Health care providers with positive tuberculosis (TB) screening require further evaluation with chest x-ray and symptom review to determine if they have latent or active disease.  Findings concerning for active TB include the following:

• Nonspecific symptoms – unexplained weight loss, anorexia, night sweats, fever, fatigue
• Pulmonary symptoms – coughing >3 weeks, hemoptysis, chest pain
• Chest x-ray findings – cavitation or infiltrate

Patients with no symptoms or x-ray abnormalities have latent tuberculosis infection (LTBI).  Although LTBI is considered noninfectious, individuals with LTBI are at risk for conversion to active disease.  If conversion occurs, TB can spread from one individual to another.  Health care providers with LTBI are generally given treatment with isoniazid daily for 9 months.

(Choices A and E)  Patients with a positive interferon-gamma release assay (IGRA) or tuberculin skin test (TST) do not require additional confirmation of TB exposure with repeat TST or IGRA.

(Choices B and D)  Individuals with active TB require microbial diagnosis with serial sputum samples for acid-fast bacilli and mycobacterial culture.  Once a microbial diagnosis is obtained, treatment with 4-drug therapy is typically initiated.  This patient with no symptoms and a normal chest x-ray has LTBI, not active TB.  Treatment with isoniazid daily should be initiated without additional testing.

Educational objective:
Health care providers with positive tuberculosis screening should receive chest x-ray and symptom review to determine if they have latent or active disease.  Those with no symptoms or chest x-ray abnormalities (eg, infiltrate, cavitation) are considered to have latent tuberculosis infection and should be offered treatment with isoniazid daily for 9 months.