Original diagnosis

Possibilities sputum smear-negative PTB

incorrect diagnosis e.g. other pathogens, heart failure, chronic obstructive airways disease sputum smear-positive PTB

patient not adherent to anti-TB treatment; drug-resistant TB; superimposed infection with other pathogens.

The flow chart shows the management approach in HIV-positive PTB patients who fail to respond or deteriorate while on anti-TB treatment.

sputum induction using 3-5% hypertonic saline may be helpful smear for AFB

positive after 5 months re-treatment regimen sputum test

TB culture patient fails to respond, or deteriorates, on TB treatment take sputum sample and do CXR

CXR result

Gram stain and culture for bacterial pathogens diffuse interstitial shadowing (sputum

AFB negative)

new cavities (sputum

AFB negative)

treatment

drug

bacterial

Pneumocystis

Nocardia

failure

resistance

pneumonia

carinii pneumonia

suspected

ill refer to specialist centre antibiotics (see below)

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