Conventional diagnostic methods for tuberculosis.

The diagnosis of tuberculosis by the discerning physician is usually not difficult. A few key features of the patient's history, including weight loss, afternoon fevers, nightsweats, cough, and risk for exposure to the bacillus together with physical signs of upper-lobe pulmonary disease, should alert the physician to screen for the infection by means of chest roentgenography, examination of a sputum specimen, and a tuberculin skin test. The diagnosis is more problematic when patients are elderly, very young, or immunocompromised (especially with infection due to human immunodeficiency virus [HIV]). The diagnosis may also be obscured when the involved lung segments are in the lower lobes or are anteriorly situated or when the disease is extrapulmonary. The conventional diagnostic considerations detailed herein should be reasonably successful when the physician maintains a high index of suspicion of this all-too-prevalent infectious disease.

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