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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The doctor will complete the following tests to diagnose tuberculosis. You may not be hospitalized for either the initial tests or the beginning of treatment.

• Chest X-ray: The most common diagnostic test that leads to the suspicion of infection is a chest X-ray.
• In primary TB, an X-ray will show an abnormality in the mid and lower lung fields, and lymph nodes may be enlarged.
• Reactivated TB bacteria usually infiltrate the upper lobes of the lungs.
• Miliary tuberculosis exhibits diffuse nodules at different locations in the body.
• The Mantoux skin test also known as a tuberculin skin test (TST or PPD test): This test helps identify people infected with M. tuberculosis but who have no symptoms. A doctor must read the test.
• The doctor will inject 5 units of purified protein derivative (PPD) into your skin. If a raised bump of more than 5 mm (0.2 in) appears at the site 48 hours later, the test may be positive.
• This test can often indicate disease when there is none (false positive). Also, it can show no disease when you may in fact have TB (false negative).
• QuantiFERON-TB Gold test: This is a blood test that is an aid in the diagnosis of TB. This test can help detect active and latent tuberculosis. The body responds to the presence of the tuberculosis bacteria. By special techniques, the patient's blood is incubated with proteins from TB bacteria. If the bacteria is in the patient, the immune cells in the blood sample respond to these proteins with the production of a substance called interferon-gamma (IFN-gamma). This substance is detected by the test. If someone had a prior BCG vaccination (a vaccine against TB given in some countries but not the U.S.) and a positive skin test due to this, the QuantiFERON-TB Gold test will not detect any IFN-gamma.
• Sputum testing: Sputum testing for acid-fast bacilli is the only test that confirms a TB diagnosis. If sputum (the mucus you cough up) is available, or can be induced, a lab test may give a positive result in up to 30% of people with active disease.
• Sputum or other bodily secretions such as from your stomach or lung fluid can be cultured for growth of mycobacteria to confirm the diagnosis.
• It may take one to three weeks to detect growth in a culture, but eight to 12 weeks to be certain of the diagnosis.

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