LATENT TUBERCULOSIS INFECTION: APPROACH TO THE POSITIVE TUBERCULIN SKIN TEST RESULT

Posted on December 28, 2010, under Anti-Infectives.

If a patient’s tuberculin skin testing is positive, that patient should be considered a candidate for treatment of latent tuberculosis infection. However, the possibility of active tuberculosis should first be ruled out prior to the initiation of treatment. A chest radiograph should be obtained to evaluate for active disease. Patients with chest radiograph findings suggestive of prior, healed tuberculosis should have three consecutive sputum samples obtained to evaluate for active disease. Sputum is not routinely obtained in the absences of chest radiograph changes.

The clinician should also consider the possibility of coexisting HIV infection, and testing should be recommended, if appropriate. In the presence of active pulmonary tuberculosis, patients with HIV may have either an abnormal appearance on chest radiograph or a normal chest radiograph. Thus, HIV patients with respiratory symptoms should have a sputum sample taken for testing, even with a normal chest radiograph. Evaluating a patient with a positive tuberculin skin test should also include determining whether there were preexisting medical conditions or medical regimens that would be a contraindication to treatment. In addition, information about prior medical therapy for tuberculosis infection should also be obtained.

*55/348/5*

LATENT TUBERCULOSIS INFECTION: APPROACH TO THE POSITIVE TUBERCULIN SKIN TEST RESULTIf a patient’s tuberculin skin testing is positive, that patient should be considered a candidate for treatment of latent tuberculosis infection. However, the possibility of active tuberculosis should first be ruled out prior to the initiation of treatment. A chest radiograph should be obtained to evaluate for active disease. Patients with chest radiograph findings suggestive of prior, healed tuberculosis should have three consecutive sputum samples obtained to evaluate for active disease. Sputum is not routinely obtained in the absences of chest radiograph changes.The clinician should also consider the possibility of coexisting HIV infection, and testing should be recommended, if appropriate. In the presence of active pulmonary tuberculosis, patients with HIV may have either an abnormal appearance on chest radiograph or a normal chest radiograph. Thus, HIV patients with respiratory symptoms should have a sputum sample taken for testing, even with a normal chest radiograph. Evaluating a patient with a positive tuberculin skin test should also include determining whether there were preexisting medical conditions or medical regimens that would be a contraindication to treatment. In addition, information about prior medical therapy for tuberculosis infection should also be obtained.*55/348/5*

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