Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children
Clin Infect Dis. December 8, 2016.
David M. Lewinsohn1,a, Michael K. Leonard2,a, Philip A. LoBue3,a, David L. Cohn4, Charles L. Daley5, Ed Desmond6, Joseph Keane7, Deborah A. Lewinsohn1, Ann M. Loeffler8, Gerald H. Mazurek3, Richard J. O’Brien9, Madhukar Pai10, Luca Richeldi11, Max Salfinger12, Thomas M. Shinnick3, Timothy R. Sterling13, David M. Warshauer14, and Gail L. Woods15
1 Oregon Health & Science University, Portland, Oregon,
2 Emory University School of Medicine and
3 Centers for Disease Control and Prevention, Atlanta, Georgia,
4 Denver Public Health Department, Denver, Colorado,
5 National Jewish Health and the University of Colorado Denver, and
6 California Department of Public Health, Richmond;
7 St James’s Hospital, Dublin, Ireland;
8 Francis J. Curry International TB Center, San Francisco, California;
9 Foundation for Innovative New Diagnostics, Geneva, Switzerland;
10 McGill University and McGill International TB Centre, Montreal, Canada;
11 University of Southampton, United Kingdom;
12 National Jewish Health, Denver, Colorado,
13 Vanderbilt University School of Medicine, Vanderbilt Institute for Global Health, Nashville, Tennessee,
14 Wisconsin State Laboratory of Hygiene, Madison, and
15 University of Arkansas for Medical Sciences, Little Rock
Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain.
A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach.
Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional.
These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.