Salomé Bellido-Calduch, Department of Pulmonology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
Zoran Stojanovic, Department of Pulmonology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
A considerable proportion of tuberculosis (TB) cases are diagnosed without microbiological confirmation, particularly in early or paucibacillary disease. This review explores the diagnostic and therapeutic approach to non-microbiologically confirmed TB, integrating evidence from recent studies and international guidelines. Patients without microbiological confirmation often have milder symptoms and less extensive radiological findings, reflecting an early stage of disease with lower bacterial load and transmission risk. Radiological tools, mainly chest X-ray and computed tomography, remain essential but lack specificity, emphasizing the need for careful clinical correlation. Empiric anti-TB therapy should be initiated in cases with strong clinical and radiological evidence, followed by close monitoring to confirm response and exclude alternative diagnoses. Emerging technologies, including computer-aided radiological detection and blood-based biomarker assays, may improve diagnostic accuracy in smear-negative or immunocompromised patients. Early recognition and prompt treatment are crucial to reduce morbidity, mortality, and transmission, supporting global TB elimination goals.
