TB Testing in Febrile Patients

When to Suspect TB in Febrile Patients

The Centers for Disease Control and Prevention recommends that fever is a recognized symptom of active TB, but it must be interpreted in the appropriate clinical context, particularly when accompanied by night sweats, weight loss, anorexia, or hemoptysis 1, 2, 3
The index of suspicion should be substantially elevated in high-prevalence areas and high-risk populations including HIV-infected individuals, immunosuppressed patients, foreign-born persons from endemic countries, homeless individuals, prisoners, and those with diabetes or silicosis 1, 3

The Centers for Disease Control and Prevention states that chest radiography is essential for all patients with suspected TB, regardless of TST results 1, 3, 2
The World Health Organization recommends that three sputum specimens on different days should be collected for acid-fast bacilli (AFB) smear microscopy and mycobacterial culture, which is the gold standard for diagnosis 5, 2
The Centers for Disease Control and Prevention advises that TST/PPD should be performed concurrently, but a negative result does not rule out active TB, especially in immunocompromised or HIV-infected patients who may have false-negative skin tests 4, 3

The Centers for Disease Control and Prevention recommends that any HIV-infected patient with fever and cough >2-3 weeks requires immediate TB evaluation, including TST, chest radiograph, and sputum studies 4, 3
The World Health Organization suggests that treat for latent TB infection regardless of TST result once active disease is excluded in HIV-infected contacts of TB cases 3, 6
The American Thoracic Society states that when fever occurs with cough PLUS night sweats, hemoptysis, and/or weight loss, the likelihood of pulmonary TB increases substantially and warrants immediate screening with sputum studies and chest imaging 7, 2