Guide for Primary Health Care Providers: Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection 2005

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Targeted Tuberculin Testing

Targeted tuberculin testing is an essential TB prevention and control strategy. Finding and treating those with LTBI reduces the number of potential TB cases; however, unfocused testing is not cost-effective or useful. Targeted testing programs should be designed to find persons at high risk for developing TB disease and who would benefit from treatment. Once TB disease has been ruled out, treatment of LTBI should be offered to patients regardless of their age. Tuberculin testing programs should be conducted only among high-risk groups, with the intent to treat if LTBI is detected.

However, there may be instances in which health care providers are asked to test individuals who are not necessarily regarded as high risk (e.g., daycare center workers, teachers, and college students). A few simple questions will help health care providers assess a patient’s risk for LTBI. Appendix A contains a sample risk assessment tool.

The two available methods of testing for M. tuberculosis infection are the tuberculin skin test (TST) and an approved blood test: QuantiFERON^®-TB test and QuantiFERON^®-TB Gold test (QFT).

Identifying Persons at Risk for Developing TB Disease

Generally, persons at high risk for developing TB disease fall into two broad categories: those who have been recently infected and those with clinical conditions that increase the risk of progression from LTBI to TB disease.

The risk of progression is greatest in the first 1 or 2 years after exposure. Persons likely to have been recently infected with M. tuberculosis include the following:

• Close contacts of a person with infectious TB
• Recent TST converters (persons with baseline testing results who have an increase of 10 mm or more in the size of the TST reaction within a 2-year period)
• Persons who have immigrated from TB-endemic regions of the world (see Appendix B)
• Children ≤ 5 years of age who have a positive TST result
• Persons who work or reside in facilities or institutions with people who are at high risk for TB, such as hospitals, homeless shelters, correctional facilities, nursing homes, or residential facilities for patients with AIDS

Also at risk are those with certain conditions associated with progression from LTBI to TB disease. These conditions include

• HIV infection
• Injection drug use
• Radiographic evidence of prior healed TB
• Low body weight (≥ 10% below ideal)
• Other medical conditions, such as silicosis, diabetes mellitus, chronic renal failure or on hemodialysis, gastrectomy, jejunoileal bypass, solid organ transplant, head and neck cancer, and other conditions that require prolonged use of prednisone or other immunosuppressive agents such as TNF-α antagonists.

Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

 
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