Approach to diagnosis of tuberculosis infection (tuberculosis screening) in individuals who require serial testing*

TB: tuberculosis; TST: tuberculin skin test; TBI: tuberculosis infection; IGRA: interferon-gamma release assay.

* For individuals with increased risk of reactivation due to presence of underlying conditions, refer to UpToDate topics for discussion.

¶ In regions with low TB incidence rate, HCWs in facilities with low TST conversion rate need not undergo routine serial TB screening. Serial TB screening may be reasonable for HCWs at increased risk for occupational exposure to TB (such as pulmonologists or respiratory therapists) or for HCWs in certain settings (such as emergency departments). Refer to the UpToDate topic on diagnosis of TBI for further discussion.

Δ Given the difficulties of interpretation of serial IGRA testing, we favor TST for TBI screening in individuals who require serial testing.

◊ Following TBI treatment, subsequent management should consist of instruction regarding how to recognize symptoms of TB and instruction to present for further evaluation if symptoms consistent with TB arise. Individuals with a prior positive TBI test should not undergo repeat TBI testing.