Latent Tuberculosis Infection: A Guide for Primary Health Care Providers

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Introduction

This guide is intended for primary care providers who care for individuals and populations who may be at risk for infection with Mycobacterium tuberculosis. Latent tuberculosis infection (LTBI) is the presence of Mycobacterium tuberculosis in the body without signs and symptoms, or radiographic or bacteriologic evidence of tuberculosis (TB) disease.

It is estimated that up to 13 million people in the United States have LTBI. While not everyone with LTBI will develop TB disease, about 5 – 10% of infected people will develop TB disease if not treated. This equates to approximately 650,000 to 1,300,000 people who will develop TB disease at some point in their life, unless they receive adequate treatment for LTBI. Identifying and treating those at highest risk for TB disease will help move toward elimination of the disease. Primary care providers play a key role in achieving the goal of TB elimination because of their access to high-risk populations.

Guidelines for testing and treating LTBI were released by the Centers for Disease Control and Prevention (CDC) and the American Thoracic Society (ATS). They can be found in the June 9, 2000 issue of Morbidity and Mortality Weekly Report (MMWR), entitled Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection.

More recently, recommendations for the use of interferon-gamma release assays (IGRAs) were released in the June 25, 2010 issue of Morbidity and Mortality Weekly Report (MMWR), entitled Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium Tuberculosis Infection. In addition, recommendations for a new regimen for the treatment of LTBI were introduced. They can be found in the December 9, 2011 issue of Morbidity and Mortality Weekly Report (MMWR), entitled Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection.

This document is not meant to be used as a substitute for the guidelines, but rather as a ready and useful reference that highlights the main points of those guidelines.