Reports on HIV/AIDS: 1990

MAY 18, 1990, MMWR, Vol. 39, RR-8: [inclusive page numbers]
Tuberculin skin testing is the standard method of identifying persons infected with
M. tuberculosis. The intracutaneous administration of 5 units of purified protein
derivative (PPD) tuberculin (Mantoux test) is the best means of detecting infection,
although multiple-puncture devices may be used for screening large, low-risk
populations.
Chest radiography or sputum smear examinations are the screening methods of
choice only when the objective is intended to identify persons with current pulmonary
disease and when the administration of preventive therapy to infected persons is not
possible (e.g., among the homeless). In all screening programs, patients with signs
and/or symptoms suggesting pulmonary or pleural tuberculosis should have a
standard posterior-anterior chest radiograph, regardless of the tuberculin skin test
result. Radiographic abnormalities suggestive of tuberculosis have been described in
medical literature; however, tuberculosis may produce almost any form of pulmonary radiographic abnormality, especially in immunosuppressed persons (2).
RECOMMENDATIONS FOR SPECIFIC HIGH-RISK GROUPS
Persons with HIV Infection and Intravenous Drug Users
Recommendations for screening individuals with HIV infection and intravenous
drug abusers to determine the presence of tuberculous infection have been
published (3).
Tuberculin testing for persons with HIV infection should be conducted at the
following sites:
* Tuberculosis and chest disease clinics
* Substance abuse treatment centers
* AIDS (acquired immunodeficiency syndrome) clinics
* HIV counseling and testing sites (including sexually transmitted disease [STD]
clinics)
* Other facilities in which HIV testing is offered
Administrators of these facilities should ensure that the recommended screening
is completed.
Contacts of Infectious Cases
Because close contacts of persons with tuberculosis are at extremely high risk of
infection and disease, they should be identified within 3 days and examined within 7
days after the infectious index case has been diagnosed. Comprehensive guidelines
for identifying, examining, and managing contacts of persons with infectious tuberculosis have been published (4). State and local health departments are responsible
for ensuring that these monitoring activities are completed.

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