Clinical evaluation and investigation of contacts of M/XDR-TB

Clinical description

Routine screening of all household contacts should include:

• Asking about cough, fever, weight loss, and other symptoms of TB.
• Detailed medical history for additional risk factors
• Physical examination
• Asking about HIV status of household contacts or performing HIV counselling and

testing A household contact with any symptoms suggestive of active TB should receive all the following:

• Evaluation by a physician, including history and physical examination.
• CXR to look for signs of active TB (e.g., infiltrates cavities). The CXR should be kept to

compare with subsequent CXRs.

• Bacteriological investigations of sputum or other samples:

o Xpert MTB/RIF is the recommended initial diagnostic test o Culture and DST may be sent if Xpert MTB/RIF is negative and suspicion of active TB or MDR-TB remains high.

Remember that follow up of DST results is necessary because delay in the diagnosis of MDR-TB and start of appropriate treatment can lead to increased morbidity and mortality.