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Positive and negative tb test1/14/2024 Children who move to the United States from countries with high TB burden (eg, Asia, Middle East, Africa, Latin America, countries of the former Soviet Union) often received no testing for TBI, expanding the pool of infected children in the United States. 2 Infants and young children (younger than 4 years) have the highest rate for tuberculosis infection (TBI) progressing to TB disease rapidly after exposure, within a few weeks to several months. 1 Of the 5175 children and adolescents younger than 18 years with TB disease reported in the United States from 2010 to 2017, 32% were born in other countries. Approximately 9000 new cases occur each year in the United States. Tuberculosis (TB) remains an important disease in the United States and throughout the world. A TB specialist should be involved when there are questions regarding testing interpretation, selection of an appropriate treatment regimen, or management of adverse effects. Daily isoniazid can be used if there is intolerance or drug interactions with rifamycins. For improved adherence to therapy, the 3 rifamycin-based regimens are preferred because of their short duration. There are now several effective and safe regimens for the treatment of TBI in children. The advantages of using IGRAs and diminished experience with the placement and interpretation of the TST favor expanded use of IGRAs in children in the United States. Both methods have high positive predictive value when applied to children with risk factors for TBI, especially recent contact with a person who has TB disease. Both IGRAs and the TST have reduced sensitivity in immunocompromised children, including children with severe TB disease. Interferon-gamma release assays (IGRAs) are blood tests that use antigens specific for M tuberculosis as a result, IGRAs yield fewer false-positive results than the TST. The tuberculin skin test (TST) has many limitations, including difficulty in administration and interpretation, the need for a return visit by the patient, and false-positive results caused by cross-reaction with Mycobacterium bovis–bacille Calmette-Guerin vaccines and many nontuberculous mycobacteria. There is no diagnostic reference standard for latent tuberculosis infection (also referred to as tuberculosis infection ). Tuberculosis (TB) remains an important problem among children in the United States and throughout the world.
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