During the physical exam, your doctor will check your lymph nodes for swelling and use a stethoscope to listen to the sounds your lungs make when you breathe.
The most commonly used diagnostic tool for tuberculosis is a skin test, though blood tests are becoming more commonplace. A small amount of a substance called tuberculin is injected just below the skin on the inside of your forearm. You should feel only a slight needle prick.
Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site. A hard, raised red bump means you're likely to have TB infection. The size of the bump determines whether the test results are significant.
Results can be wrong
The TB skin test isn't perfect. Sometimes, it suggests that people have TB when they don't. It can also indicate that people don't have TB when they do.
You can have a false-positive result if you've been vaccinated recently with the bacille Calmette-Guerin (BCG) vaccine. This tuberculosis vaccine is seldom used in the United States but is widely used in countries with high TB infection rates.
False-negative results also can occur.
Blood tests can confirm or rule out latent or active tuberculosis. These tests measure your immune system's reaction to TB bacteria.
These tests require only one office visit. A blood test might be useful if you're at high risk of TB infection but have a negative response to the skin test, or if you've recently received the BCG vaccine.
If you've had a positive skin test, your doctor is likely to order a chest X-ray or a CT scan. This might show white spots in your lungs where your immune system has walled off TB bacteria, or it might reveal changes in your lungs caused by active tuberculosis.
If your chest X-ray shows signs of tuberculosis, your doctor might take samples of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria.
Sputum samples can also be used to test for drug-resistant strains of TB. This helps your doctor choose the medications that are most likely to work. Getting results of these tests can take four to eight weeks.