Tuberculosis Clinic

TB Screening in San Francisco

Community Clinics are important partners in TB control because of the high rates of tuberculosis in San Francisco. In assessing who should be screened, population and medical risk factors for TB (listed below) should be asked and/or determined as part of your patient’s routine medical evaluation. The following information outlines who should be screened, the interval of screening and who should be referred to the TB Clinic at SFGH.

WHO SHOULD BE SCREENED FOR TB WITH A SYMPTOM REVIEW AND SKIN TEST or QUANTIFERON TB BLOOD TEST:

• Newcomers to the US (<5 yrs) from Asia and other endemic TB countries (SCREEN REGARDLESS OF AGE)
• Foreign born under the age of 35 from TB endemic areas
• Individuals with medical risk factors for TB reactivation (diabetes, renal failure, cancer, silicosis, malnutrition, HIV or on immunosuppressive drugs)
• Patients found to have an abnormal chest x-ray consistent with old or active TB without prior evaluation or treatment (e.g., CXR=upper lobe fibrotic infiltrates. Exclude: those with isolated granulomas or pleural lesions. Include: those with parenchymal infiltrates even if stable over time)
• Patients with unexplained chronic cough or weight loss
• Renal dialysis patients
• Residents and employees of high-risk congregate sites (e.g., nursing homes, jails, prison, shelters, substance abuse treatment facilities and hospitals)
• Homeless individuals
• Injection drug users
• Patients with planned or are post organ transplant
• Contacts to active TB cases
• Children who have the above risk factors or live with adults with the TB risk factors or travel to TB endemic countries for >2weeks

FREQUENCY OF TB TESTING: Individuals should be retested on a regular basis if there is an ongoing risk of TB exposure or infection. The frequency of testing should depend on the degree of risk of TB exposure. (eg. TB Clinic and SFGH ER staff get tested every 6 months while primary care clinic staff get tested annually)

WHO SHOULD BE REFERRED TO TB CLINIC, WARD 94, SFGH

• ALL individuals listed above with a positive quantiFERON TB blood test or tuberculin skin test reading of 10 millimeters or more, unless HIV+ or immunocompromised (5 mm considered positive)
• ALL individuals with an abnormal chest x-ray (described above) consistent with old or active TB regardless of skin test results
• ALL individuals with TB symptoms regardless of skin test results

Download printable version of the information above, plus any of these four files below:

• Latent Tuberculosis Infection: A Guide for San Francisco Providers (Acrobat file, 32 pgs)
• Tuberculosis Risk Assessment PDF Form (Acrobat file)
• Treatment of Latent TB Infection - 2003 (Acrobat file, 4 pgs)
• Follow-Up Protocols for Patients With a Positive PPD (Acrobat file