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Tuberculin Skin Testing Tx 2008 by 9Dr3haxy

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									                       Guide for Primary Health Care Providers
                                       Targeted TST and Treatment of LTBI

                                   Indications: see categories of induration for positive test


    Clinical indications/NH resident/Admission to Rehabilitation/Employee /others
                                   AND                                                                           NO
                           Previously negative TST                                                                                  NO
                                                                                                                                    TST

                                            YES



          PLACE 0.1 ML (5 TU) PPD INTRADERMAL INTO INNER SURFACE
          OF THE FOREARM, USING TUBERCULIN SYRINGE; SHOULD
          PRODUCE 6-10 MM ELEVATION OF SKIN. READ RESULTS AT                                             Consider CXR if clinical
          48-72 HRS; IF NOT READ BY 72 HRS RESCHEDULE ANOTHER                                             suspicion for TB or a
          TEST. Trained HC personnel read and document TST.                                                positive TST in past




   INDURATION 5mm                      INDURATION                        INDURATION                                                CXR
   /MORE                               10 mm /more                       15MM OR MORE                 CXR C/W                    Normal or
   HIV infected persons                -Immigration <5 yrs               -Persons with no             TB                          not c/w
   -Recent contact with                from high prevalence              known risk factor
   infectious TB case                  countries
   -CXR showing fibrotic               -Injection drug users
   lung changes c/w TB                 -Residents/employees
   -organ transplant                   of high risk congregate                                                                    W/U on
   recipient                           setting                                                                                    Clinical
   -Other causes of                    Mycobacteriology lab                                                                      Diagnosis
   immunosuppression                   personnel
    -on Prednisone 15 mg 1             -Age <4yrs                                                AIRBORNE
   or more months                      -Children/adolescents                                     ISOLATION
   -on TNF-ą antagonists               exposed to adults at                                      Until 3 negative AFB
                                       high risk                                                 concentrated
                                       -Persons with certain                                     smears £
                                       clinical conditions*                                      Referral to ID §




                                                                                             ABNORMAL CXR
                                             ORDER CXR                                    C/W TB disease/sequeale
                                       Childrne/adults

                                            CXR NORMAL



                                         Diagnosis is LTBI**
                                              Treat+


    *Silicosis, DM, chronic renal failure, some hematologic disorders, other malignancies (carcinoma of head, neck
    or lung), weight loss of 10 % or more of body weight, gastrectomy, jejunoileal bypass. §Call ID/Infection control
    for atypical situations **Review history and do complete physical examination, base line hematological/chemistry
    including renal chemistry and liver function test. Consider HIV TESTING. Provide education to patient.
    +Treat for LTBI (Isoniazid 300 mg with pyridoxine) x 9 mo.. LFT monitoring is not required unless there is
    preexisting liver disease or patient develops symptoms.
    £ Cx collected every 8-24 hours with one being an early morning specimen.
    ----------------------------------------------------------------------------------------------------------------------------------------
    Abbreviations: c/w =consistent wit h, CXR= xray chest, LTBI= latent tuberculous infection, w/u=work up,
    c/w=consistent with,,TST tubercular skin testing (Montoux), LFT=liver function testing.




Reference: Guide for Primary Health Care Providers: Targered Tuberculin Testing and Treatment of Latent Tuberculosis
Infection. Department of Health and Human Services, CDC, National Center for HIV, STD and TB prevention, Division of
TB Elimination, Atlanta, GA, 2005. Link: CDC Guidelines\TargetedLTBI05 (2).pdf .

								
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