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__NOTOC__
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{{Tuberculosis}}
{{Tuberculosis}}
{{CMG}}
{{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}}; {{marjan}}
==Overview==
==Overview==
Screening for tuberculosis is generally done with using a mantoux tuberculin skin test, also known as a tuberculin skin test or a PPD. The test involves injecting a small amount of a purified protein derivative of the tuberculosis bacterium intradermally, and watching for a reaction in the following days.
[[Tuberculosis]] [[Screening (medicine)|screening]] is performed using a [[mantoux tuberculin skin test]], also known as a tuberculin skin test or a [[PPD]]. This test is done by [[intradermal]] [[Injection (medicine)|injection]] of a small amount of a [[Mantoux test|purified protein derivative]] ([[Mantoux test|PPD]]) of the [[tuberculosis]] [[Bacteria|bacterium]] then observing the [[Chemical reaction|reaction]] in the following days.
 
==Screening==
==Screening==
The results of a [[Mantoux tuberculin skin test]] must be interpreted carefully. The person's medical risk factors determine at which increment (5 mm, 10 mm, or 15 mm) of induration the result is considered positive.<ref>From the CDC team of the CDC team at the Saskatchewan Lung Association, [http://www.lung.ca/tb/tbtoday/tbdiagnosis/skin_test.html photos of a PPD bump].</ref> A positive result indicates TB exposure.
===Mantoux Tuberculin Skin Test===
 
*The [[Mantoux tuberculin skin test]] ([[Mantoux test|TST]]) is primarily used to [[evaluate]] a person whether they are [[infected]] with [[Mycobacterium tuberculosis]].
 
*The TST is done by intradermal injection 0.1 ml of [[tuberculin]] purified protein derivative ([[PPD]]) into the inner surface of the forearm.  The injection is done using a [[Tuberculin test|tuberculin]] [[syringe]], with the needle bevel facing upward. In case of a correct injection, it produces a pale elevation of the skin ([[wheal]]) 6 to 10 mm in diameter.
 
*The reaction is read between 48 and 72 hours after administration. If the patient does not return within 72 hours, another [[Mantoux test|TST]] should be rescheduled.
 
*The [[induration]] ([[Palpation|palpable]], raised, [[hardened]] area, or [[swelling]]) should be measured in millimeters not the [[erythema]] (redness), and the diameter of the indurated area is measured across the [[forearm]] (perpendicular to the long axis).
 
*The only [[contraindication]] for TST is in persons who had any severe reaction (e.g., [[necrosis]], [[blister|blistering]], [[anaphylactic shock]], or [[ulcerations]]) to another previous [[Mantoux tuberculin skin test|TST]].
 
*TST is not [[Contraindication|contraindicated]] for any other individuals, including infants, children, pregnant women, [[Human Immunodeficiency Virus (HIV)|HIV]]-infected patients, or individuals who received [[BCG]] vaccination.
 
*In some individuals with with previous [[M. tuberculosis]] infection, the reaction to [[tuberculin]] can wane over time, so if [[Mantoux tuberculin skin test|TST]] is done years after infection, it may yield [[False-negative test result|false-negative]] reaction. However, the [[Mantoux tuberculin skin test|TST]] may activate the immune system, leading to a positive, or boosted reaction to the following tests. Doing a second [[Mantoux test|TST]] after an initial negative TST reaction, that is known as two-step testing, is preferred especially for healthcare workers or nursing home residents (retested periodically).
 
====Classification of Tuberculin Reaction====
Interpretation of [[Mantoux test|TST]] is based on on two elements:
 
*Measurement of the [[induration]] in millimeters.
*The individual’s risk of being [[infected]] with [[Tuberculosis|TB]] and also of progression to disease if infected.
 
<div style="float: right;">
 
{|
| valign="top" |
[[File:Mantoux tuberculin skin test.jpg|thumb|none|300px|Image from Public Health Image Library (PHIL)]]
[[File:Tuberculin Skin Testing2.jpg|thumb|none|300px|Image from Public Health Image Library (PHIL)]]
[[File:Mantoux test.jpg|thumb|none|300px|Image from Public Health Image Library (PHIL)]]
|}</div>
{| style="border: 0px; font-size: 90%; width:700px; margin: 3px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Tuberculin Reaction}}
! style="background: #4479BA; width: 450px;" |{{fontcolor|#FFF|Considered a Positive Result in:}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''≥ 5 mm '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[HIV-positive]] patients
*Recent contacts with TB case
*Individuals with nodular or fibrotic changes on [[CXR]] indicating old healed TB
*[[Organ transplant]] patients and other conditions of [[immunosuppression]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''≥ 10 mm  '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Recent travel (less than 5 years) from endemic countries
*Injection drug users
*Employees or residents of high-risk settings (e.g., nursing homes, hospitals, prisons, or homeless shelters)
*Mycobacteriology lab personnel
*Individuals with high-risk conditions (e.g., [[diabetes]], prolonged [[corticosteroid|corticosteroid therapy]], [[leukemia]], [[end-stage renal disease]], [[malabsorption|chronic malabsorption syndromes]], low body weight)
*Children less than 4 years old, or children and adolescents who are in contact with adults of high-risk categories
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''≥ 15 mm '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Persons with no known risk factors for TB
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<SMALL>Table adapted from CDC<ref name="CDC TST">{{cite web|url= http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm|title= CDC Tuberculin Skin Testing| }}</ref></SMALL>
|}
 
 
{| style="border: 0px; font-size: 90%; width:700px; margin: 3px;" align="center"
|+
! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|False-Positive Reactions}}
! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|False-Negative Reactions}}
|-
| style="padding: 5px 5px; background: #F5F5F5;" |In some cases, some individuals react to the TST positively although they are not infected with M. tuberculosis. The causes of these false-positive reactions involve, but are not limited to, the following:
 
*Infection with [[nontuberculosis mycobacteria]]
*Previous [[BCG]] vaccination
*Incorrect method of TST administration
*Incorrect interpretation of reaction
*Incorrect bottle of antigen used
| style="padding: 5px 5px; background: #F5F5F5;" |
On the other hand, Some individuals do not react to the TST although they are infected with M. tuberculosis. The causes for these false-negative reactions involve, but are not limited to, the following:


*5 mm or more is positive in
*Cutaneous [[anergy]] ([[anergy]] is the inability to react to skin tests because of a weakened [[immune system]])
**[[HIV]]-positive person
*Recent TB infection (within 8-10 weeks of exposure)
**Recent contacts of TB case
*Very old TB infection (many years)
**Persons with [[nodular]] or fibrotic changes on [[chest x-ray]] consistent with old healed TB
*Very young age (less than 6 months old)
**Patients with [[organ transplant]]s and other [[immunosuppressed]] patients
*Recent live-virus vaccination (e.g., [[measles]] and [[smallpox]])
*Overwhelming TB disease
*Some viral illnesses (e.g., [[measles]] and [[chicken pox]])
*Incorrect method of TST administration
*Incorrect interpretation of reaction
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<SMALL>Table adapted from CDC<ref name="CDC TST">{{cite web|url= http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm|title= CDC Tuberculin Skin Testing| }}</ref></SMALL>
|}


*10 mm or more is positive in
===Recommendations for Human Immunodeficiency Virus (HIV) Screening in Tuberculosis Clinics<small><small><small> Adapted from CDC<ref name="CDC HIV"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/testing/HIVscreening.htm| title=CDC Recommendations for Human Immunodeficiency Virus (HIV) Screening in Tuberculosis (TB) Clinics}} </ref></small></small></small>===
**Recent arrivals (less than 5 years) from high-prevalence countries
**Injection drug users
**Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
**[[Mycobacteria|Mycobacteriology]] lab personnel
**Persons with clinical conditions that place them at high risk (e.g., [[diabetes]], prolonged [[corticosteroid]] therapy, [[leukemia]], [[renal failure|end-stage renal disease]], chronic [[malabsorption]] syndromes, low body weight, etc)
**Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories


*15 mm or more is positive in
*According to [[Centers for Disease Control and Prevention|CDC]], [[HIV]] screening is recommended for all [[Tuberculosis|TB]] patients after the patient notification that testing will be done unless the patient defers (i.e., [[opt-out]] [[Screening (medicine)|screening]]). This includes patients with TB disease and with [[latent TB]] infection.
**Persons with no known risk factors for TB
*[[HIV]] testing is also recommended for individuals who are suspected of having [[Tuberculosis|TB]] disease, patients with latent [[Tuberculosis|TB]] infection, and [[contacts]] of [[Tuberculosis|TB]] patients.
** (Note: Targeted skin testing programs should only be conducted among high-risk groups)
*Prevention counseling and separate written consent for [[Human Immunodeficiency Virus (HIV)|HIV]] testing are no longer necessary.
*These recommendations are effective for eliminating missed opportunities for [[HIV]] [[screening]] and reducing significant barriers to [[Human Immunodeficiency Virus (HIV)|HIV]] [[testing]] in health care settings by:


A few important notes about [[Mantoux tuberculin skin test]]s:
:*Using opt-out [[HIV]] screening.
*A tuberculin test conversion is defined as an increase of 10 mm or more within a 2-year period, regardless of age.
:*Annually [[Screening (medicine)|screening]] persons at high risk for [[HIV]].
*[[Mycobacterium avium intracellulare]] ([[MAI]]) or other mycobacterium cause 5 mm induration, but TB is what causes ≥10mm.  
:*No need for separate written [[consent]] for [[HIV]] [[testing]].
* Decision to test is decision to treat.  
:*No need for prevention counseling for [[HIV]] [[screening]].
* If a patient is treated fully, then re-exposed, they should only be retreated if they are [[HIV]] positive (immunocompromised) or the risk of reinfection is high.


====Contact Screening====
*Opt-out [[screening]] refers to performing [[Human Immunodeficiency Virus (HIV)|HIV]] testing after informing the patient that the test will be done, and despite being declined by the patient, it is strongly recommended. Assent is inferred unless the patient defers [[Human Immunodeficiency Virus (HIV)|HIV]] testing.
When someone is diagnosed with tuberculosis, all their close contacts should be screened for TB with a tuberculin skin test or a chest [[x-ray]] or both.
 
===Quantiferon Gold testing===
 
*The early [[Identification of sites|identification]] of  [[Mycobacterium tuberculosis]] infection is a complex issue regarding the [[control]] and [[Prevention (medical)|prevention]] of [[Tuberculosis|TB]].<ref name="urlWHO | Global tuberculosis report 2018, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/tb/publications/global_report/en/ |title=WHO &#124; Global tuberculosis report 2018, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Over several years, the [[Mantoux test|tuberculin skin test]] ([[Mantoux test|TST]]) was the most commonly used test for the diagnosis of [[Tuberculosis|TB]] infection due to its low cost and convenience in most countries.<ref name="pmid27780211">{{cite journal |vauthors=Houben RM, Dodd PJ |title=The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling |journal=PLoS Med. |volume=13 |issue=10 |pages=e1002152 |date=October 2016 |pmid=27780211 |pmc=5079585 |doi=10.1371/journal.pmed.1002152 |url=}}</ref>
*However, [[Mantoux test|PPD]] testing has several [[disadvantages]], including low [[Specificity (tests)|specificity]] in individuals who received the [[BCG vaccine|Bacillus Calmette-Guerin]] ([[BCG]]) [[vaccination]].<ref name="pmid17599309">{{cite journal |vauthors=Detjen AK, Keil T, Roll S, Hauer B, Mauch H, Wahn U, Magdorf K |title=Interferon-gamma release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis |journal=Clin. Infect. Dis. |volume=45 |issue=3 |pages=322–8 |date=August 2007 |pmid=17599309 |doi=10.1086/519266 |url=}}</ref>
*In the last decade, [[interferon gamma release assays]] (IGRAs) have been used to detect Latent Tuberculosis.<ref name="pmid27039307">{{cite journal |vauthors=Lu P, Chen X, Zhu LM, Yang HT |title=Interferon-Gamma Release Assays for the Diagnosis of Tuberculosis: A Systematic Review and Meta-analysis |journal=Lung |volume=194 |issue=3 |pages=447–58 |date=June 2016 |pmid=27039307 |doi=10.1007/s00408-016-9872-5 |url=}}</ref>
*[[Interferon-gamma release assays]] ([[Interferon-γ release assays|IGRAs]]) are [[immunodiagnostics]] techniques that measure [[interferon-gamma]] ([[IFN-γ]]) released by [[T cell|T-cells]] in response to [[Mycobacterium tuberculosis]]-specific antigen.<ref name="pmid17565023">{{cite journal |vauthors=Lalvani A |title=Diagnosing tuberculosis infection in the 21st century: new tools to tackle an old enemy |journal=Chest |volume=131 |issue=6 |pages=1898–906 |date=June 2007 |pmid=17565023 |doi=10.1378/chest.06-2471 |url=}}</ref>
*There are two commercial in vitro [[Interferon-γ release assays|IGRAs]]; including the [[QuantiFERON-TB Gold]] In-Tube (QFT-GIT) test  and [[T-SPOT.TB]] that have been used for for the early detection of [[Mycobacterium tuberculosis|M. tuberculosis]] infection.<ref name="pmid17565023">{{cite journal |vauthors=Lalvani A |title=Diagnosing tuberculosis infection in the 21st century: new tools to tackle an old enemy |journal=Chest |volume=131 |issue=6 |pages=1898–906 |date=June 2007 |pmid=17565023 |doi=10.1378/chest.06-2471 |url=}}</ref>
*[[QuantiFERON-TB Gold]] includes [[proteins]] that are almost exclusively found in [[mycobacterium tuberculosis]].<ref name="pmid21099095">{{cite journal |vauthors=Dilektasli AG, Erdem E, Durukan E, Eyüboğlu FÖ |title=Is the T-cell-based interferon-gamma releasing assay feasible for diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country? |journal=Jpn. J. Infect. Dis. |volume=63 |issue=6 |pages=433–6 |date=November 2010 |pmid=21099095 |doi= |url=}}</ref>
*[[The QuantiFERON-TB Gold]] In-Tube test (QFT-GIT) [[assay]] measures the [[Interferon|IFN]]-γ [[serum]] [[concentration]] following stimulation by specific [[Tuberculosis|TB]] [[Antigen|antigens]].<ref name="pmid21099095">{{cite journal |vauthors=Dilektasli AG, Erdem E, Durukan E, Eyüboğlu FÖ |title=Is the T-cell-based interferon-gamma releasing assay feasible for diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country? |journal=Jpn. J. Infect. Dis. |volume=63 |issue=6 |pages=433–6 |date=November 2010 |pmid=21099095 |doi= |url=}}</ref>
*[[The Quantiferon Gold test]] is used on a large scale in developed countries.<ref name="pmid27039307">{{cite journal |vauthors=Lu P, Chen X, Zhu LM, Yang HT |title=Interferon-Gamma Release Assays for the Diagnosis of Tuberculosis: A Systematic Review and Meta-analysis |journal=Lung |volume=194 |issue=3 |pages=447–58 |date=June 2016 |pmid=27039307 |doi=10.1007/s00408-016-9872-5 |url=}}</ref>
*The ability of [[QFT-GIT]] will be to [[Monitor role|monitor]] the [[Response rate|response]] to [[anti-tuberculosis treatment]] is not fully-understood.<ref name="pmid17448540">{{cite journal |vauthors=Dheda K, Pooran A, Pai M, Miller RF, Lesley K, Booth HL, Scott GM, Akbar AN, Zumla A, Rook GA |title=Interpretation of Mycobacterium tuberculosis antigen-specific IFN-gamma release assays (T-SPOT.TB) and factors that may modulate test results |journal=J. Infect. |volume=55 |issue=2 |pages=169–73 |date=August 2007 |pmid=17448540 |doi=10.1016/j.jinf.2007.02.005 |url=}}</ref>
 
<br />
{| class="wikitable"
|+'''Comparison of 2005 and 2019 recommendations for tuberculosis (TB) screening and testing of U.S. health care personnel (HCP)'''
!Category
!2005 Recommendation
!2019 Recommendation
|-
|'''Baseline (preplacement) screening and testing'''
|TB screening of all HCP, in addition to a symptom evaluation and testing (TST or IGRA) for those without documented previous TB disease or LTBI.
|TB screening of all HCP, in addition to a symptom evaluation and testing (TST or IGRA) for those without documented previous TB disease or LTBI '''(unchanged)'''; individual TB risk assessment '''(new)'''.
|-
|'''Postexposure screening and testing'''
|Symptom evaluation for all HCP if exposure is identified. For HCP having a baseline negative TB test and no previous TB disease or LTBI, do a test (IGRA or TST) when the exposure is detected. If that test is negative, perform another test 8–10 weeks following the last exposure.
|Symptom evaluation for all HCP if exposure is identified. For HCP having a baseline negative TB test and no previous TB disease or LTBI, do a test (IGRA or TST) when the exposure is detected. If that test is negative, perform another test 8–10 weeks following the last exposure '''(unchanged)'''.
|-
|'''Serial screening and testing for HCP without LTBI'''
|According to health care facility and setting risk assessment. Not recommended for HCP working in low-risk health care settings. Recommended for HCP working in medium-risk health care settings and settings with potential ongoing transmission.
|Not routinely recommended '''(new)'''; can consider for selected HCP groups '''(unchanged)'''; recommend annual TB education for all HCP '''(unchanged)''', including information about TB exposure risks for all HCP '''(new emphasis)'''.
|-
|'''Evaluation and treatment of positive test results'''
|Referral to determine whether LTBI treatment is indicated.
|Treatment is encouraged for all HCP with untreated LTBI, unless medically contraindicated '''(new)'''.
|-
| colspan="3" |'''Abbreviations:''' IGRA = interferon-gamma release assay; LTBI = latent tuberculosis infection; TST = tuberculin skin test.
 
 
<nowiki>*</nowiki>Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of ''Mycobacterium tuberculosis'' in health-care settings, 2005. MMWR Recomm Rep 2005;54(No. RR-17). <nowiki>https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm</nowiki>.
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Bacterial diseases]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category: Pulmonology]]
[[Category:Pulmonology]]

Latest revision as of 05:24, 23 March 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; Alejandro Lemor, M.D. [3]; Marjan Khan M.B.B.S.[4]

Overview

Tuberculosis screening is performed using a mantoux tuberculin skin test, also known as a tuberculin skin test or a PPD. This test is done by intradermal injection of a small amount of a purified protein derivative (PPD) of the tuberculosis bacterium then observing the reaction in the following days.

Screening

Mantoux Tuberculin Skin Test

  • The TST is done by intradermal injection 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. The injection is done using a tuberculin syringe, with the needle bevel facing upward. In case of a correct injection, it produces a pale elevation of the skin (wheal) 6 to 10 mm in diameter.
  • The reaction is read between 48 and 72 hours after administration. If the patient does not return within 72 hours, another TST should be rescheduled.
  • TST is not contraindicated for any other individuals, including infants, children, pregnant women, HIV-infected patients, or individuals who received BCG vaccination.
  • In some individuals with with previous M. tuberculosis infection, the reaction to tuberculin can wane over time, so if TST is done years after infection, it may yield false-negative reaction. However, the TST may activate the immune system, leading to a positive, or boosted reaction to the following tests. Doing a second TST after an initial negative TST reaction, that is known as two-step testing, is preferred especially for healthcare workers or nursing home residents (retested periodically).

Classification of Tuberculin Reaction

Interpretation of TST is based on on two elements:

  • Measurement of the induration in millimeters.
  • The individual’s risk of being infected with TB and also of progression to disease if infected.
Image from Public Health Image Library (PHIL)
Image from Public Health Image Library (PHIL)
Image from Public Health Image Library (PHIL)
Tuberculin Reaction Considered a Positive Result in:
≥ 5 mm
≥ 10 mm
  • Recent travel (less than 5 years) from endemic countries
  • Injection drug users
  • Employees or residents of high-risk settings (e.g., nursing homes, hospitals, prisons, or homeless shelters)
  • Mycobacteriology lab personnel
  • Individuals with high-risk conditions (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight)
  • Children less than 4 years old, or children and adolescents who are in contact with adults of high-risk categories
≥ 15 mm
  • Persons with no known risk factors for TB
Table adapted from CDC[1]


False-Positive Reactions False-Negative Reactions
In some cases, some individuals react to the TST positively although they are not infected with M. tuberculosis. The causes of these false-positive reactions involve, but are not limited to, the following:
  • Infection with nontuberculosis mycobacteria
  • Previous BCG vaccination
  • Incorrect method of TST administration
  • Incorrect interpretation of reaction
  • Incorrect bottle of antigen used

On the other hand, Some individuals do not react to the TST although they are infected with M. tuberculosis. The causes for these false-negative reactions involve, but are not limited to, the following:

  • Cutaneous anergy (anergy is the inability to react to skin tests because of a weakened immune system)
  • Recent TB infection (within 8-10 weeks of exposure)
  • Very old TB infection (many years)
  • Very young age (less than 6 months old)
  • Recent live-virus vaccination (e.g., measles and smallpox)
  • Overwhelming TB disease
  • Some viral illnesses (e.g., measles and chicken pox)
  • Incorrect method of TST administration
  • Incorrect interpretation of reaction
Table adapted from CDC[1]

Recommendations for Human Immunodeficiency Virus (HIV) Screening in Tuberculosis Clinics Adapted from CDC[2]

  • According to CDC, HIV screening is recommended for all TB patients after the patient notification that testing will be done unless the patient defers (i.e., opt-out screening). This includes patients with TB disease and with latent TB infection.
  • HIV testing is also recommended for individuals who are suspected of having TB disease, patients with latent TB infection, and contacts of TB patients.
  • Prevention counseling and separate written consent for HIV testing are no longer necessary.
  • These recommendations are effective for eliminating missed opportunities for HIV screening and reducing significant barriers to HIV testing in health care settings by:
  • Opt-out screening refers to performing HIV testing after informing the patient that the test will be done, and despite being declined by the patient, it is strongly recommended. Assent is inferred unless the patient defers HIV testing.

Quantiferon Gold testing


Comparison of 2005 and 2019 recommendations for tuberculosis (TB) screening and testing of U.S. health care personnel (HCP)
Category 2005 Recommendation 2019 Recommendation
Baseline (preplacement) screening and testing TB screening of all HCP, in addition to a symptom evaluation and testing (TST or IGRA) for those without documented previous TB disease or LTBI. TB screening of all HCP, in addition to a symptom evaluation and testing (TST or IGRA) for those without documented previous TB disease or LTBI (unchanged); individual TB risk assessment (new).
Postexposure screening and testing Symptom evaluation for all HCP if exposure is identified. For HCP having a baseline negative TB test and no previous TB disease or LTBI, do a test (IGRA or TST) when the exposure is detected. If that test is negative, perform another test 8–10 weeks following the last exposure. Symptom evaluation for all HCP if exposure is identified. For HCP having a baseline negative TB test and no previous TB disease or LTBI, do a test (IGRA or TST) when the exposure is detected. If that test is negative, perform another test 8–10 weeks following the last exposure (unchanged).
Serial screening and testing for HCP without LTBI According to health care facility and setting risk assessment. Not recommended for HCP working in low-risk health care settings. Recommended for HCP working in medium-risk health care settings and settings with potential ongoing transmission. Not routinely recommended (new); can consider for selected HCP groups (unchanged); recommend annual TB education for all HCP (unchanged), including information about TB exposure risks for all HCP (new emphasis).
Evaluation and treatment of positive test results Referral to determine whether LTBI treatment is indicated. Treatment is encouraged for all HCP with untreated LTBI, unless medically contraindicated (new).
Abbreviations: IGRA = interferon-gamma release assay; LTBI = latent tuberculosis infection; TST = tuberculin skin test.


*Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54(No. RR-17). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm.

References

  1. ↑ 1.0 1.1 "CDC Tuberculin Skin Testing".
  2. ↑ "CDC Recommendations for Human Immunodeficiency Virus (HIV) Screening in Tuberculosis (TB) Clinics".
  3. ↑ "WHO | Global tuberculosis report 2018, SYSTEM DO NOT MOVE OR EDIT".
  4. ↑ Houben RM, Dodd PJ (October 2016). "The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling". PLoS Med. 13 (10): e1002152. doi:10.1371/journal.pmed.1002152. PMC 5079585. PMID 27780211.
  5. ↑ Detjen AK, Keil T, Roll S, Hauer B, Mauch H, Wahn U, Magdorf K (August 2007). "Interferon-gamma release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis". Clin. Infect. Dis. 45 (3): 322–8. doi:10.1086/519266. PMID 17599309.
  6. ↑ 6.0 6.1 Lu P, Chen X, Zhu LM, Yang HT (June 2016). "Interferon-Gamma Release Assays for the Diagnosis of Tuberculosis: A Systematic Review and Meta-analysis". Lung. 194 (3): 447–58. doi:10.1007/s00408-016-9872-5. PMID 27039307.
  7. ↑ 7.0 7.1 Lalvani A (June 2007). "Diagnosing tuberculosis infection in the 21st century: new tools to tackle an old enemy". Chest. 131 (6): 1898–906. doi:10.1378/chest.06-2471. PMID 17565023.
  8. ↑ 8.0 8.1 Dilektasli AG, Erdem E, Durukan E, Eyüboğlu FÖ (November 2010). "Is the T-cell-based interferon-gamma releasing assay feasible for diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country?". Jpn. J. Infect. Dis. 63 (6): 433–6. PMID 21099095.
  9. ↑ Dheda K, Pooran A, Pai M, Miller RF, Lesley K, Booth HL, Scott GM, Akbar AN, Zumla A, Rook GA (August 2007). "Interpretation of Mycobacterium tuberculosis antigen-specific IFN-gamma release assays (T-SPOT.TB) and factors that may modulate test results". J. Infect. 55 (2): 169–73. doi:10.1016/j.jinf.2007.02.005. PMID 17448540.

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