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Practice Guidelines

Diagnosis of active and latent tuberculosis: summary of NICE guidance

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6828 (Published 17 October 2012) Cite this as: BMJ 2012;345:e6828
  1. Ibrahim Abubakar, professor of infectious disease epidemiology1,
  2. Chris Griffiths, professor of primary care2,
  3. Peter Ormerod, professor of respiratory medicine3
  4. on behalf of the Guideline Development Group
  1. 1Research Department of Infections and Population Health, University College London, London
  2. 2Centre for Primary Care and Public Health, Queen Mary University of London
  3. 3Royal Blackburn Hospital, Blackburn, UK
  1. Correspondence to: I Abubakar i.abubakar{at}ucl.ac.uk

Tuberculosis is a major preventable infectious cause of morbidity and mortality globally, which has re-emerged in high risk groups such as migrants, homeless people, problem drug users, and prisoners in the UK.1 This article summarises the most recent recommendations (2011) from the National Institute for Health and Clinical Excellence (NICE)2 on the diagnosis of latent tuberculosis (including the use of new tests) and of active tuberculosis. Although this summary focuses on diagnosis, the full guidelines cover the public health and clinical management of tuberculosis and replaced the guidelines published in 2006.3

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Diagnosing latent tuberculosis (New/updated recommendations)

All contacts of tuberculosis cases, aged 5 years or older

  • Offer Mantoux testing in line with the Department of Health’s Green Book4 to:

    • -Household contacts of all people with active tuberculosis

    • -Non-household contacts (other close contacts, such as in workplaces and schools).

  • A positive Mantoux test is an induration of ≥6 mm diameter for those who have not been vaccinated with BCG and ≥15 mm diameter for those who have been vaccinated.

  • Consider interferon-γ release assay (IGRA) for people whose Mantoux test shows positive results, or in people for whom Mantoux testing may be less reliable (such as those who have been vaccinated with BCG).

  • Refer people with a positive IGRA or an inconclusive Mantoux test to a tuberculosis specialist.

Household contacts aged 2–5 years

  • Offer Mantoux testing.

  • If the initial test is positive (taking into account BCG vaccination history), refer to a tuberculosis specialist to exclude active disease and consider treating latent tuberculosis.

  • If the initial Mantoux test is negative but the child is a contact of a person …

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