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Diagnosis of TB Guidelines PDF

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6 Diagnosis Figure 2. Summary of Recommendations for Testing for LTBI Group Testing Strategy Considerations Likely to be Infected High Risk of Progression (TST ≥5 mM) Adults: Acceptable: IGRA or TST Consider dual testing where a positive result from either result would be considered positive Children ≤5 years of age: Preferred: TST Acceptable: IGRA or TST Consider dual testing where a positive result from either would be considered positive a • Prevalence of BCG vaccination • Expertise of staff and/or laboratory • Test availability • Patient perceptions • Staff perceptions • Programmatic concerns Likely to be Infected Low to Intermediate Risk of Progression (TST ≥10 mM) Preferred: IGRA where available Acceptable: IGRA or TST Unlikely to be Infected (TST >15 mM) Testing for LTBI is NOT recommended If necessary: Preferred: IGRA where available. Acceptable: Either IGRA or TST For serial testing: Acceptable: Either IGRA or TST Consider repeat or dual testing where a negative result from either would be considered negative b a Performing a second diagnostic test when the initial test is negative is a strateg y to increase sensitivity. is may reduce specificity, but the panel decided that this is an acceptable trade-off in situations in which the consequences of missing LTBI (ie, not treating individuals who may benefit from therapy) exceed the consequences of inappropriate therapy (ie, hepatotoxicity). b Performing a confirmatory test following an initial positive result is based upon both the evidence that false-positive results are common among individuals who are unlikely to be infected with Mtb and the committee's presumption that performing a second test on those patients whose initial test was positive will help identify initial false-positive results.

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