Diagnostic Approach for Suspected Tuberculosis in Non-Healing Wounds

Initial Clinical Assessment

The American College of Radiology recommends assessing TB exposure history, including close contact with active TB patients, residence in or travel to TB-endemic countries, and time spent in high-risk settings, to evaluate the risk of TB in patients with non-healing wounds 2, 3
The American Journal of Respiratory and Critical Care Medicine suggests evaluating immunocompromised status, including HIV infection with CD4 count, use of anti-TNF medications, corticosteroids >1 month, or other immunosuppressive therapy, to assess the risk of TB in patients with non-healing wounds 4, 5
The American College of Radiology recommends screening for systemic TB symptoms, including unexplained weight loss, night sweats, fever, prolonged cough (>2-3 weeks), hemoptysis, and fatigue, to evaluate the risk of TB in patients with non-healing wounds 2, 4, 1

The American College of Radiology recommends performing chest radiography in all patients with suspected extrapulmonary TB to look for evidence of active or old pulmonary TB 2, 1, 6
The Journal of Crohn's and Colitis suggests that IGRA is preferred in BCG-vaccinated individuals to avoid false-positive results from vaccination 5
The MMWR Recommendations and Reports recommends interpreting TST results as ≥5mm induration is positive in immunocompromised patients, those with recent TB contact, or those with radiographic evidence of old TB 8, 5

The American Journal of Respiratory and Critical Care Medicine recommends that every newly diagnosed HIV patient should be assessed for TB with symptom review, physical examination, chest radiography, and TST (≥5mm is positive) 4
The Journal of Crohn's and Colitis suggests that patients on anti-TNF agents have increased risk of TB reactivation with more severe disease 5

The Journal of Crohn's and Colitis recommends not relying solely on TST/IGRA, as these tests indicate infection but do not distinguish active from latent TB 5
The American College of Radiology recommends not interpreting negative chest X-ray as excluding TB in immunocompromised patients, and proceeding to CT imaging instead 2, 1