[Skip to Content]
[Skip to Content Landing]

Management of Latent Tuberculosis Infection

To identify the key insights or developments described in this article
1 Credit CME

In the US, approximately 13 million people have latent tuberculosis infection (LTBI), defined as people who are infected with Mycobacterium tuberculosis who do not have symptoms and do not transmit the disease. Without treatment, approximately 5% to 10% of immunocompetent persons with LTBI develop active TB disease in their lifetimes.1

In 2016, the US Preventive Services Task Force recommended screening all at-risk adults older than 18 years for LTBI with a blood test (interferon-gamma release assay) or a tuberculin skin test. At-risk individuals include those from TB-endemic regions and those who are immunocompromised or are starting an immunosuppressive medication, such as tumor necrosis factor antagonists or systemic corticosteroids at a dose of at least 15 mg of prednisone per day, or take immunosuppressive drugs after organ transplant.2 Evaluation for LTBI should include a medical history, physical examination, and chest radiographic imaging to rule out active TB disease. After confirmation that active TB is not present, LTBI treatment can be initiated. This article reviews the 2020 Centers for Disease Control and Prevention and National Tuberculosis Controllers Association LTBI treatment recommendations.1

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Daria Szkwarko, DO, MPH, 111 Brewster St, Pawtucket, RI 02860 (Szkwarkd@gmail.com).

Published Online: January 19, 2023. doi:10.1001/jama.2022.24362

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Szkwarko was partially supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the NIH, which funds Advance Clinical and Translational Research. Dr Kim was supported by NIH/NIAID under R25AI140490 Emerging Infectious Disease Scholars Program at Brown University.

Role of the Funder/Sponsor: The funders had no role in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Advance-CTR, or Emerging Infectious Disease Scholars.

Additional Contributions: All authors contributed equally. The authors would like to thank John Bernardo, MD (Massachusetts Department of Public Health), who did not receive compensation, for his support in formalizing this article.

References
1.
Sterling  TR , Njie  G , Zenner  D ,  et al.  Guidelines for the treatment of latent tuberculosis infection.   MMWR Recomm Rep. 2020;69(1):1-11. PubMedGoogle ScholarCrossref
2.
Latent Tuberculosis Infection. Centers for Disease Control and Prevention; 2020.
3.
Menzies  D , Adjobimey  M , Ruslami  R ,  et al.  Four months of rifampin or nine months of isoniazid for latent tuberculosis in adults.   N Engl J Med. 2018;379(5):440-453. doi:10.1056/NEJMoa1714283PubMedGoogle ScholarCrossref
4.
Sterling  TR , Villarino  ME , Borisov  AS ,  et al.  Three months of rifapentine and isoniazid for latent tuberculosis infection.   N Engl J Med. 2011;365(23):2155-2166.PubMedGoogle ScholarCrossref
5.
International Union Against Tuberculosis Committee on Prophylaxis.  Efficacy of various durations of isoniazid preventive therapy for tuberculosis.   Bull World Health Organ. 1982;60(4):555-564.PubMedGoogle Scholar
6.
CDC estimates for latent TB infection (LTBI) treatment costs. Centers for Disease Control and Prevention. Accessed November 10, 2022. https://www.cdc.gov/tb/publications/infographic/ltbi-treatment-costs.htm
7.
Update on rifamycin issues. Centers for Disease Control and Prevention. Accessed December 30, 2022. https://www.cdc.gov/tb/publications/letters/Rifamycin_Update.html
8.
Laboratory analysis of rifampin/rifapentine products. US Food and Drug Administration. Accessed May 29, 2022. https://www.fda.gov/drugs/drug-safety-and-availability/laboratory-analysis-rifampinrifapentine-products
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close