When should I consider referring a patient with suspected active TB to a specialist for further evaluation?

Consider referring a patient with suspected active tuberculosis (TB) to a specialist for further evaluation:

• If the patient is highly symptomatic, systemically unwell, or has complex social needs such as homelessness, arrange hospital admission or urgent referral to the local multidisciplinary TB team depending on clinical judgement.
• If hospital admission is not required, arrange urgent referral to the local multidisciplinary TB team to confirm diagnosis and manage ongoing care without waiting for culture results when symptoms strongly suggest active TB.
• If the patient has known active or latent TB but has not completed treatment as planned (e.g., interrupted or stopped due to adverse effects or complex needs), refer urgently for specialist re-assessment and treatment re-establishment.
• Refer all patients with suspected active TB to a clinician with training and experience in TB care once diagnosis is suspected or confirmed.
• Consider rapid diagnostic nucleic acid amplification tests (NAATs) and specialist investigations (e.g., sputum induction, bronchoscopy, CT/MRI) that are not available in primary care, which require specialist input.
• Refer patients with suspected drug-resistant TB or risk factors for multidrug-resistant TB (previous treatment, contact with MDR-TB case, or birth/residence in high MDR-TB prevalence countries) promptly to specialist teams for appropriate testing and management.
• Children with suspected active TB should be managed or referred to paediatricians with TB expertise.

Do not delay specialist referral by waiting for culture results if clinical suspicion is high. TB is a notifiable disease, and specialist teams coordinate diagnosis, treatment, contact tracing, and public health measures.

These referral criteria ensure timely diagnosis, appropriate treatment initiation, and management of complex cases, including drug resistance and extrapulmonary TB.

NICE CKS,NICE NG33