02.03 Resp
02.03 Respiratory [PDF link]: Tuberculosis (TB), RIPE – rifampicin, isoniazid, pyrazinamide, ethambutol, Cystic fibrosis (CF), Sarcoidosis, Alpha-1 antitrypsin deficiency (AATD)
More on tuberculosis
NICE guideline NG33, last updated Feb 2024
More specific guidance on specific populations including healthcare workers, migrants, children, pregnant women, etc.
Sputum smears aren’t specifically mentioned as a means of diagnosing TB, but they are mentioned in Passmed and other resources. They are commonly done because they are quick and inexpensive.
For reference – testing for TB [based on my clinical experience]
TB blood cultures = 2-3x citrate (blue or green) bottles
If you send standard blood cultures the lab cannot culture for TB
TB IGRA = 4x quantiferon bottles, or citrate bottles work as well
TB PCR can be asked for in almost any kind of sample (including sputum, broncheolaveolar lavage, faeces, CSF, urine, etc)
If a patient is having an ultrasound biopsy with consideration for TB, indicate on request that samples should be sent to Microbiology (and not only to histopathology)!
More on cystic fibrosis
NICE guideline NG78, published Oct 2017
More on sarcoidosis
No specific NICE guideline on sarcoidosis, but there is a NICE CKS page on this
Lofgren syndrome
Distinct phenotype of sarcoidosis – an acute form characterised by erythema nodosum, migratory polyarthritis, and hilar lymphadenopathy (as opposed to the more insidious/slow-onset course of sarcoidosis)
See nice case presentation with photos: Hassan M. Löfgren’s Syndrome. N Engl J Med 2025;393:389–389. https://doi.org/10.1056/NEJMicm2501706.
Heerfordt syndrome
Sarcoidosis causing parotid enlargement, fever and uveitis.
More on alpha-1 antitrypsin deficiency
No NICE guideline on AATD. I have based most of the information from BMJ Best Practice which itself sources guidelines from EASL.
