From Tuberculosis › Chapter 7: Case definitions · Médecins Sans Frontières, Current online edition
Case definitions for confirmed and non-confirmed tuberculosis based on bacteriological and biomarker testing.
- Issuer
- Médecins Sans Frontières
- Edition
- Current online edition
- Audience
- Clinicians and public health professionals managing tuberculosis
- Reviewed
- 22 Oct 2026 · GMJ
What this guideline says
GMJ summary
This section from the MSF Tuberculosis guideline establishes standardised case definitions for tuberculosis based on bacteriological status. It distinguishes between confirmed TB cases—defined by positive bacteriological tests (molecular test, microscopy or culture) or, in HIV-infected patients, a positive lateral flow urine lipoarabinomannan assay (LF-LAM)—and non-confirmed TB cases.
The guideline notes that whilst LF-LAM is technically a biomarker detection test rather than a bacteriological test, WHO recommends recording patients with positive LF-LAM results as bacteriologically confirmed TB cases. Non-confirmed TB cases are those for whom a clinician has decided to prescribe a full course of TB treatment despite not meeting bacteriological confirmation criteria.
Key points
For clinicians — doses and thresholds as stated in the guideline
- A confirmed TB case is defined as a patient with a positive bacteriological test result (molecular test, microscopy or culture)
- HIV-infected patients with a positive lateral flow urine lipoarabinomannan assay (LF-LAM) result are also classified as confirmed TB cases
- LF-LAM is a biomarker detection test, not a bacteriological test, but WHO recommends recording positive results as bacteriologically confirmed TB
- A non-confirmed TB case is a patient who does not meet confirmation criteria but for whom a clinician has decided to prescribe a full course of TB treatment
- The definitions align with WHO's definitions and reporting framework for tuberculosis (2013 revision, updated 2020)
From the guideline
Verbatim
“Patient with a positive bacteriological test (molecular test, microscopy or culture) result.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia, I recognise that standardised TB case definitions are essential for accurate surveillance and programme evaluation in our national TB programme. Georgia has made considerable progress in TB control, but consistent application of these definitions—particularly regarding LF-LAM use in our HIV co-infected population—requires strengthening of diagnostic capacity and inter-programme coordination. I would emphasise to Georgian clinicians the importance of the non-confirmed case category: clinical judgment remains crucial when bacteriological confirmation is unattainable, but this decision must be documented clearly. The main implementation challenge will be ensuring LF-LAM availability and appropriate use in HIV care settings across all regions, not only in Tbilisi.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 22 Oct 2026
Applicability
Georgia and the South Caucasus
These standardised case definitions are directly applicable to Georgia’s National TB Programme, which manages approximately 1,500–2,000 TB cases annually. Georgian TB programmes should ensure consistent application of these definitions across diagnostic laboratories and clinical sites, particularly regarding LF-LAM use in HIV co-infected patients. Implementation requires coordination between TB and HIV services, adequate supply of diagnostic tests including LF-LAM for HIV-positive patients, and training of clinicians on classification criteria for non-confirmed cases requiring empirical treatment.
Questions this guideline answers
Quick answers
What tests qualify for bacteriologically confirmed TB?
A confirmed TB case requires a positive result from molecular testing, microscopy, or culture. In HIV-infected patients, a positive lateral flow urine lipoarabinomannan assay (LF-LAM) also qualifies.
When should a patient be classified as a non-confirmed TB case?
When bacteriological tests are negative or unavailable, but a clinician has decided based on clinical judgment to prescribe a full course of TB treatment.
Is LF-LAM considered a bacteriological test?
No, LF-LAM is a biomarker detection test, not a bacteriological test. However, WHO recommends recording patients with positive LF-LAM results as bacteriologically confirmed TB cases for reporting purposes.
Can LF-LAM be used for all TB patients?
According to this guideline section, LF-LAM is specifically mentioned for use in HIV-infected patients with TB, not for the general TB population.
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Same guideline
- High-risk groups — MSF TuberculosisChapter 6: Screening for active tuberculosis
- MSF Tuberculosis: Chapter 6.1 Introduction — Screening for active tuberculosis — MSF TuberculosisChapter 6: Screening for active tuberculosis
- Guidance for using diagnostic algorithm for pulmonary tuberculosis — MSF TuberculosisChapter 5: Diagnostic algorithm for pulmonary tuberculosis in symptomatic adolescents and adults
- Diagnostic approach — MSF TuberculosisChapter 4: Diagnosis of active tuberculosis in children
- Diagnosis of Active Tuberculosis in Children: Introduction — MSF TuberculosisChapter 4: Diagnosis of active tuberculosis in children
- Other investigations — MSF TuberculosisChapter 3: Diagnosis and follow-up investigations
Other guidelines on this topic
- High-risk groups — MSF Tuberculosis
- MSF Tuberculosis: Chapter 6.1 Introduction — Screening for active tuberculosis — MSF Tuberculosis
- Guidance for using diagnostic algorithm for pulmonary tuberculosis — MSF Tuberculosis
- Diagnostic approach — MSF Tuberculosis
- Diagnosis of Active Tuberculosis in Children: Introduction — MSF Tuberculosis
- Issuer
- Médecins Sans Frontières
- Guideline
- Tuberculosis
- Chapter
- Chapter 7: Case definitions
- Type
- Clinical guideline (chapter)
- Edition
- Current online edition
- Status
- Current
- Published
- 2026-10-14
- Scope
- Case definitions for tuberculosis based on bacteriological status
- Audience
- Clinicians and public health professionals managing tuberculosis
- Record history
- Created 22 Oct 2026 · updated 22 Oct 2026 · next check Apr 2027
Médecins Sans Frontières. 7.2 Bacteriological status. In: Tuberculosis [guideline]. Paris: MSF; 2026 [cited 2026 Oct 14]. Available from: https://medicalguidelines.msf.org/en/viewport/TUB/english/chapter-7-case-definitions-16688569.htmlGMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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