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screening for tuberculosis

Indications: 1) contacts of persons with tuberculosis 2) immigrants from Asia, Africa, Latin America, Eastern Europe, Russia* - people born in or who frequently travel to countries where TB is common (Mexico, Philippines, Vietnam, India, China, Haiti, Guatemala ... other) [4,5] 3) health care workers who care for high-risk patients - baseline TB screening [8] - individual TB risk assessment. - for clinicians without latent TB (& when there's no known exposure or evidence of ongoing TB transmission), routine serial screening is no longer recommended [8] 4) admission to skilled nursing facility or long-term care facility 5) medically underserved, low-income populations 6) injection drug use 7) high-risk communal facilities - homeless shelters - correctional facilities [1] * > 50% foreign-borne people with active TB infection were born in Mexico, the Philippines, Vietnam, India, or China [4] * CDC recommends screening of all foreign-born residents regardless of the time since U.S. arrival [6] Procedure: - tuberculin skin testing - may be preferable in low-risk populations [3] - 2-step PPD for elderly patient discharged to a skilled nursing facility after hospitalization [9] - tuberculin-induced IFN-gamma release - preferred method of tuberculosis screening for patients who have received BCG either as vaccine or as cancer chemotherapy - preferred method for HIV-negative, non-U.S.-born residents [7] - preferred method for patients unlikely to return (i.e. homeless, IV drug users) [1] - if person is from a highly TB-endemic region, especially if recently immigrated, & about to start immunosuppressive agent, both tuberculin skin testing & tuberculin-induced IFN-gamma release recommended [10] - if patient was exposed to an active case of TB, 8-10 weeks may be necessary for a response to tuberculin-induced IFN-gamma release - if 2 weeks after exposure, IFN-gamma release is indeterminant or negative, the test should be repeated in 8 weeks* - chest X-ray reserved for positive IFN-gamma release (see exposure to tuberculosis) - if tuberculin skin testing or tuberculin-induced IFN-gamma release is positive, chest X-ray to distinguish latent tuberculosis from active tuberculosis * no confirmed cases of active tuberculosis resulting from exposure on a commercial aircraft Radiology: - chest X-ray is screening modality if - prior history of treated latent tuberculosis or active tuberculosis - prior positive tuberculin skin testing or tuberculin-induced IFN-gamma release - chest X-ray indicated to rule out active tuberculosis if positive test, repeat testing in 8-10 weeks Management: - screening for HIV1 (all patients with active or latent tuberculosis) [1] - see tuberculosis & chemoprophylaxis for tuberculosis

Related

chemoprophylaxis for tuberculosis tuberculosis

Specific

screening for pulmonary tuberculosis tuberculin-skin testing (TST)

General

screening for bacterial infection

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021
  2. Mazurek GH, Jereb J, Vernon A, LoBue P et al Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010. MMWR Recomm Rep. 2010 Jun 25;59(RR-5):1-25. PMID: 20577159 corresponding NGC guideline withdrawn Jan 2016
  3. McMullen SE et al. Performance of QuantiFERON-TB Gold and tuberculin skin test relative to subjects' risk of exposure to tuberculosis. Clin Infect Dis 2014 May 1; 58 PMID: 24585559 http://cid.oxfordjournals.org/content/58/9/1260
  4. U.S. Preventive Services Task Force (USPSTF) Latent Tuberculosis Infection: Screening Draft Recommendation Statement. March 2016 http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement144/latent-tuberculosis-infection-screening
  5. US Preventive Services Task Force Screening for Latent Tuberculosis Infection in Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(9):962-969 PMID: 2759933 http://jama.jamanetwork.com/article.aspx?articleid=2547762 - Kahwati LC, Feltner C, Halpern M et al Primary Care Screening and Treatment for Latent Tuberculosis Infection in AdultsEvidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;316(9):970-983 PMID: 26897342 http://jama.jamanetwork.com/article.aspx?articleid=2547761 - Blumberg HM, Ernst JD The Challenge of Latent TB Infection JAMA. 2016;316(9):931-933 PMID: 27599327 http://jama.jamanetwork.com/article.aspx?articleid=2547733 - US Preventive Services Task Force Screening for Latent Tuberculosis Infection in Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(17):1487-1494 PMID: 37129649 https://jamanetwork.com/journals/jama/fullarticle/2804319 - Jonas DE, Riley SR, Lee LC et al Screening for Latent Tuberculosis Infection in Adults. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2023;329(17):1495-1509 PMID: 37129650 https://jamanetwork.com/journals/jama/fullarticle/2804320
  6. Tsang CA, Langer AJ, Navin TR, Armstrong LR. Tuberculosis Among Foreign-Born Persons Diagnosed >= 10 Years After Arrival in the United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2017;66:295-298 https://www.cdc.gov/mmwr/volumes/66/wr/mm6611a3.htm
  7. Tasillo A, Salomon JA, Trikalinos TA et al. Cost-effectiveness of testing and treatment for latent tuberculosis infection in residents born outside the United States with and without medical comorbidities in a simulation model. JAMA Intern Med 2017 Oct 16; [e-pub]. PMID: 29049814 - Flood J, Barry PM. Mainstreaming latent tuberculosis infection testing and treatment in the United States: Who and how. JAMA Intern Med 2017 Oct 16; PMID: 29049821
  8. Sosa LE, Njie GJ, Lobato MN, et al. Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. MMWR Morb Mortal Wkly Rep 2019;68:439-443 https://www.cdc.gov/mmwr/volumes/68/wr/mm6819a3.htm
  9. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  10. Sax PE Five Quick Questions from Our Course " ID in Primry Care" HIV and ID Observations. Nov 7, 2022 https://blogs.jwatch.org/hiv-id-observations/index.php/five-quick-questions-from-our-course-id-in-primary-care/2022/11/07/