Abstracts e147 presentation are unknown; it is possible that the immature immune response of children < 2 years is dysregulated and over-produces pro-inflammatory cytokines resulting in systemic symptoms. Whereas in older children, the mature host cellular immune response may be sufficient to contain the organism in granulomas with minimal systemic signs or symptoms. Further research is needed to understand the effect of age and immune response to M. tuberculosis. Background: Tuberculosis is a

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... ajor contributor to disease burden in developing countries; it is considered the second fatal disease all over the world and the third most important public health problem in Egypt. The direct causes of increasing the burden of tuberculosis are the inconsistent and fragmented health services. The nursing interventions of tuberculosis in community settings require system of recommendation that ensures the consistency of care. The present study aimed at provid a valid clinical guideline that assist nurses to intervene consistently to the newly diagnosed pulmonary tuberculosis patient. Methods: The needs analysis of community health nurses working in out patient chest clinics in addition to the expectation of newly diagnosed pulmonary tuberculosis patient regarding nursing interventions. The guideline development process established according to the criteria of experts of guideline development organizations. The Scottish Intercollegiate Guidelines Network (Sign) research appraisal tools were used for the critical appraisal phase of the obtained evidence. AGREE instrument was used for assessing the internal validity of the guideline. The guideline and apprised for internal validity by academic nursing and medical staff, nursing, and medical practitioners. Results: The scores of all appraisers in relation to scope and Purpose, stakeholder involvement, rigour of development ranged from (62.9-77.7%, 53.5-77.7%, and 66.6-76.2%), respectively. While the scores for the clarity and presentation were 50-76.4, applicability were 61.9-68.5, and editorial independence were 88-93. The four groups of revision strongly recommended the application of the guideline. Conclusion: In conclusion, the developed guideline based on the needs of the intended users of nurses and end points beneficiaries, i.e., patients. It was strongly recommended by the reviewers and stockholders to be used in the outpatients chest clinics. It is recommended that the guideline should disseminate to the authoritative level to be applied in the chest out patient clinics and evaluated for applicability and achieved outcomes.