Case 4: Latent Tuberculosis Infection

Question | Discussion | References | CME Credit

You answered:

	You should test for latent TB infection with a tuberculin skin test and for anergy with a mumps control. If, 50 hours later, he has 0 mm of induration for both of the tests, you should inform him he does not require further treatment.

This answer is incorrect. Anergy testing is no longer recommended for HIV-infected patients receiving the tuberculin skin test. Although this patient may be anergic, this finding would not alter your decision to treat him. In this situation, the patient has had close contact with a person who had active pulmonary TB. Therefore, after excluding active TB, he should be treated for latent TB infection regardless of his tuberculin skin test result.

	After excluding active TB with a symptom review and a chest radiograph, you should treat him with 9 months of isoniazid (INH).
	You should ask him about current symptoms that would suggest active TB and obtain a chest radiograph. If his chest radiograph is negative, he does not require further treatment.
	You should discontinue his antiretroviral therapy and start him on four-drug TB treatment.

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