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Guide for Primary Health Care Providers: Targeted
Tuberculin Testing and Treatment of Latent Tuberculosis Infection 2005
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Appendix A
Sample TB Risk Assessment Tool
Persons with any of the following risk factors are candidates for
tuberculin testing, unless there is written documentation of a previous
positive TST or QFT.
Risk Factor |
Yes |
No |
Recent close or prolonged contact with someone
with infectious TB disease |
|
|
Foreign-born person from or recent traveler to
high-prevalence area |
|
|
Chest radiographs with fibrotic changes suggesting
inactive or past TB |
|
|
HIV infection |
|
|
Organ transplant recipient |
|
|
Immunosuppression secondary to use of prednisone
(equivalent of ≥ 15 mg/day for ≥ 1 month) or other
immunosuppressive medication such as TNF-α antagonists
|
|
|
Injection drug user |
|
|
Resident or employee of high-risk congregate setting
(e.g., prison, LTC facility, hospital, homeless shelter) |
|
|
Medical conditions associated with risk of progressing
to TB disease if infected (e.g., diabetes mellitus, silicosis,
cancer of head or neck, Hodgkin’s disease, leukemia, and end-stage
renal disease, intestinal bypass or gastrectomy, chronic malabsorption
syndrome, low body weight [10% or more below ideal for given
population]) |
|
|
Signs and symptoms of TB |
|
|
Adapted from a form developed by Minnesota Department of Health
TB Prevention and Control Program
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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