Clinical Diagnosis of Drug Resistant Tuberculosis

This chapter deals with the clinical diagnosis of drug resistant tuberculosis. Clinical detection of drug resistant tuberculosis requires a high index of suspicion by the clinician based in the information obtained from clinical records and the patient’s medical history. Underlying drug resistance must be considered in patients who have been previously treated for TB, especially if there is a history of inadequate treatment regimen, in patients who are not showing significant clinical improvement or lack of bacteriological conversion, in contacts of a known drug resistant case and in chronic cases with a history of multiple treatment regimens. Required information includes a detailed clinical history of past tuberculosis episodes, name, dose and time a particular drug was taken by the patient, adverse reactions while under treatment, previous image studies for comparison purposes and all previous bacteriological studies available from clinical or laboratory records. The initial evaluation must include a thorough physical examination and basic laboratory tests (hemogram, blood chemistry, viral panel for hepatitis and HIV), audiometry, new chest x-rays and obtaining appropriate samples for complete bacteriological studies.