Screening for Tuberculosis

In 2007, there were approximately 10 million cases of new and recurrent tuberculosis (TB) and 1.8 million deaths worldwide, with the highest rates occurring in low-income countries (Marais et al., 2009). The incidence of active TB is much lower in the United States, but an estimated 10 to 15 million persons have latent tuberculosis infection (LTBI). Six groups considered at high risk are children, foreign-born persons, HIV-infected persons, homeless persons, detainees and prisoners in correctional facilities, and close contacts of infectious persons (CDC, 2005). Targeted rather than universal testing of children for TB is now recommended. Risk factors for LTBI include (1) previous positive tuberculin skin test; (2) birth in foreign country with high prevalence of TB (e.g., China, India, Mexico, Philippine Islands, Vietnam, certain African countries); (3) nontourist travel to a high-prevalence country for more than 1 week; (4) contact with TB-infected person, and (5) presence in the household of another person with LTBI (CDC, 2005). The Mantoux TB skin test is recommended for children because its correlation with results of interferon-y release assays is often discordant in children (Connell et al., 2008).

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