Latent Tuberculosis Infection: A Guide for Primary Health Care Providers
Appendix A
Sample TB Risk Assessment Tool
Persons with any of the following risk factors should be tested for TB infection unless there is written documentation of a previous positive TST or IGRA result.
| Risk Factor | Yes | No |
|---|---|---|
| Recent close or prolonged contact with someone with infectious TB disease | ||
| Foreign-born person from or recent traveler to high-prevalence area | ||
| Chest radiographs with fibrotic changes suggesting inactive or past TB | ||
| HIV infection | ||
| Organ transplant recipient | ||
| Immunosuppression secondary to use of prednisone (equivalent of <15 mg/day for <1 month) or other immunosuppressive medication such as TNF-α antagonists | ||
| Injection drug user | ||
| Resident or employee of high-risk congregate setting (e.g., prison, long term care facility, hospital, homeless shelter) | ||
| Medical conditions associated with risk of progressing to TB disease if infected (e.g., diabetes mellitus, silicosis, cancer of head or neck, Hodgkin’s disease, leukemia, and end-stage renal disease, intestinal bypass or gastrectomy, chronic malabsorption syndrome, low body weight [10% or more below ideal for given population]) | ||
| Signs and symptoms of TB |
Adapted from a form developed by Minnesota Department of Health TB Prevention and Control Program
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