Epidemiology:  From 1953-84, cases decreased by 5.6%/yr.  From 1985-93, cases increased by 14%.



1.   No TB exposure, no infection (PPD negative)

1.   TB exposure, no infection (PPD negative)

2.   TB infection, no disease (PPD positive, sputum/CXR negative)

3.      Disease (sputum pos or BOTH PPD and CXR)

4.   TB hx, no disease

5.   TB suspect





PPD skin test:

1.   A reaction of 5 mm or greater INDURATION is positive IF:

a.   close, recent contact w/ known TB

b.   CXR c/w TB

c.   immunosuppressed

d.   HIV +

e.   high risk for HIV

1.   A reaction of 10 mm or more is pos in all others. Chemoprophylaxis should be considered IF:

a.   CXR c/w past disease

b.   recent conversion documented

c.   consequences to others is significant

d.   comorbid disease

e.   high risk for HIV



Highly recommended for the following groups:

1.      Close contacts of pulmonary TB pts.  After 3 mos, if PPD still negative, may D/C

2.      PPD convertors (change w/in past 2 yrs)

PPD positive w/ positive CXR

PPD convertors w/ or at high risk for HIV

PPD positive, immigrants < 2yrs, < 35 yrs old fr Cent and S America, Asia, Phillipines, Africa.

PPD positive < 21 yrs old

Lower priority:

1.      Post-partum < 35 yrs old, PPD positive

2.      PPD positive on steroids, immunosuppressive rx, leukemia, lymphoma, IDDM, silicosis, post gastrectomy, renal failure w/ uremia

PPD positive, health care workers

Contraindications to INH:

1.      Unstable liver disease, AST > 3 X normal

2.      Known INH adverse reaction


Length of Rx:

Immunocompromised including HIV( 1 yr

Children ( 9 mos

All others ( 6 mos

Vitamin B6:  should be given to persons at high risk for peripheral neuropathy- DM, uremia, alcoholics, malnutrition, HIV, pregnant, elderly.



1.   6 mos: INH, RIF, PZA, EMB

2.   9 mos: INH, RIF, EMB