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Internal Medicine

Tuberculosis   

Questions discussed in this category

What is the interpretation of two IGRAs with negative mitogen wells, in the absence of immunosuppression?
A patient on meloxicam for LBP developed high, persistent fevers and no other symptoms. An IGRA, among many tests, was sent. The IGRA’s mitogen ...
2 Answers available
What is your approach to a positive PPD or IGRA in a patient with well-controlled HIV without significant TB risk factors?
3 Answers available
What are your top takeaways from ID Week 2024?
1 Answer available
Are there clinical scenarios in which you would start empiric treatment for pulmonary TB without microbiologic confirmation?
2 Answers available
How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?
7 Answers available
How would you approach treatment of latent TB for patients who cannot tolerate rifamycins or isoniazid due to allergy, intolerance, or drug-drug interactions?
2 Answers available
What is the preferred four-drug regimen for initial treatment of pan-susceptible tuberculous meningitis, given the need to achieve optimal CNS penetration?
1 Answer available
How do you approach a positive Quantiferon/PPD test result in a patient for whom testing is sent without a clinical indication and who does not have a risk factor for TB exposure nor TB reactivation?
Do you routinely offer latent TB treatment in these cases?  
2 Answers available
For which patients or under which circumstances do you recommend a 9-month over a 6-month course of isoniazid for treatment of LTBI?
1 Answer available
For how long do you recommend treatment for latent tuberculosis prior to initiation of anti-TNF therapy?
6 Answers available
How do you approach a patient who has anterior uveitis and is referred for evaluation of ocular TB with a positive Quantiferon gold (as part of their workup) in countries with low TB incidence?
2 Answers available
Does your institution have formal policies or work flows to reduce unnecessary IGRAs ordered for patients on biologics?
1 Answer available
How do you approach biologic initiation in patients with inflammatory arthritis and repeatedly indeterminate Quantiferon?
5 Answers available
How do you approach ongoing screening for TB in patients with a history of treated latent TB, but who have ongoing use of DMARDs and/or biologics given Quantiferon testing and PPD can remain positive?
How do you approach ongoing screening for TB in patients with history of treated latent TB, but have ongoing use of DMARDs and/or biologics given quan...
1 Answer available
Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?
1 Answer available
Does your approach to treating latent tuberculosis differ in a patient on anti-fibrotic therapy?
1 Answer available
Do you rule out TB in patients with AIDS and lobar pneumonia?
What’s your threshold to get the three AFBs and place the patient in airborne isolation?
1 Answer available
Do you routinely monitor imaging or pulmonary function in patients with pulmonary TB after the completion of therapy?
1 Answer available
Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?
2 Answers available
Which medications have the lowest risk of tuberculosis reactivation in patients with uncertain tuberculosis history and active rheumatologic disease?
2 Answers available
How would you manage methotrexate therapy in an active rheumatoid arthritis patient undergoing treatment for latent TB with rifampin?
Do you stop methotrexate or adjust the dose? 
1 Answer available
Would you hold all immunosuppressive medications for the first month of LTBI treatment, or just biologics?
1 Answer available
Should tuberculosis screening be performed before beginning methotrexate for treatment of rheumatoid arthritis?
1 Answer available


Papers discussed in this category

Scientific reports, 2017 Aug 10
Analysis of Factors Influencing Diagnostic Accuracy of T-SPOT.TB for Active Tuberculosis in Clinical Practice.
Ann Am Thorac Soc, 2017 May
Minimizing Tuberculosis Risk in Patients Receiving Anti-TNF Therapy.
Arthritis Care Res (Hoboken), 2016 Jan
2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.
Alimentary pharmacology & therapeutics, 2022 May 20
Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management.
JAMA ophthalmology, 2017 Dec 01
Clinical Features and Outcomes of Patients With Tubercular Uveitis Treated With Antitubercular Therapy in the Collaborative Ocular Tuberculosis Study (COTS)-1.
Infection control and hospital epidemiology, 2018-05
Time to Detection in Culture Supports Prediction of Low Transmissibility of Tuberculosis and Discontinuation of Isolation for Low-Risk Patients With A Single AFB-Negative and NAAT-Negative Respiratory Specimen.
Clinical microbiology reviews, 2018-10
Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection.
JAMA internal medicine, 2018-10-01
Association of Rapid Molecular Testing With Duration of Respiratory Isolation for Patients With Possible Tuberculosis in a US Hospital.
American journal of respiratory and critical care medicine, 2021 Jan 15
The Epidemiological Importance of Subclinical Tuberculosis. A Critical Reappraisal.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024 Apr 18
NTCA Guidelines for Respiratory Isolation and Restrictions to Reduce Transmission of Pulmonary Tuberculosis in Community Settings.
American journal of respiratory and critical care medicine, 2019 Nov 15
Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline.

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