a
Anergy panel testing is not recommended.
b
IGRA is preferred if patient has a history of Bacillus-Calmette-Guérin (BCG) vaccination.
c
Risk factors for TB exposure are defined based on a publication from the US Centers for Disease
Control and Prevention (CDC) as: close contacts of persons known or suspected to have active
tuberculosis, foreign-born persons from areas that have a high incidence of active tuberculosis (e.g.,
Africa, Asia, Eastern Europe, Latin America, and Russia), persons who visit areas with a high prevalence
of active tuberculosis, especially if visits are frequent or prolonged, residents and employees of congregate
settings whose clients are at increased risk for active tuberculosis (e.g., correctional facilities, long-term
care facilities, and homeless shelters), health-care workers who serve clients who are at increased risk for
active tuberculosis, populations defined locally as having an increased incidence of latent M. tuberculosis
infection or active tuberculosis, possibly including medically underserved, low-income populations, or
persons who abuse drugs or alcohol, and infants, children, and adolescents exposed to adults who are at
increased risk for latent M. tuberculosis infection or active tuberculosis.
d
If patient is immunosuppressed and false negative results more likely, consider repeating screening test(s)
with TST or IGRA.
e
Chest radiograph may also be considered when clinically indicated in patients with risk factors, even
with a negative repeat TST or IGRA.
f
Obtain respiratory (e.g., sputum, bronchoalveolar lavage) or other samples as clinically appropriate for
AFB smear and culture. Consider referral to TB specialist for further evaluation and treatment.
g
In a patient diagnosed with latent or active TB, consider referral to a specialist for the recommended
treatment.
h
Patients who test positive for TST or IGRA at baseline (pre-treatment) oen remain positive for
these tests even aer successful treatment of TB. ese patients need monitoring for clinical signs and
symptoms of recurrent TB disease, since repeating tests will not allow help in diagnosis of recurrent TB.
e level of evidence supporting each recommendation for TB reactivation was derived from consensus
opinion of experts, case studies, or standards of care. e level of evidence for initiation of biologics in
patients being treated for latent TB infection was higher, with data derived from a single randomized
trial or nonrandomized studies.
Figure 3. Tuberculosis (TB) Screening Algorithm for
Biologics and Tofacitinib– Footnotes
15
Disease state or prior treatment state
Disease activity
Treatment options or strateg y
Green box for Strong Recommendation
Yellow box for Conditional Recommendation
Algorithm Pathway for most patients
Disease state
Testing Strateg y
Treatment
Test result, positive or negative
Figures 1 and 2 Legend
Figure 3 Legend
