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Issue link: https://eguideline.guidelinecentral.com/i/847015
9 S, strong ; C, conditional; H, high; M, moderate; L, low; VL, very low quality of evidence ➤ The panel suggests flexible bronchoscopic sampling, rather than no bronchoscopic sampling, in adults with suspected miliary TB and no alternative lesions that are accessible for sampling whose induced sputum is AFB smear microscopy negative or from whom a respiratory sample cannot be obtained via induced sputum (C-VL). Remarks: Bronchoscopic sampling in patients with suspected miliary TB should include bronchial brushings and/or transbronchial biopsy, as the yield from washings is substantially less and the yield from BAL unknown. For patients in whom it is important to provide a rapid presumptive diagnosis of tuberculosis (ie, those who are too sick to wait for culture results), transbronchial biopsies are both necessary and appropriate. ➤ The panel suggests that cell counts and chemistries be performed on amenable fluid specimens collected from sites of suspected extrapulmonary TB (C-VL). Remarks: Specimens that are amenable to cell counts and chemistries include pleural, cerebrospinal, ascitic, and joint fluids. ➤ The panel suggests that adenosine deaminase levels be measured, rather than not measured, on fluid collected from patients with suspected pleural TB, TB meningitis, peritoneal TB, or pericardial TB (C-L). ➤ The panel suggests that free IFN-γ levels be measured, rather than not measured, on fluid collected from patients with suspected pleural TB or peritoneal TB (C-L). ➤ The panel suggests that AFB smear microscopy be performed, rather than not performed, on specimens collected from sites of suspected extrapulmonary TB (C-VL). Remarks: A positive result can be used as evidence of extrapulmonary TB and guide decision making because false-positive results are unlikely. However, a negative result may not be used to exclude TB because false-negative results are exceedingly common. ➤ The panel recommends that mycobacterial cultures be performed, rather than not performed, on specimens collected from sites of suspected extrapulmonary TB (S-L). Remarks: A positive result can be used as evidence of extrapulmonary TB and guide decision making because false-positive results are unlikely. However, a negative result may not be used to exclude TB because false-negative results are exceedingly common. ➤ The panel suggests that NAAT be performed, rather than not performed, on specimens collected from sites of suspected extrapulmonary TB (C-VL). Remarks: A positive NAAT result can be used as evidence of extrapulmonary TB and guide decision making because false-positive results are unlikely. However, a negative NAAT result may not be used to exclude TB because false-negative results are exceedingly common. At present, NAAT testing on specimens other than sputum is an off-label use of the test.