Core IM | Internal Medicine Podcast #12 Latent TB: 5 Pearls segment
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Mar 28, 2018 Dr. Carly Kaplan-Shaw, pulmonologist and TB program director at Bellevue, gives an authoritative clinical recap. Dr. Rafael Revedon, an NYU IM resident, and Varen Kolf, pulmonary/critical care fellow, discuss who to screen for latent TB. They compare TST versus IGRA, review treatment regimens and shorter rifamycin options, and cover monitoring, hepatotoxicity, and important drug interactions.
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Who To Screen For Latent TB
- Screen asymptomatic adults who are at increased risk for LTBI.
- This includes people born in TB-endemic countries regardless of years in the US, residents/employees of congregate settings, and recent close contacts.
Why IGRAs Often Outperform PPD
- Both TST and IGRAs are acceptable but IGRAs are preferred for many patients.
- IGRAs need one visit, avoid false positives from BCG, and are better for foreign-born patients like those from India.
BCG Scars Fuel Misconceptions About PPD
- Clinicians often encounter patients convinced BCG causes lifelong positive PPDs.
- Rafael Revedon and colleagues recount patients showing BCG scars and calling them a 'TB tattoo' despite limited effect on PPD after infancy.