called 2HRZE/4HR. Exact regimen and duration can differ by country, drug-susceptibility results, site of TB, age, pregnancy, liver disease, HIV medicines, and other factors. Drug-susceptible pulmonary TB has traditionally been treated for about 6 months. Textbook of Family Medicine, p. 298.
WHO states that TB disease is curable and typically treated with a 6-month course of combination antibiotics; drug-resistant TB requires longer, more complex, specialist-directed treatment. See WHO TB information.

Important treatment points

  • Never stop treatment early, even if symptoms improve.
  • Taking only one drug or missing doses can lead to drug-resistant TB.
  • Treatment should be supervised or supported by a TB program where available.
  • The clinician will monitor response, side effects, and sputum results.
  • Rifampicin has many drug interactions, including with some HIV drugs and hormonal contraceptives.
  • Urgent review is needed for jaundice, severe vomiting, visual changes, rash, numbness/tingling, or major weakness while on treatment.

Drug-resistant TB

If the TB bacteria are resistant to rifampicin, isoniazid, or other drugs, treatment must be selected using resistance-test results. It is not treated with the standard regimen alone. Specialist and public-health TB program care is needed.

Red flags: get urgent medical care

Seek urgent care now if there is:
  • Coughing up a large amount of blood
  • Severe shortness of breath or chest pain
  • Confusion, severe headache, neck stiffness, seizures
  • New leg weakness, inability to walk, or loss of bladder/bowel control
  • High fever with severe weakness, especially in a young child, older adult, pregnant person, or someone with HIV
If you have a persistent cough plus fever, night sweats, or weight loss, avoid close indoor contact with others where possible, wear a well-fitting mask, and arrange TB testing promptly.
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