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by Haresh11 on January 14th, 2009

Haresh11

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Clinically, how do you tell the difference between TB and pneumonia? Without running any cultures.

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  • by ChrisDG on January 14th, 2009

    ChrisDG

    First off, take a good history. 80% of diagnoses are made on histories alone. Foreign travel/lived/worked in areas with endemic TB? Susceptible population?

    As mentioned by uncacal, night sweats, as is you have to change the sheets because they are that soaked is a good indicator of TB over pneumonia. WonderWomen2009 is right that coughing blood is a "classical" sign of TB, but as so often in medicine, classical signs aren't present. Plus, they could cough blood for other reasons as well, so don't go on this alone.

    Are there any non-respiratory signs? Erythema nodosum on the lower legs (red patches that are painful),strongly indicates TB over pneumonia, though you need to exclude sarcoidosis if it's a respiratory problem.

    Have you got any imaging? Cavitation, calcification and fibreosis on an X-ray are all good evidence for TB over pneumonia.

    I'm guessing you don't have any histology, otherwise it would probably be ptretty conclusive if you see non-caseating granuloma.

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    • That's brilliant =) Thanks. I've got my exams in a few days and I was trying to work out whether or not you'd be able to tell if a patient has pneumonia or TB based solely on the history.

      I guess you should be able to. But the tests would just confirm it.

      A sign of TB is actually caseating granuloma, not a non-caseating one right? and you could just do the heaf test right?

      But yeah, i was trying to work it out without ordering any tests..

      Haresh11

      by Haresh11 on January 14th, 2009

    • Sorry yes, I meant caseating, I've got sarcoid on the brain today. Don't know where you are studying but in the UK the Mantoux test is used, not the Heaf test.

      ChrisDG

      by ChrisDG on January 14th, 2009

    • Thanks =) I'm studying in the UK. That really helped =)

      Haresh11

      by Haresh11 on January 14th, 2009

    • Ditto. 4th year at Newcastle.

      ChrisDG

      by ChrisDG on January 14th, 2009

    • Ha ha, cool, did you do an intercalated?

      Haresh11

      by Haresh11 on January 14th, 2009

    • No, just straight five year course.

      ChrisDG

      by ChrisDG on January 15th, 2009

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