3
Assessment
Figure 1. Factors to be Considered in Deciding to Initiate
Treatment Empirically for Active Tuberculosis (TB)
(Prior to Microbiologic Confirmation)
Patient
Risk for progression/dissemination
(eg, HIV, TNF alpha inhibitor)
Age< 2 years
TB exposure risk
(eg, contact, born in higher TB incidence
country)
Laboratory/
Radiographic
Clinical
Status/
Suspicion
Public
Health
Elevated concern for adverse
treatment events
(eg, severe liver disease, pregnancy)
No TB exposure risk
Radiographic imaging
consistent with TB
Evidence of Mtb infection
(ie, positive TST or IGRA)
Extended time to microbiologic
confirmation
(eg, Rapid molecular test not available)
Pathologic findings consistent
with TB
AFB smear positive,
Rapid molecular test positive
AFB smear negative,
Rapid molecular test positive
Radiographic imaging
not consistent with TB
AFB smear positive,
Rapid molecular test negative
AFB smear negative,
Rapid molecular test negative
Life-threatening disease
Symptoms typical for TB
Alternative diagnosis less
likely
Clinically stable
Symptoms not typical for TB
Alternative diagnosis
Concern for loss to follow-up
High transmission risk
(eg, congregate setting, corrections)
Low transmission risk
Favors Treatment Initiation
Favors Delayed or No Treamtent
Modified from Figure 1. Nahid P. et al. Clin Infec Dis. 2016;63(7):e147-195.
