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Tuberculosis Algorithm: Countries With Incidence ≥ 20 Cases per 100,000 Population 1, 2

Tuberculosis Algorithm: Countries with incidence < 20 cases per 100,000 population

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

2Please note that some tests will be performed simultaneously

3For “TST or IGRA” under “Personal history of TB only?”, test will depend on the child’s previous and current reaction to TST

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

This algorithm is a visual representation of a portion of Tuberculosis Screening and Treatment Technical Instructions (TB TIs) using Cultures and Directly Observed Therapy (DOT) for Panel Physicians.

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”, “TST or 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”, “TST or IGRA2
              • 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 2 years of age?”
                  • If “Yes”, “No further testing; history and physical exam only”
                  • If “No”, “2-14 years of age?”
                    • If “Yes”, “TST or IGRA”
                      • If “Negative”, “No further testing”
                      • If “Positive”, “Chest x-ray”
                        • If “Negative”, “No further testing”
                        • If “Positive” “Sputum smears and culture”
                          • 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”
                        • If “No”, “15 years of age or older?”, “Yes”, “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 2]

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