Tuberculosis Exposure Research Articles

Imaging latent tuberculosis infection with radiolabeled nitroimidazoles.

Imaging latent tuberculosis infection with radiolabeled nitroimidazoles.

A comparative analysis of two interferon-γ releasing assays to detect past tuberculosis infections in Japanese rheumatoid arthritis patients

Objectives: To compare the utility of QuantiFERON-TB Gold in tube (QFT-GIT) and T-SPOT.TB assays to detect past tuberculosis infection in Japanese rheumatoid arthritis patients receiving methotrexate.Methods: We compared the sensitivities and specificities, the rates of indeterminate results, and the rates of positive results in patients with total and CD4-positive lymphocyte counts of both assays simultaneously performed on 68 rheumatoid arthritis patients receiving methotrexate, in whom 33 had evidence of past tuberculosis infection by chest computed tomography and the other had neither history of tuberculosis exposure nor abnormalities in chest computed tomography.Results: The sensitivities, specificities, and the rates of indeterminate results of QFT-GIT were 21.2%, 100%, and 4.4%, and those of T-SPOT.TB were 21.9%, 100%, and 1.5%, respectively. The overall agreement of both assays was good (κ = 0.68). In patients with past tuberculosis infection, there are significant positive linear trends in positive rates of both assays across ranges of larger numbers of total and CD4-positive lymphocyte counts.Conclusions: Both assays were equally useful with high specificities, but may falsely identify past tuberculosis infection owing to low sensitivities. In patients with low total and CD4-positive lymphocyte counts, both assays might give higher rates of false negative results.

Postpartum Tuberculosis: A Diagnostic and Therapeutic Challenge.

Tuberculosis (TB) infection in pregnant women and newborn babies is always challenging. Appropriate treatment is pivotal to curtail morbidity and mortality. TB diagnosis or exposure to active TB can be emotionally distressing to the mother. Circumstances can become more challenging for the physician if the mother's TB status is unclear. Effective management of TB during pregnancy and the postpartum period requires a multidisciplinary approach including pulmonologist, obstetrician, neonatologist, infectious disease specialist, and TB public health department. Current guidelines recommend primary Isoniazid prophylaxis in TB exposed pregnant women who are immune-suppressed and have chronic medical conditions or obstetric risk factors and close and sustained contact with a patient with infectious TB. Treatment during pregnancy is the same as for the general adult population. Infants born to mothers with active TB at delivery should undergo a complete diagnostic evaluation. Primary Isoniazid prophylaxis for at least twelve weeks is recommended for those with negative diagnostic tests and no evidence of disease. Repeated negative diagnostic tests are mandatory before interrupting prophylaxis. Separation of mother and infant is only necessary when the mother has received treatment for less than 2 weeks, is sputum smear-positive, or has drug-resistant TB. This case highlights important aspects for management of TB during the postpartum period which has a higher morbidity. We present a case of a young mother migrating from a developing nation to the USA, who was found to have a positive quantiFERON test associated with multiple cavitary lung lesions and gave birth to a healthy baby.

Prevalence and risk factors of latent tuberculosis infection in close contacts of tuberculosis patients among non-resident populations in Shanghai, China

To investigate the prevalence of latent tuberculosis (TB) infection (LTBI), and to identify the risk factors in close contacts of pulmonary TB patients among non-resident population in Shanghai. The study subjects were the close contacts of pulmonary TB patients among non-resident populations in Xuhui, Minhang and Songjiang Districts in Shanghai from 2013 to 2014.Questionnaire interview was applied to collect the socio-demographics, TB-related clinical and TB exposure information from the enrolled TB patients and their close contacts. The T-SPOT.TB test was used to identify the infection of M. TB. LTBI was defined as a positive T-SPOT.TB result inthe absence of signs and symptoms related to TB. In total, 182 pulmonary TB patients and 360 close contacts were enrolled in the present study. The mean age of the close contacts was (34±14) years(range, 2-83 years), including 160 men and 200 women. The T-SPOT.TB test and TB related examination revealed that 17.2% (62/360) of the close contacts were latently infected with M. TB. All the LTBI subjects were household contacts (χ(2)=16.814, P<0.001). In multivariate analysis, the risk of LTBI was statistically associated with the presence of TB symptoms of the index case (OR=2.696, 95%CI: 1.060-6.857) and duration of exposure (OR=1.007, 95%CI: 1.001-1.014); whereas there were no statistically significant associations among age, gender, diagnostic delay of index case, environment of contact place and the risk of LTBI among the studied close contacts. The prevalence of LTBI in close contacts of pulmonary TB patients among non-resident population in Shanghai is 17.2%.Contact with patients with TB symptoms and longer duration of exposure might increase the risk of LTBI.

Major Loci on Chromosomes 8q and 3q Control Interferon γ Production Triggered by Bacillus Calmette-Guerin and 6-kDa Early Secretory Antigen Target, Respectively, in Various Populations.

Background. Interferon γ (IFN-γ) release assays (IGRAs) provide an in vitro measurement of antimycobacterial immunity that is widely used as a test for Mycobacterium tuberculosis infection. IGRA outcomes are highly heritable in various populations, but the nature of the involved genetic factors remains unknown.Methods. We conducted a genome-wide linkage analysis of IGRA phenotypes in families from a tuberculosis household contact study in France and a replication study in families from South Africa to confirm the loci identified.Results. We identified a major locus on chromosome 8q controlling IFN-γ production in response to stimulation with live bacillus Calmette-Guerin (BCG; LOD score, 3.81; P = 1.40 × 10−5). We also detected a second locus, on chromosome 3q, that controlled IFN-γ levels in response to stimulation with 6-kDa early secretory antigen target, when accounting for the IFN-γ production shared with that induced by BCG (LOD score, 3.72; P = 1.8 × 10−5). Both loci were replicated in South African families, where tuberculosis is hyperendemic. These loci differ from those previously identified as controlling the response to the tuberculin skin test (TST1 and TST2) and the production of TNF-α (TNF1).Conclusions. The identification of 2 new linkage signals in populations of various ethnic origins living in different M. tuberculosis exposure settings provides new clues about the genetic control of human antimycobacterial immunity.

Paradoxical anti-TNF-associated TB worsening: Frequency and factors associated with IRIS

ObjectivesParadoxical tuberculosis (TB) worsening, an example of the immune reconstitution inflammatory syndrome (IRIS), is an increasing phenomenon now described in several settings, including anti-tumor necrosis factor (TNF) discontinuation during biotherapy-induced TB. To better recognize it, we analyzed the frequency and factors associated with anti-TNF-induced TB–IRIS. MethodsCase-control study on anti-TNF-associated TB patients. IRIS cases, defined with the following consensus criteria, were matched to two controls (anti-TNF-associated TB without IRIS). IRIS frequency was based on the French RATIO registry. Conditional logistic-regression identified IRIS risk factors. ResultsFourteen patients developed anti-TNF-associated TB–IRIS within medians of 45 [IQR 22–131] days after starting anti-TB therapy and 110 [IQR 63–164] days after the last anti-TNF infusion. Each case was matched to two controls by year of TB diagnosis. IRIS-associated factors were (odds ratio [95% CI]): disseminated TB (11.4 [1.4–92.2], P=0.03), history of Mycobacterium tuberculosis exposure (12.7 [1.6–103.0], P=0.02) and steroid use at the time of TB diagnosis (4.6 [1.2–17.2], P=0.02). The RATIO registry IRIS frequency was 7%. ConclusionAfter stopping biotherapy, paradoxical anti-TNF-associated TB worsening occurred most often in patients with disseminated TB. Although diagnosis remains difficult, physicians must be aware of IRIS because prolonged anti-TB treatment is not needed but, paradoxically, immunosuppressant reintroduction may be.

313P Tuberculosis exposure and the risk of cancer

313P Tuberculosis exposure and the risk of cancer

Assessment of latent tuberculosis infection in psychiatric inpatients: A survey after tuberculosis outbreaks.

To investigate risk factors of latent tuberculosis infection (LTBI) among inpatients of chronic psychiatric wards with tuberculosis (TB) outbreaks. In April 2013, inpatients of four all-male wards with TB outbreaks were tested for LTBI using the QuantiFERON-TB Gold in Tube (QFT) method. Based on this investigation, a retrospective study was conducted to assess risk factors for LTBI. Inpatients exposed to cluster-A or cluster-B TB cases were defined as contacts of cluster-A or cluster-B, and others, as nonclustered contacts. Among 355 inpatients with TB exposure, 134 (38%) were QFT-positive for LTBI. Univariate analysis showed that significant predictors for QFT-positivity were age, case-days of exposure to all TB cases (TB-all) and to sputum smear positive cases, number of source cases with cough, and exposure to cluster-A TB cases. Independent risk factors for LTBI were higher age [adjusted odds ratio (OR) 1.03, 95% confidence intervals (CI: 1.01-1.05)], TB-all exposure case-days≥200 [adjusted OR 2.04 (1.06-3.92)] and exposure to cluster-A TB cases [adjusted OR 2.82 (1.30-6.12)] after adjustment for the sputum smear positivity, and cough variables of the source cases. The contacts of cluster-A had a greater risk of LTBI than did those of cluster-B, especially in the younger population (≤50years) after adjustment [adjusted OR 2.64 (1.03-6.76)]. After TB outbreaks, more than one third of inpatients were QFT-positive for LTBI. Our findings suggest that, beside the infectiousness of source cases, intensity of exposure, and age of contacts, exposure to TB cases in potential genotyping clusters may be predictive for LTBI in this male psychiatric population.

Risk of Disease After Isoniazid Preventive Therapy for Mycobacterium tuberculosis Exposure in Young HIV-uninfected Children.

Background:The risk of developing tuberculosis (TB) disease in HIV-uninfected children after isoniazid preventive therapy (IPT) for a positive QuantiFERON-TB Gold In-Tube test (QFT-GIT) is unknown. The aim of this study was to evaluate risk of TB disease after IPT in young HIV-uninfected children with a positive QFT-GIT result, or household TB contact.Methods:HIV-uninfected South African infants aged 4–6 months were screened for enrolment in a TB vaccine trial. Baseline household TB contact and positive QFT-GIT result were exclusion criteria, and these infants were referred for IPT. Outcome data are reported for 36 months after IPT referral.Results:Four thousand seven hundred forty-nine infants were screened. Household TB contact was reported in 131 (2.8%) infants; 279 (6.0%) were QFT-GIT positive, and 138 of these 410 infants (34.0%) started IPT. Forty-four cases of TB disease (11.0%) were recorded within 991 child years of observation. TB disease incidence was 4.8 versus 3.6 per 100 child years in household exposed versus QFT-GIT-positive children [incidence rate ratio: 1.35; 95% confidence interval (CI): 0.67–2.88] and 2.4 versus 5.5 per 100 child years in children who received versus did not receive IPT, respectively (incidence rate ratio: 0.44; 95% CI: 0.17–0.96). Adjusted hazard ratio (Cox regression) for TB disease was 0.48 (95% CI: 0.21–1.05) for those who received IPT.Conclusion:In young HIV-uninfected children, the effect of IPT on risk of TB disease is similar, whether TB exposure was defined by household contact history or by positive QFT-GIT result. International IPT guidelines for HIV-uninfected children with a positive QFT-GIT result should be updated.

The Risk of Depressive Disorder Among Contacts of Tuberculosis Patients in a TB-endemic Area: A Population-based Cohort Study.

Tuberculosis (TB) disease may be transmitted to close contacts of index cases, causing physical illness. No studies have investigated the risk of developing depressive disorder among TB contacts in a TB-endemic area.Adult participants with a new diagnosis of TB contact (ICD-9-CM codes V01.1 plus chest radiographic order) since January 1, 2008, were identified from the National Health Insurance Research Database in Taiwan. A control cohort matched for age (±5 y), sex, enrolled years, and income level was selected. These 2 cohorts were followed until December 31, 2012, and observed for the development of depressive disorder. The Kaplan-Meier method and the log-rank test were used to examine the difference in cumulative incidences of depressive disorder between groups. Cox proportional-hazard models were used to calculate adjusted hazard ratios (aHRs) for depressive disorder.The TB contact cohort consisted of 9046 patients and matched controls of 36,184 ones. The mean age of TB contacts was 44.7 years, and 56.0% of them were women. During a mean follow-up period of 2.5 years, 127 (1.40%) TB contacts and 521 (1.44%) matched controls developed depressive disorder. TB exposure was found to be an independent risk factor of depressive disorder in women (aHR 1.34, 95% confidence interval [CI] 1.07–1.68), but not in men (aHR 0.71, 95% CI 0.48–1.06) after adjusting for age, comorbidities, and income levels. The risk of depression was significantly higher for female TB contacts than for matched controls in the first and second years (aHR 1.49, 95% CI 1.03–2.14; and aHR 1.53, 95% CI 1.05–2.23, respectively), but not thereafter. Of note, 67 (0.74%) TB contacts and 88 (0.24%) matched controls developed active TB, but none of them had subsequent depressive disorder during follow-up periods.Female TB contacts had an increased risk of depression within the first 2 years after exposure. Clinicians should consider conducting depression evaluations in addition to routine TB contact investigations in this subgroup population.

Evaluation of tuberculin skin testing in tuberculosis contacts in Victoria, Australia, 2005-2013.

To review the programmatic use of the tuberculin skin test (TST) following tuberculosis (TB) exposure in Victoria, Australia. A retrospective review of data collected for public health surveillance was performed to identify contact demographic factors, including bacille Calmette-Guérin (BCG) status and age and outcomes of TST. Contact tracing was performed for 15 094 people, of whom 13 427 (89.0%) had a TST performed. The TST was positive in 31.4% (95%CI 30.6-32.2) of all contacts, and 48.8% of contacts born outside of Australia. Amongst contacts who were TST-negative at baseline, the conversion rate following exposure was 14.8%. Conversion was most common in those aged 45-54 years, with <12% positivity in both the youngest (<5 years) and oldest (⩾65 years) age groups. Active TB developed in 1.1% of all contacts. Contacts aged <5 years had the highest risk of developing active TB following exposure (3.8%), while low risk was seen in those aged ⩾65 years (0.3%). Overall, contact tracing and TST in this setting appear to yield a high proportion of people at risk for the development of active TB. The yield of testing in some groups, particularly those aged ⩾65 years, was low, and investigation of alternative strategies should be considered.

Chronic obstructive pulmonary disease – diagnosis and classification of severity

Chronic obstructive pulmonary disease (COPD) is a common, progressive and preventable non-communicable respiratory disorder. It is often confused with asthma and poorly understood by many lay people. The primary cause of COPD is tobacco smoking, but in the South African (SA) context, biomass fuel exposure/household pollution, tuberculosis, HIV and mining exposure are additional important causes.There is a very high prevalence of COPD in SA and it is the third leading cause of mortality globally.The diagnosis of COPD is based predominantly on symptoms, i.e. progressive shortness of breath and cough in a patient with risk factors–usually smoking. Lung function testing is required to formally make the diagnosis, which places a significant hurdle in correctly identifying COPD in SA, given the limited access to spirometry in many areas. Spirometry is also required to grade the severity of lung function obstruction.Severity assessment, which is used to plan a management strategy (predominantly bronchodilators with inhaled steroids in severe cases), combines symptoms, lung function and exacerbations. Based on these 3 factors, a patient can be categorised into 1 of 4 groups and appropriate management instituted. Additional comorbidities, particularly cardiovascular and mental illness, should also be evaluated.Early identification of COPD, with further avoidance of an aetiological cause such as smoking, is key in preventing disease progression.Appropriate therapy, comprising non-pharmacological and pharmacological interventions and based on a comprehensive severity assessment, should result in symptom improvement and reduced risk for exacerbations.

The Moth-Eaten Lung: Lung Adenocarcinoma with Cavitating Miliary intrapulmonary Carcinomatosis

1375 Journal of Thoracic Oncology ® • Volume 10, Number 9, September 2015 CASE PRESENTATION A 64-year-old man of Asian descent presented to our clinic because of dry cough and shortness of breath for 2 months. He was a never-smoker and denied tuberculosis exposure. His chest radiography showed diffuse miliary nodules distributed at bilateral lungs. The computed tomography of chest showed a 2.5-cm nodule at the superior segment of right lower lung and widespread of cavitating and noncavitating miliary nodules at bilateral lungs (Fig. 1). A diagnosis of stage IV lung adenocarcinoma with EGFR exon-19 deletion mutation was made. The patient was treated with afatinib 40 mg per day. On afatinib treatment at 3 months, the chest computed tomography showed shrinkage of the main tumor and regression of the cavitating and noncavitating miliary nodules (Fig. 2). The patient is currently undergoing afatinib treatment with good partial response. Lung is frequently a metastatic site for non–small-cell lung cancer. It can present as multiple lung nodules, lymphadenopathy, and effusion on chest imaging. Nevertheless, lung cancer with cavitating miliary carcinomatosis is extremely uncommon. It indicates a hematogenous dissemination of cancer cells and usually carries a rapidly fatal clinical course. Interestingly, this patient population has been shown to harbor a higher rate of adenocarcinoma and EGFR mutation, especially EGFR exon-19 deletion mutation.

Mycobacterium tuberculosis nucleic acid amplification tests reduce nosocomial tuberculosis exposure in intensive care units: A nationwide cohort study.

This retrospective national surveillance study investigated the burden of and risk factors for nosocomial exposure of pulmonary tuberculosis (TB) in intensive care units. Patients admitted to intensive care units were identified from the National Health Insurance Research Database. During 2004-2009, there were 1 387 707 intensive care unit admissions of 900 562 adult patients. Pulmonary tuberculosis association was considered if the patient was diagnosed with pulmonary tuberculosis during admission or within 3 months after discharge. Nosocomial transmissible period was calculated based on the length of anti-tuberculosis treatment and negative-pressure isolation during admission. Pulmonary tuberculosis was associated with 1.20% of all intensive care unit admissions and 6731 (38.9%) started anti-TB treatment during admission. For the other 10 583 admissions, the diagnosis was made after discharge and anti-TB treatment was not prescribed during admission. The probability paralleled the regional tuberculosis incidence. On average, 2794 pulmonary tuberculosis associated intensive care unit admissions contributed to 42 999-44 062 days of nosocomial exposure per year. The length of nosocomial transmissible period decreased with the gradual implementation of Mycobacterium tuberculosis nucleic acid amplification tests in intensive care practice. Multivariate linear regression analysis revealed that the length of nosocomial transmissible period was inversely associated with male gender, airway symptoms prior to admission and performing M. tuberculosis nucleic acid amplification tests and mycobacterial culture. Nosocomial tuberculosis exposure is not uncommon in intensive care units. Performing rapid molecular diagnostic tests in those suspected of tuberculosis is recommended to reduce the risk of nosocomial exposure.

Aplicación y utilidad actual de las técnicas de interferón-γ en el diagnóstico de la tuberculosis

Utility of the in-vitro immunodiagnostic methods, based on the detection of interferon-γ released by T-cells after specific Mycobacterium tuberculosis antigen stimulation (IGRA), has been an improvement in the accuracy of the latent tuberculosis infection diagnosis. IGRA have a well-known higher specificity than the tuberculin skin testing (TST). Moreover, they can obtain a larger number of positive results than the TST in immunocompromised patients. IGRA have shown a high correlation with M. tuberculosis exposure, but their positive and negative predictive value are similar than those obtained by TST. Nevertheless, given their high specificity, they allow reducing number of unnecessary preventive treatments. In addition, these in-vitro techniques are less affected than TST by the different immunosuppressing status. In this review is discussed up-to-date applicability of IGRA in different patient groups: contact studies, pediatric population, immunosuppressed patients, health care workers and active tuberculosis patients. Furthermore, it has been included possible future directions for latent tuberculosis infection and active tuberculosis diagnosis.

The Prevalence and Incidence of Latent Tuberculosis Infection and Its Associated Factors among Village Doctors in China.

BackgroundChina is a high tuberculosis (TB) burden country. More than half of acute TB cases first seek medical care in village doctors’ clinics or community health centers. Despite being responsible for patient referral and management, village doctors are not systematically evaluated for TB infection or disease. We assessed prevalence and incidence of latent TB infection (LTBI) among village doctors in China.Methods and FindingsA longitudinal study was conducted in Inner Mongolia Autonomous Region. We administered a questionnaire on demographics and risk factors for TB exposure and disease; Tuberculin skin testing (TST) and QuantiFERON-TB Gold in-tube assay (QFT-GIT) was conducted at baseline and repeated 12 months later. We used a logistic regression model to calculate adjusted odds ratios (ORs) for risk factors for TST and QFT-GIT prevalence and incidence. At the time of follow up, 19.5% of the 880 participating village doctors had a positive TST and 46.0% had a positive QFT-GIT result. Factors associated with TST prevalence included having a BCG scar (OR = 1.45, 95%CI 1.03–2.04) and smoking (OR = 1.69, 95%CI 1.17–2.44). Risk factors associated with QFT-GIT prevalence included being male (OR = 2.17, 95%CI 1.63–2.89), below college education (OR=1.42, 95%CI 1.01–1.97), and working for ≥25 years as a village doctor (OR = 1.64, 95%CI 1.12–2.39). The annual incidence of LTBI was 11.4% by TST and 19.1% by QFT-GIT. QFT-GIT conversion was associated with spending 15 minutes or more per patient on average (OR = 2.62, 95%CI 1.39–4.97) and having BCG scar (OR = 0.53, 95%CI 0.28–1.00).ConclusionsPrevalence and incidence of LTBI among Chinese village doctors is high. TB infection control measures should be strengthened among village doctors and at village healthcare settings.

Preventing tuberculosis transmission at a maternity hospital by targeted screening radiography of migrants

Israel has been the destination of large numbers of illegal migrants from East African countries in recent years. Despite efforts to detect and treat active tuberculosis (TB) at the border, 75% of all active TB cases diagnosed in our hospital were illegal migrants. In 2012, there was a large-scale TB exposure in our maternity ward, neonatal, and paediatric intensive care units following the admission of an infectious but apparently asymptomatic migrant who was in labour. A hospital-wide screening programme was subsequently implemented to prevent exposure of patients and staff to TB. To report the results of the first year of this intervention in the maternity hospital. All illegal migrants from countries where TB is highly prevalent were screened by chest radiography (CR) upon admission to the maternity hospital. The results were immediately categorized by a radiologist as either 'suggestive of active pulmonary TB' or 'non-suggestive'. Patients with CR suggestive of TB were placed in airborne isolation and underwent further evaluation. Four hundred and thirty-one apparently asymptomatic migrant women underwent CR screening. Most (363, 84%) presented in labour. Eleven women (2.6%) had a CR suggestive of active pulmonary TB which was confirmed in three (0.7% of screened women). No TB cases were missed by the CRs. Neither patients nor hospital staff were exposed to TB. Targeted CR screening for TB among high-risk women upon their admission to a maternity hospital had a high yield and was an effective strategy to prevent in-hospital transmission of TB.

Epidemiologic link between tuberculosis and cigarette/biomass smoke exposure: Limitations despite the vast literature.

The geographic overlap between the prevalence of cigarette smoke (CS) exposure and tuberculosis (TB) in the world is striking. In recent years, relatively large number of studies has linked cigarette or biomass fuel smoke exposure and various aspects of TB. Our goals are to summarize the significance of the known published studies, graphically represent reports that quantified the association and discuss their potential limitations. PubMed searches were performed using the key words 'tuberculosis' with 'cigarette', 'tobacco', 'smoke' or 'biomass fuel smoke.' The references of relevant articles were examined for additional pertinent papers. A large number of mostly case-control and cross-sectional studies significantly associate both direct and second-hand smoke exposure with tuberculous infection, active TB, and/or more severe and lethal TB. Fewer link biomass fuel smoke exposure and TB. While a number of studies interpreted the association with multivariate analysis, other confounders are often not accounted for in these analyses. It is also important to emphasize that these retrospective studies can only show an association and not any causal link. We further explored the possibility that even if CS exposure is a risk factor for TB, several mechanisms may be responsible. Numerous studies associate cigarette and biomass smoke exposure with TB but the mechanism(s) remains largely unknown. While the associative link of these two health maladies is well established, more definitive, mechanistic studies are needed to cement the effect of smoke exposure on TB pathogenesis and to utilize this knowledge in empowering public health policies.

Cheerios in the lung: a rare but characteristic radiographic sign

A 52-year-old woman presented with a 3-month history of right pleuritic chest pain and recent night sweats. In terms of premedical history, she had a 30 pack-year smoking history but denied any environmental exposure. There was no evidence of tuberculosis exposure or a positive tuberculin test in the past. She denied weight loss and her travel history included visits only to European countries. Physical …

Tuberculosis Infection Control: An Interdisciplinary Perspective

Although tuberculosis rates have declined in the United States over the past 19 years, new cases and cases of drug resistant strains continue to appear. Healthcare workers are at particular risk for contracting tuberculosis as they care for those who are undergoing diagnosis. This article proposes an interdisciplinary tuberculosis management protocol which will reduce the exposure of laboratory and radiography staff to tuberculosis high risk patients during diagnostic testing. Further, we demonstrate the use of interdisciplinary diagnostic management teams to improve communication of tuberculosis exposure risk and reduce the infection of healthcare workers. ABBREVIATIONS:Mycobacterium tuberculosis (TB), Infectious Dose (ID), Centers for Disease Control and Prevention (CDC), Electronic Health Record (EHR), high efficiency particulate air (HEPA), Occupational Safety and Health Administration (OSHA), Personal Protective Equipment (PPE)