Management of Patients Exposed to Active Tuberculosis

Initial Assessment and Contact Investigation

The Centers for Disease Control and Prevention recommends identifying all individuals who had contact with the person with active TB, focusing first on those with the most intense exposure 1, 3
The Centers for Disease Control and Prevention suggests determining the areas where the TB patient was present before isolation and identifying all potentially exposed individuals 1, 4
Coordination with local public health departments is necessary to ensure proper reporting and follow-up, as recommended by the American Thoracic Society 1, 5

The European Respiratory Society recommends administering tuberculin skin test (TST) or interferon-gamma release assay (IGRA) to all exposed individuals as soon as possible after exposure 1, 6
A reaction ≥5 mm of induration is considered positive in HIV-infected persons, as stated by the Centers for Disease Control and Prevention 7, 8
The European Respiratory Society suggests that either commercial IGRA or Mantoux TST can be used for testing, with IGRA preferred in BCG-vaccinated individuals 6

The European Respiratory Society recommends that all contacts with positive tests but no evidence of active TB should receive treatment for LTBI 2, 6
The Centers for Disease Control and Prevention recommends treatment regimens for LTBI, including 6 or 9 months of isoniazid daily or twice weekly 6, 7
HIV-infected persons who have been exposed to active TB should receive LTBI treatment regardless of their initial TST result, after active TB has been ruled out, as recommended by the American Journal of Respiratory and Critical Care Medicine 5, 7

The American Journal of Respiratory and Critical Care Medicine suggests that HIV-infected contacts require particular attention due to higher risk of progression to active TB 5, 7
The Centers for Disease Control and Prevention recommends that all HIV-infected persons should be screened for TB infection at the time of HIV diagnosis 7, 8
The European Respiratory Society recommends that children exposed to active TB should be evaluated promptly, as they are at higher risk for progression to active disease 2, 6

The Centers for Disease Control and Prevention recommends ensuring adherence to the full course of preventive therapy 7
Directly observed preventive therapy (DOPT) should be considered for certain populations to improve adherence, as suggested by the Centers for Disease Control and Prevention 8