Approach to diagnosis of latent tuberculosis infection (tuberculosis screening) in individuals who require serial testing*

TB: tuberculosis; TST: tuberculin skin test; LTBI: latent tuberculosis infection; IGRA: interferon-gamma release assay.
* For individuals with increased risk of reactivation due to presence of underlying conditions, refer to UpToDate topics for discussion.
¶ In regions with low TB incidence rate, HCWs in facilities with low TST conversion rate need not undergo routine serial TB screening. Serial TB screening may be reasonable for HCWs at increased risk for occupational exposure to TB (such as pulmonologists or respiratory therapists) or for HCWs in certain settings (such as emergency departments). Refer to the UpToDate topic on diagnosis of LTBI for further discussion.
Δ Given the difficulties of interpretation of serial IGRA testing, we favor TST for LTBI screening in individuals who require serial testing.
◊ Following LTBI treatment, subsequent management should consist of instruction regarding how to recognize symptoms of TB and instruction to present for further evaluation if symptoms consistent with TB arise. Individuals with a prior positive LTBI test should not undergo repeat LTBI testing.
§ Individuals with presumptive negative diagnostic evaluation for LTBI should continue to undergo serial testing as warranted based on relevant epidemiologic exposure.