This chapter deals with the clinical diagnosis of drug resistant tuberculosis.
Clinical detection of drug resistant tuberculosis requires a high index of suspicion by
the clinician based in the information obtained from clinical records and the patient’s
medical history. Underlying drug resistance must be considered in patients who have
been previously treated for TB, especially if there is a history of inadequate treatment
regimen, in patients who are not showing significant clinical improvement or lack of
bacteriological conversion, in contacts of a known drug resistant case and in chronic
cases with a history of multiple treatment regimens. Required information includes a
detailed clinical history of past tuberculosis episodes, name, dose and time a particular
drug was taken by the patient, adverse reactions while under treatment, previous image
studies for comparison purposes and all previous bacteriological studies available from
clinical or laboratory records. The initial evaluation must include a thorough physical
examination and basic laboratory tests (hemogram, blood chemistry, viral panel for
hepatitis and HIV), audiometry, new chest x-rays and obtaining appropriate samples for
complete bacteriological studies.
