A 32-year-old immigrant from China with BCG vaccination and a PPD of 12 mm has which risk status and recommended management?

A 32-year-old immigrant from China with BCG vaccination and a PPD of 12 mm has which risk status and recommended management?

• A. Low risk; observation
• B. Moderate risk; chest X-ray
• C. High risk; start isoniazid therapy
• D. High risk; start rifampin therapy

Answer: (C)

Interpreting TB screening results in someone from a country with high TB prevalence focuses on latent infection and the risk of progression to active disease. A PPD that is positive (12 mm) in an immigrant from China meets the threshold for latent TB infection given the risk factors, even though BCG vaccination can cause false positives. The key step is to rule out active tuberculosis—assess for symptoms and obtain a chest radiograph. If there are no signs of active disease and the imaging is clear, this patient has latent TB infection and is considered high risk for progression because of recent immigration from a high-prevalence area. The best management is preventive therapy with isoniazid for about nine months, which substantially lowers the chance that latent TB will become active. Monitor for hepatotoxicity during treatment and counsel on adherence and alcohol use. Rifampin is an alternative in certain cases, but the preferred first-line approach here is isoniazid therapy.

Interpreting TB screening results in someone from a country with high TB prevalence focuses on latent infection and the risk of progression to active disease. A PPD that is positive (12 mm) in an immigrant from China meets the threshold for latent TB infection given the risk factors, even though BCG vaccination can cause false positives. The key step is to rule out active tuberculosis—assess for symptoms and obtain a chest radiograph. If there are no signs of active disease and the imaging is clear, this patient has latent TB infection and is considered high risk for progression because of recent immigration from a high-prevalence area. The best management is preventive therapy with isoniazid for about nine months, which substantially lowers the chance that latent TB will become active. Monitor for hepatotoxicity during treatment and counsel on adherence and alcohol use. Rifampin is an alternative in certain cases, but the preferred first-line approach here is isoniazid therapy.