Tuberculosis Algorithm: Countries With Incidence < 20 Cases per 100,000 Population ^{1, 2}

Flowchart 1: Tuberculosis Algorithm for Countries With Incidence < 20 Cases per 100,000 Population

IGRA = Interferon gamma release assay, TST= Tuberculin skin test

This algorithm is a visual representation of a portion of Tuberculosis Technical Instructions for Panel Physicians.

¹CDC accepts the World Health Organization’s Tuberculosis country profilesexternal icon to determine the rate of TB disease for a given country.

²Please note that some tests will be performed simultaneously.

³If IGRA is not licensed for use in the county where the overseas medical exam is taking place, a TST can be conducted instead of an IGRA.

* Applicants under two years of age can have either an IGRA or TST

Text Description/Overview of Flowchart

Following the completion of the history and physical exam, does child have one or more of the following: Known HIV infection, signs or symptoms of TB or personal history of TB?

• If “Yes”, “Known HIV infection and/or signs or symptoms of TB?”
  • If “Yes”, “Younger than 15 years of age?”
    • If “Yes”, “IGRA”
      • If “Positive or Negative”, “Chest x-ray”
        • If “Positive or Negative”, “Sputum smears and cultures”
          • If “Negative”, “No further testing”
          • If “Positive (Class A TB)”, “Drug Susceptibility Test”, then “Directly Observed Therapy”
    • If “No”, “15 years of age or older?”, “Yes”, “Chest x-ray”
      • If “Positive or Negative”, “Sputum smears and cultures”
        • If “Negative”, “No further testing”
        • If “Positive (Class A TB)”, “Drug Susceptibility Test”, then “Directly Observed Therapy”
  • If “No, child has a personal history of TB only”, then “Personal history of TB only?”, “Yes”, “IGRA ”
    • If “Positive or Negative”, “Chest x-ray”
      • If “Negative”, “No further testing”
      • If “Positive”, “Sputum smears and cultures”
        • If “Negative”, “No further testing”
        • If “Positive (Class A TB)”, “Drug Susceptibility Test”, then “Directly Observed Therapy”
• If “No”, “Younger than 15 years of age?”
  • If “Yes”, “No further testing; history and physical exam only”
  • If “No”, “15 years of age or older?”, “Yes”, then “Chest x-ray”
    • If “Negative”, “No further testing”
    • If “Positive”, “Sputum smears and cultures”
      • If “Negative”, “No further testing”
      • If “Positive (Class A TB)”, “Drug Susceptibility Test”, then “Directly Observed Therapy”

[end algorithm 1]