Testing for Tuberculosis (TB)

Tuberculosis (TB) is a disease that is spread through the air from one person to another. When someone with TB
disease coughs, speaks, laughs, sings, or sneezes, people nearby may breathe TB bacteria into their lungs.
TB usually attacks the lungs, but can also attack other parts of the body, such as the brain, spine or kidneys.

There are two types of TB: What does a positive TST result mean?
1. TB infection The TST result depends on the size of the raised, hard area
2. TB disease
or swelling. It also depends on the person’s risk of being
TB bacteria can live in the body without making a infected with TB bacteria and the progression to TB disease
person sick. This is called TB infection. People with TB if infected.
infection do not feel sick, do not have TB symptoms, ⓦ Positive TST: This means the person’s body may have
and cannot spread TB bacteria to others. Some people been infected with a mycobacteria. Additional tests are
with TB infection go on to develop TB disease. People needed to determine if the person has TB infection
with TB disease can spread the bacteria to others, feel or TB disease. A health care worker will recommend
sick, and can have symptoms including fever, night further testing or treatment.
sweats, coughing and weight loss. ⓦ Negative TST: This means the person’s body did not
There are two kinds of tests that are used react to the test, and that TB infection or TB disease
to determine if a person has been infected with TB is not likely.
bacteria: the tuberculin skin test and Interferon Who can receive a TST?
Gamma Release Assay (IGRA). Almost everyone can receive a TST, including infants,
children, pregnant women, people living with HIV, and
Tuberculin Skin Test (TST) people who have had a BCG shot. People who had a severe
Of the two test available, the TST is older, least reaction to a previous TST should not receive another TST.
specific, and less preferred. How often can a TST be given?
What is a TST? Usually, there is no problem with repeated TSTs unless a
The Mantoux tuberculin skin test is a test to check person has had a severe reaction to a previous TST.
if a person has been infected with TB bacteria.
How does the TST work? Testing for TB in People
Using a small needle, a health care provider injects
a liquid (called tuberculin) into the skin of the lower
with a BCG
The IGRA is the preferred test for people who have had
part of the arm. When injected, a small, pale bump will
a BCG shot. BCG does not cause a false reaction in an
appear. This is different from a Bacille Calmette-Guerin
IGRA as it can with a TST. People who have had a previous
(BCG) shot (a TB vaccine that many people living
outside of the United States receive). BCG shot may receive a TST. In some people, the BCG shot
may cause a positive TST when they are not infected with
The person given the TST must return within two or TB bacteria. If a TST is positive, additional tests are needed.
three days to have a trained health care worker look
for a reaction on the arm where the liquid was
injected. The health care worker will look for a raised,
hard area or swelling, and if present, measure its size
using a ruler. Redness by itself is not considered part
of the reaction. MISSISSIPPI STATE DEPARTMENT OF HEALTH
Tuberculosis & Refugee Health
TB Blood Tests Who Should Get Tested for TB?
TB tests are generally not needed for people with
What is an Interferon Gamma Release
a low risk of infection with TB bacteria.
Assay (IGRA)?
Certain people should be tested for TB bacteria
An IGRA is a blood test that can determine if a person because they are more likely to get TB disease,
has been infected with TB bacteria. An IGRA measures including:
how strong a person’s immune system reacts to TB ⓦ People who have spent time with someone who
bacteria by testing the person’s blood in a laboratory. has TB disease
Two IGRAs are approved by the U.S. Food and Drug ⓦ People with HIV infection or another medical
Administration (FDA) and are available in the problem that weakens the immune system
United States: ⓦ People who have symptoms of TB disease (fever,
1) QuantiFERON®-TB Gold In-Tube test (QFT-GIT) night sweats, cough and weight loss)
2) T-SPOT®TB test (T-Spot) ⓦ People from a country where TB disease is
common (most countries in Latin America,
How does the IGRA work? the Caribbean, Africa, Asia, Eastern Europe
Blood is collected into special tubes using a needle. and Russia)
The blood is delivered to a laboratory as directed ⓦ People who live or work somewhere in the
by the IGRA test instructions. The laboratory runs United States where TB disease is more common
the test and reports the results to the health care (homeless shelters, prison or jails or some
provider. nursing homes)
ⓦ People who use illegal drugs
What does a positive IGRA result mean?
ⓦ People prescribed TNF inhibitors prior to starting
ⓦ Positive IGRA: This means that the person has
therapy
been infected with TB bacteria. Additional tests
ⓦ People with a chronic disease such as diabetes
are needed to determine if the person has TB
infection or TB disease. A health care worker will
Choosing a TB Test
then provide treatment as needed.
Choosing which TB test to use should be done by the
ⓦ Negative IGRA: This means that the person’s person’s health care provider. Factors in selecting
blood did not react to the test and that TB which test to use include the reason for testing, test
infection or TB disease is not likely. availability, and cost.
Who can receive an IGRA? Diagnosis of TB Infection or TB Disease
Anyone can have an IGRA in place of a TST. This can If a person is found to be infected with TB bacteria,
be for any situation where a TST is recommended. other tests are needed to see whether the person has
In general, a person should have either a TST or an TB disease.
IGRA. There are times when results from both tests TB disease can be diagnosed by medical history,
may be useful in deciding whether a person has physical examination, chest X-ray, and other
been infected with TB. laboratory tests. TB disease is treated by taking
several drugs as recommended by a health care
IGRAs are the preferred method of TB infection provider.
testing especially for the following:
If a person does not have TB disease, but has TB
ⓦ People who have received the BCG shot bacteria in the body, then TB infection is diagnosed.
ⓦ People who have a difficult time returning The decision about taking treatment for TB infection
for a second appointment to look at the TST will be based on a person’s chances of developing
after the test was given TB disease.
ⓦ People who have been exposed to TB disease
Related Links
How often can an IGRA be given? CDC Tuberculosis (TB): http://www.cdc.gov/tb
There is no problem with repeated IGRAs. Basic TB Information: http://www.cdc.gov/tb/
publications/factsheets/general/tb.htm
Mississippi State Department of Health
www.HealthyMS.com
June 2015