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Doctor to review chest X-RayIntrathoraciclymphadenopathyMiliary TBPleural effusionConfirm with tap.Any lung opacification/scan be TB in HIV patientUpper lobecavitationPericardial effusionDoctor decision about chest X-RayChest X-Ray similar to X-Ray above Chest X-Ray normal Chest X-Ray different to above or unsureDiagnose TB on basis of chest X-Ray.• Give routine TB care and start TB treatmentsame day 57.• Send one spot sputum specimen for smearmicroscopy.• Register as smear negative or positivedepending on microscopy result.• Look for extra-pulmonary TB. If diagnosed, give routine TB care 57:--If patient has abdominal pain, swelling or diarrhoea refer forabdominal ultrasound.--If patient has headache, refer for lumbar puncture.--If patient has lymphnode ≥ 2cm, aspirate for TB and cytology 5.• Look for other cause of cough 16.• Give antibiotics if not yet given: amoxicillin 3 1g 8 hourly for 5 days.• Ask patient to return in 1 week for review and LPA 1 or DST 2 results if taken.Drug sensitiveDrug resistant (DR)Culture negative or still pendingDiagnose TB• Give routine TB care and start TBtreatment same day 57.• Send one spot sputum specimen forsmear microscopy.• Register as smear negative or positivedepending on microscopy result.Diagnose DR-TBRefer to DR-TB unit.• If symptoms persist: Refer forexperienced TB clinician review.• If culture negative and symptomsresolve: advise to return ifsymptoms recur.Do not discharge from workupuntil TB excluded.1Line Probe Assay detects TB drug resistance and is quicker than culture and DST. 2 Drug susceptibility testing.3If penicillin-allergic: erythromycin 500mg 6 hourly for 5 days.TB56