1. Medical History

A medical history includes a patient's social, family, medical, and occupational information. Clinicians should ask patients if they have:

 

• Symptoms of TB disease (for example, unexplained weight loss, night sweats, loss of appetite, fever, fatigue, cough lasting 3 or more weeks, or coughing up blood or sputum)
• Been exposed to a person with infectious TB disease or have risk factors for exposure to TB
• Had latent TB infection or TB disease before (and, if so, whether they completed treatment)
• Any risk factors for developing TB disease (for example, HIV infection, diabetes, substance use [such as injection drug use])

Clinicians should be more likely to consider TB disease as a diagnosis in patients with any of these factors. As noted in Lesson 3: Testing for TB Infection, some people with weaker immune systems, such as those with certain health conditions or who take certain medications, have a higher risk of developing TB disease once infected. For a summary of groups at high risk for TB infection and TB disease, click here.

 

Additionally, because HIV is the strongest known risk factor for progressing to TB disease, collecting a history of HIV status or HIV testing and counseling should be routinely offered to all patients.