From the Guidelines
To rule out active Tuberculosis (TB) in a patient with a history of childhood TB, a thorough clinical evaluation is necessary, including a physical examination, chest radiograph, and laboratory tests such as sputum smear microscopy, GeneXpert MTB/RIF, and/or a Mantoux tuberculin skin test (TST) 1.
Key Steps to Rule Out Active TB
- Perform a thorough clinical evaluation to identify any symptoms or signs of active TB
- Obtain a chest radiograph to rule out pulmonary TB and to prevent the possibility of transmission within the health-care setting 1
- Use laboratory tests such as sputum smear microscopy, GeneXpert MTB/RIF, and/or a Mantoux tuberculin skin test (TST) to confirm the diagnosis
Treatment Considerations
If the patient is symptomatic or has a positive screening test, a course of empirical anti-TB treatment may be considered, consisting of isoniazid (INH) 300 mg/day, rifampicin (RIF) 600 mg/day, pyrazinamide (PZA) 1.5-2 grams/day, and ethambutol (EMB) 1.2-1.6 grams/day for 2 months, followed by INH and RIF for an additional 4 months 1. However, if the patient is asymptomatic and has a negative screening test, but still has a high risk of reactivation due to underlying conditions such as immunosuppression, latent TB infection (LTBI) treatment with INH 300 mg/day for 9 months or RIF 600 mg/day for 4 months may be considered to prevent reactivation 1.
Monitoring and Follow-Up
It is essential to monitor the patient for signs and symptoms of TB, as well as potential side effects of anti-TB medications, and adjust the treatment regimen accordingly 1.
- Regular follow-up appointments should be scheduled to assess the patient's response to treatment and to detect any potential complications early
- Patients should be educated on the importance of adherence to their treatment regimen and the potential consequences of non-adherence.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Ruling Out Active Tuberculosis (TB) in a Patient with a History of Childhood TB
To rule out active TB in a patient with a history of childhood TB, the following steps can be taken:
- Clinical evaluation: Assess the patient's symptoms, such as fever, weight loss, and persistent cough, as these can be indicative of active TB 2.
- Radiological examination: Chest radiographs can provide important information in many patients, and advanced imaging can be applied in case of inconclusive diagnosis 2.
- Bacteriological confirmation: Although difficult, bacteriological confirmation is useful for doubtful cases or when drug resistance is suspected 2, 3.
- Diagnostic tests: Various diagnostic tests are available, including:
- Tuberculin skin test (Mantoux test): Positive in up to 70% of non-immunocompromised TB patients, but may have lower reactivity in HIV co-infection or malnourishment 2.
- Interferon-gamma release assays: Can be used to diagnose latent TB, but may not offer substantial improvements in sensitivity over tuberculin skin testing for active disease 4.
- Xpert MTB/RIF test: A rapid mycobacteria tuberculosis diagnostic tool that has been shown to have high sensitivity and specificity in diagnosing childhood pulmonary TB 3, 5.
- Other tests: Such as smear microscopy, culture, and nucleic acid amplification platforms, which can be used to diagnose TB in children 6.
Considerations for Diagnostic Tests
When choosing a diagnostic test, consider the following:
- Age of the patient: The Xpert MTB/RIF test has been shown to have high sensitivity in children aged 1-5 years and 6-10 years 5.
- Type of specimen: The Xpert MTB/RIF test can be used on various specimens, including gastric aspirates, cerebrospinal fluids, and induced sputum 5.
- Presence of symptoms: Patients with symptoms such as fever, weight loss, and persistent cough may be more likely to have active TB 2.