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[edit | edit source]

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[edit | edit source]

### Screening[edit | edit source]

Further information: [[:Tuberculosis screening]]

##### Tuberculin Skin Test[edit | edit source]

* 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)[edit | edit source]

* IGRA can be used in place of (but not in addition to) TST in screening for M. tuberculosis infection in the following conditions:[1]

* 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[2]

### Early Diagnosis[edit | edit source]

* 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:[3]

* 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:[3]

* 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[edit | edit source]

* 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

## References[edit | edit source]

1. ↑ "CDC Interferon-Gamma Release Assays (IGRAs) - Blood Tests for TB Infection".
2. ↑ Hong-Van Tieu, Piyarat Suntarattiwong, Thanyawee Puthanakit, Tawee Chotpitayasunondh, Kulkanya Chokephaibulkit, Sunee Sirivichayakul, Supranee Buranapraditkun, Patcharawee Rungrojrat, Nitiya Chomchey, Simon Tsiouris, Scott Hammer, Vijay Nandi & Jintanat Ananworanich (2014). "Comparing interferon-gamma release assays to tuberculin skin test in thai children with tuberculosis exposure". PloS one. 9 (8): e105003. doi:10.1371/journal.pone.0105003. PMID 25121513.CS1 maint: Multiple names: authors list (link)
3. ↑ 3.0 3.1 "CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005".

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