---
title: Tuberculosis Screening and Treatment
description: A comprehensive clinical reference on the screening, diagnosis, and management of tuberculosis.
keywords: [tuberculosis, TB, screening, treatment, infection, latent TB]
category: clinical
---

## Tuberculosis Overview

Tuberculosis (TB) is a highly contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. TB primarily affects the lungs (pulmonary TB) but can also occur in other parts of the body (extrapulmonary TB). Individuals with weakened immune systems, such as those with HIV/AIDS, are at a higher risk of developing active TB disease.

## Tuberculosis Screening

### Latent TB Infection Screening
Screening for latent TB infection (LTBI) is recommended for high-risk individuals, including:
- Recent close contacts of someone with active TB disease
- Individuals from countries with high TB prevalence
- Healthcare workers
- Immunosuppressed patients (e.g., HIV, transplant recipients, those on biologics)

The preferred screening test for LTBI is the interferon-gamma release assay (IGRA), such as the QuantiFERON-TB Gold or T-SPOT.TB test. Alternatively, the tuberculin skin test (TST) can be used.

### Active TB Disease Screening
Screening for active TB disease is indicated in individuals with symptoms suggestive of TB, such as:
- Persistent cough (>2 weeks)
- Unexplained weight loss
- Fever
- Night sweats
- Hemoptysis

The initial diagnostic workup includes a chest radiograph and sputum acid-fast bacilli (AFB) smear and culture. Additional tests, such as nucleic acid amplification tests (e.g., Xpert MTB/RIF), may be used to rapidly detect Mycobacterium tuberculosis and identify drug resistance.

## Tuberculosis Treatment

### Treatment of Latent TB Infection (LTBI)
The goal of LTBI treatment is to prevent the development of active TB disease. Recommended regimens include:
- Isoniazid (INH) for 6-9 months
- Rifampicin (RIF) for 4 months
- Isoniazid and rifapentine (3HP) for 3 months

Adherence to LTBI treatment is crucial, as incomplete treatment increases the risk of progression to active TB disease.

### Treatment of Active TB Disease
The treatment of active TB disease involves a combination of antimycobacterial medications for an extended duration, typically 6-9 months. The standard first-line regimen includes:
- Isoniazid (INH)
- Rifampicin (RIF)
- Pyrazinamide (PZA)
- Ethambutol (EMB)

The initial 2-month intensive phase is followed by a 4-7 month continuation phase, depending on the specific regimen. Directly observed therapy (DOT) is recommended to ensure adherence and prevent the development of drug resistance.

### Monitoring and Adverse Effects
Patients receiving TB treatment should be monitored for adverse effects, including:
- Hepatotoxicity (elevated liver enzymes)
- Peripheral neuropathy
- Optic neuritis
- Gastrointestinal side effects
- Rash

Regular laboratory monitoring, including liver function tests, is recommended. Appropriate management of adverse effects, such as dose adjustments or medication substitutions, is crucial to ensure successful treatment completion.

## Multidrug-Resistant Tuberculosis (MDR-TB)

Multidrug-resistant tuberculosis (MDR-TB) is defined as TB resistant to at least isoniazid and rifampicin, the two most potent first-line anti-TB drugs. MDR-TB is a significant public health concern, as it requires the use of more complex, less effective, and more toxic second-line medications.

The treatment of MDR-TB is more challenging and typically involves a combination of second-line drugs, such as fluoroquinolones, aminoglycosides, and newer agents like bedaquiline and delamanid. The duration of treatment for MDR-TB is often longer, ranging from 12 to 24 months.

Patients with MDR-TB should be managed in collaboration with experienced clinicians and referred to specialized TB treatment centers when possible. Strict infection control measures are essential to prevent the transmission of MDR-TB.

## Tuberculosis in Special Populations

### Tuberculosis and HIV
Individuals with HIV/AIDS are at a significantly higher risk of developing active TB disease, and TB is a leading cause of mortality in this population. The management of TB in HIV-positive patients requires close coordination between infectious disease and HIV specialists.

Antiretroviral therapy (ART) should be initiated as soon as possible in HIV-positive patients with TB, typically within the first 2-8 weeks of TB treatment. Potential drug-drug interactions between TB and HIV medications must be carefully considered.

### Tuberculosis in Pregnancy
Pregnant women with active TB disease should be treated with a standard first-line regimen, as the benefits of treatment outweigh the potential risks to the fetus. Isoniazid, rifampicin, and ethambutol are considered safe during pregnancy.

Breastfeeding is generally recommended for women receiving TB treatment, as the benefits of breastfeeding outweigh the minimal risk of drug exposure to the infant. Pyrazinamide should be avoided during breastfeeding due to limited data on its safety.

## Conclusion

Tuberculosis remains a significant global health challenge, requiring a comprehensive approach to screening, diagnosis, and management. Adherence to evidence-based guidelines and close collaboration between healthcare providers are essential to ensure optimal outcomes for patients with tuberculosis.