Screening for Tuberculosis

Who Should Be Screened

The Centers for Disease Control and Prevention recommends that all individuals at increased risk for TB should undergo baseline screening with an individual risk assessment, symptom evaluation, and testing with either interferon-gamma release assay (IGRA) or tuberculin skin test (TST), followed by chest radiography if testing is positive to distinguish latent TB infection (LTBI) from active TB disease 1, 2
Close contacts of persons with active pulmonary TB, such as household members and frequent visitors, should be screened for TB 1
Foreign-born persons from high TB burden countries, including Africa, Asia, Eastern Europe, Latin America, and Russia, should be screened for TB 3
Healthcare personnel should be screened for TB at baseline, prior to starting work 1, 2
Persons living with HIV should be screened for TB 4
Patients initiating immunosuppressive therapy, including anti-TNF biologics, rituximab, and corticosteroids, should be screened for TB 3, 4, 5
Patients preparing for organ or hematological transplantation should be screened for TB 4
Patients with chronic kidney disease or on dialysis should be screened for TB 4
Residents of congregate settings, such as correctional facilities, homeless shelters, and long-term care facilities, should be screened for TB 6, 3
Persons with diabetes mellitus, malignancies, hepatitis C, rheumatoid arthritis, or vitamin D deficiency should be screened for TB 4

The American College of Radiology recommends that all persons should receive an individual TB risk assessment before testing to guide interpretation of results 2, 9
The risk assessment should identify history of TB exposure, country of origin, living/working conditions, immunosuppressive conditions, and HIV status 2, 3
The Centers for Disease Control and Prevention recommends screening for TB symptoms, including cough, fever, night sweats, weight loss, and hemoptysis 1, 2
IGRA is preferred over TST, especially in patients with prior BCG vaccination, patients already on immunosuppressive therapy, and situations where return for TST reading is unlikely 3, 5
Testing should only be performed in persons without documented prior LTBI or TB disease 1, 2, 9
For asymptomatic persons at low risk with a positive initial test, a second confirmatory test should be performed (either IGRA or TST); consider infected only if both tests are positive 9, 10
Chest radiography should be obtained after positive IGRA or TST to distinguish latent TB from active disease 6, 3

The Centers for Disease Control and Prevention recommends performing symptom evaluation immediately when exposure is recognized, and testing with IGRA or TST at the time exposure is identified 1, 7
If initial test is negative, repeat testing 8-10 weeks after last exposure using the same test type as the initial test 1, 7, 8
Persons with documented prior LTBI or TB disease do not need repeat testing after exposure, but should have clinical evaluation if TB disease is suspected 1, 10

The Centers for Disease Control and Prevention recommends treatment for all persons with untreated LTBI, unless medically contraindicated 1, 2
Preferred regimens include isoniazid plus rifapentine once weekly for 3 months, isoniazid plus rifampin daily for 3-4 months, rifampin alone daily for 4 months, and isoniazid alone for 9 months 5
For patients starting biologics, including rituximab, initiate or resume biologic therapy after at least 1 month of LTBI treatment 3, 5

Annual TB screening should be considered for persons with ongoing TB exposure risk, such as healthcare workers in high-risk areas and frequent travelers to endemic regions 3, 5
Persons with untreated LTBI should receive annual symptom screening 8
Do not repeat IGRA or TST in persons who previously tested positive; instead, monitor for clinical signs and symptoms of active TB 5