Diagnosing active tuberculosis in primary care

### What you need to know A 58 year old transportation worker in India with uncontrolled diabetes (HbA1c 97 mmol/mol) presents with a three month history of productive cough and decreased energy level. He has been treated empirically for community acquired pneumonia twice without improvement in symptoms. A 24 year old student who arrived in Canada from the Philippines three years ago presents with a two month history of bilateral multiple enlarged cervical lymph nodes. Of the 10 million people who develop active tuberculosis (TB) disease each year, approximately three million are not identified by national TB care programmes and many are undiagnosed.1 Diagnostic delays are common in both low and high resource settings2 and lead to worse individual outcomes and ongoing transmission.34 Patients often see several healthcare providers before the disease is diagnosed.56 TB most commonly presents with pulmonary involvement, but can present in a number of ways, most commonly lymphadenitis, pleural effusions, and …