Newly Released Guidelines for Diagnosis of Tuberculosis in Adults and Children

Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children
Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children

The U.S. Centers for Disease Control and Prevention (CDC) is pleased to announce the release of 2016 Clinical Practice Guidelines for Diagnosis of Tuberculosis in Adults and Children.  The guidelines were developed by CDC, the American Thoracic Society (ATS), and the Infectious Diseases Society of America (IDSA), and they have been endorsed by the European Respiratory Society. The guidelines update the previous tuberculosis (TB) diagnostics guidelines published by ATS/CDC/IDSA in 2000.

The newly released guidelines provide recommendations on the diagnosis of latent TB infection, pulmonary TB, and extrapulmonary TB in adults and children.  The guidelines provide evidence-based recommendations that were developed with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. GRADE involves structured literature review, systematic reviews and meta-analyses of combined data, and expert discussion to assess the certainty in the evidence and determine the strength of each recommendation.

The twenty-three evidence-based recommendations include guidance for clinicians on how to employ newer tests to diagnose TB disease and latent TB infection, including interferon-gamma release assays (IGRAs) and molecular diagnostics.  Although TB is less common in the United States than in other parts of the world, clinicians should consider testing patients who have a higher-risk for TB infection, including patients who were born in or who frequently travel to countries where TB disease is common; patients who live or have lived in large group settings, such as homeless shelters or prisons and jails; or those with other risk factors, as described in the guidelines.

We encourage you to share these guidelines with your partners, especially clinicians. For more information on the diagnosis of TB and latent TB infection, please see the full version of the guidelines in Clinical Infectious Disease.

Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children

1. David M. Lewinsohn¹,^a, 
2. Michael K. Leonard²,^a, 
3. Philip A. LoBue³,^a, 
4. David L. Cohn⁴,
5. Charles L. Daley⁵, 
6. Ed Desmond⁶, 
7. Joseph Keane⁷, 
8. Deborah A. Lewinsohn¹, 
9. Ann M. Loeffler⁸,
10. Gerald H. Mazurek³, 
11. Richard J. O’Brien⁹, 
12. Madhukar Pai¹⁰, 
13. Luca Richeldi¹¹, 
14. Max Salfinger¹²,
15. Thomas M. Shinnick³, 
16. Timothy R. Sterling¹³, 
17. David M. Warshauer¹⁴, and 
18. Gail L. Woods¹⁵

+Author Affiliations

1. ¹ Oregon Health & Science University, Portland, Oregon,
2. ² Emory University School of Medicine and
3. ³ Centers for Disease Control and Prevention, Atlanta, Georgia,
4. ⁴ Denver Public Health Department, Denver, Colorado,
5. ⁵ National Jewish Health and the University of Colorado Denver, and
6. ⁶ California Department of Public Health, Richmond;
7. ⁷ St James’s Hospital, Dublin, Ireland;
8. ⁸ Francis J. Curry International TB Center, San Francisco, California;
9. ⁹ Foundation for Innovative New Diagnostics, Geneva, Switzerland;
10. ¹⁰ McGill University and McGill International TB Centre, Montreal, Canada;
11. ¹¹ University of Southampton, United Kingdom;
12. ¹² National Jewish Health, Denver, Colorado,
13. ¹³ Vanderbilt University School of Medicine, Vanderbilt Institute for Global Health, Nashville, Tennessee,
14. ¹⁴ Wisconsin State Laboratory of Hygiene, Madison, and
15. ¹⁵ University of Arkansas for Medical Sciences, Little Rock

1. ↵^aAuthors are co-chairs of this guideline committee.
2. Correspondence: D. M. Lewinsohn, Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR (lewinsod@ohsu.edu).

 

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Abstract

Background. Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain.

Methods. A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results. Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional.

Conclusions. These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.