Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children

Abstract

Background Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain. Methods A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional. Conclusions These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.

Pneumonia in the tropics

“…66 Sputum induction is more cost effective than bronchoscopic examination and should be the test of choice if smear-negative pulmonary TB is the most likely diagnosis. 66,67 Chew et al have demonstrated that, in an intermediate burden setting where clinicians may be reluctant to start expectant treatment, the testing of Xpert MTB/RIF assay can help facilitate diagnostic yield and early treatment decisions in patients with pulmonary TB. 68 We must also consider that in certain settings, it is common to lack access to high-quality chest roentgenograms and people who can reliably interpret them, and there may not be access to the Xpert MTB/RIF assay.…”

False-Positive Tuberculin Skin Test Results Among Low-Risk Healthcare Workers Following Implementation of Fifty-Dose Vials of Purified Protein Derivative

“…These results also provide another demonstration of the potential pitfalls of serial TB screening in a low-risk population. When the prevalence of a disease in the population is low (e.g., <1%) and the performance characteristics of screening tests are poor, 4 most positive tests are falsely positive. 3,10 Annual TB screening programs should be modified to eliminate automatic annual LTBI testing for low-risk, previously negative HCWs and could instead be structured to carefully evaluate individual exposure risks and personal health history.…”

“…4 Additionally, any HCWs exposed to a patient with pulmonary TB prior to the institution of airborne precautions are evaluated with a postexposure TST. 4 All positive TST results are followed up with a clinical exam and chest radio-graph to evaluate for active TB disease.…”

A journey through infectious risk associated with ruxolitinib

“…According to international guidelines (Lewinsohn et al, 2017), there are insufficient data to recommend a preference for either a TST or an IGRA as the first-line diagnostic test in immunocompromised patients: it has been suggested that a combined TST-IGRA test is probably the best way to improve sensitivity, particularly when the consequences of missing a case of LTBI exceed the risk of adverse events related to the treatment, mostly liver toxicity (Anibarro & Pena, 2014;Lewinsohn et al, 2017).…”