Tuberculosis secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; Alejandro Lemor, M.D. [3]

Overview

Secondary prevention for tuberculosis refers to the methods that are used for screening and early diagnosis, such as tuberculin skin test (TST) and IGRAs; as well as ensuring that the right treatment regimen is given at the right time to prevent disease progression.

Secondary Prevention

Screening

Further information: [[:Tuberculosis screening]]

Tuberculin Skin Test

• Evaluation of children who are having close contact with a confirmed case of TB.
• TST is the test of choice for screening for TB infection.

Interferon-Gamma Release Assays (IGRAs)

• IGRA can be used in place of (but not in addition to) TST in screening for M. tuberculosis infection in the following conditions:

• A patient has received BCG vaccination
• Groups with poor follow up return for TST reading

• TST is favored over IGRA for TB screening due to its low cost and high availability

Early Diagnosis

• Early diagnosis of tuberculosis disease is essential to give the right treatment at the appropriate time and prevent complications.
• All patients should be routinely asked about:

• History of TB exposure, infection, or disease
• Symptoms or signs of TB disease
• Medical conditions that increase their risk for TB disease

• Patients with the following characteristics should be tested for tuberculosis:

• Cough for ≥3 weeks
• Loss of appetite
• Unexplained weight loss
• Night sweats
• Hemoptysis
• Hoarseness
• Fever
• Fatigue
• Chest pain
• Patient from an endemic area of TB

Prompt Treatment

• Empiric therapy should be started once the diagnosis of TB is confirmed.
• Sputum specimens should be sent for culture and DST before initiation of therapy