4
Diagnosis
Figure 1. Paradigm for Evaluation of Those with LTBI
Based on Risk of Infection, Risk of Progression
to Tuberculosis, and Benefit of Therapy
Risk
of
Infection
Groups with Increased Likelihood
of Infection with Mtb
Benefit of Therapy
Household contact or recent exposure
of an active case
Yes
Mycobacteriolog y laboratory
personnel
Not demonstrated
Immigrants from high burden
countries (>20/100,000)
Not demonstrated
Residents and employees of high risk
congregate settings
Yes
None Not demonstrated
In developing a diagnostic approach for the evaluation of those with suspected LTBI, the panel
recommends the clinician weigh the likelihood of infection, the likelihood of progression to
tuberculosis if infected, and the benefit of therapy (Horsburgh and Rubin, Clinical practice: latent
tuberculosis infection in the United States. N Engl J Med. 2011; 364:1441–8). Recommendations
were formulated for each of the 3 groups illustrated above. ese groups are concordant with current
recommendations for the interpretation of the tuberculin skin test (American oracic Society,
Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR Recomm Rep.
2000; 49:1–51).
