NTCA



Criteria for Assessing Contagiousness and Response to Treatment for Placement in General PopulationCategoryCriteriaNo symptoms suggestive of pulmonary TB disease, andInitial respiratory specimens AFB smear negative x3, andNegligible likelihood of MDR TB (no known exposure to MDR TB, no history of prior episodes of TB with poor compliance during treatment), and not from a country or region with high incidence of MDR and XDR TB?Has produced 3 consecutive respiratory specimens NEGATIVE for AFB on smear microscopy, each obtained 8-24 hours apart with at least one collected in the morning*Respiratory specimens include: ?3 sputa (preferably induced), OR ?2 sputa (preferably induced) and 1 bronchoalveolar lavage (BAL); at least 1 sputum should be collected after BALANDHas completed 5–7 days of standard multidrug anti-TB treatment**Treatment should be initiated after the initial 3 respiratory specimens have been collectedSymptoms suggestive of pulmonary TB disease, and/orOne or more initial three respiratory specimens positive for AFB on smear microscopy, andNegligible likelihood of MDR TB (no known exposure to MDR TB, no history of prior episodes of TB with poor compliance during treatment), and not from a country or region with high incidence of MDR and XDR TB?Exhibits clinical improvementANDHas completed at least 2 weeks of standard multidrug anti-TB treatment*ANDHas produced 3 consecutive respiratory specimens NEGATIVE for AFB on smear microscopy, each obtained 8-24 hours apart with at least one collected in the morning*Respiratory specimens include: ?3 sputa (preferably induced), OR ?2 sputa (preferably induced) and 1 bronchoalveolar lavage (BAL); at least 1 sputum should be collected after BAL*Treatment should be initiated after the initial 3 respiratory specimens have been collectedSuspected or confirmed to have MDR-TB disease (i.e., TB that is resistant to both isoniazid and rifampin)Notify the Regional Medical Director, Associate Medical Director, Deputy Assistant Director for Clinical Services, and the PHSP Unit of any detainee with or suspected of having MDR or XDR TB for awareness and placement on the HQ Significant Detainee Illness (SDI) listANDHas produced 3 consecutive sputum specimens negative for AFB on smear microscopy and culture, each obtained 8-24 hours apart with at least two collected in the morning more frequent AFB smears may be useful to assess the early response to treatment and to provide an indication of infectiousnessduring treatment of patients with suspected MDR-TB pulmonary tuberculosis, a sputum specimen for microscopic examination and culture should be obtained at a minimum of monthly intervals until two consecutive early morning specimens are negative on culture ANDHas completed at least 2 weeks of effective multidrug anti-TB treatmentANDExhibits clinical improvementExtrapulmonary TBDetainees with extrapulmonary TB are usually not contagious and do not require placement in AII; however, TB can be transmitted from a draining skin or tissue abscess, or post-operative incisions, containing M. tuberculosis. Follow established treatment guidelines in consultation with applicable subspecialties which include infectious disease and possibly other depending on the organ(s) involved.-200025-549910Flow Diagram Criteria for placing detainees in general population following evaluation for TB disease with respiratory specimens negative for AFB§00Flow Diagram Criteria for placing detainees in general population following evaluation for TB disease with respiratory specimens negative for AFB§24606252788285□ No alternate explanation for clinical findings, AND □ 5–7 days standard multidrug anti-TB treatment by DOT taken and tolerated, AND□ Evidence of clinical improvement if symptoms initially present00□ No alternate explanation for clinical findings, AND □ 5–7 days standard multidrug anti-TB treatment by DOT taken and tolerated, AND□ Evidence of clinical improvement if symptoms initially present409448041408350013608055131435General population, ANDContinue treatment by DOT unless TB disease is excluded00General population, ANDContinue treatment by DOT unless TB disease is excluded359410976630□ 3 consecutive respiratory specimens++ negative for acid-fast bacilli (AFB) on smear microscopy (collected 8–24 hours apart including 1 early morning specimen)++ Respiratory specimens include: 3 sputa (preferably induced), OR 2 sputa (preferably induced) and 1 bronchoalveolar lavage (BAL); at least 1 sputum should be collected after BAL00□ 3 consecutive respiratory specimens++ negative for acid-fast bacilli (AFB) on smear microscopy (collected 8–24 hours apart including 1 early morning specimen)++ Respiratory specimens include: 3 sputa (preferably induced), OR 2 sputa (preferably induced) and 1 bronchoalveolar lavage (BAL); at least 1 sputum should be collected after BAL140970022713950028092402271395002844804233545General population00General population885825376682000393703053080□ Alternate explanation for clinical findings00□ Alternate explanation for clinical findings103695543180□ CXR suspicious for TB disease with or without symptoms 00□ CXR suspicious for TB disease with or without symptoms 298196054800500335153017716500033432751771650001537970177165000-67310619125□ At least 1 of 3 consecutive respiratory specimens++ positive for acid-fast bacilli (AFB) on smear microscopy (collected 8–24 hours apart including 1 early morning specimen)++ Respiratory specimens include: 3 sputa (preferably induced), OR 2 sputa (preferably induced) and 1 bronchoalveolar lavage (BAL); at least 1 sputum should be collected after BAL00□ At least 1 of 3 consecutive respiratory specimens++ positive for acid-fast bacilli (AFB) on smear microscopy (collected 8–24 hours apart including 1 early morning specimen)++ Respiratory specimens include: 3 sputa (preferably induced), OR 2 sputa (preferably induced) and 1 bronchoalveolar lavage (BAL); at least 1 sputum should be collected after BAL23812505283835□ 3 consecutive and all subsequent respiratory specimens++ negative for acid-fast bacilli (AFB) on smear microscopy (collected on separate days including 1 early morning specimen), ++ Respiratory specimens include: 3 sputa (preferably induced), OR 2 sputa (preferably induced) and 1 bronchoalveolar lavage (BAL); at least 1 sputum should be collected after BAL– AND –□ Clinical and radiographic improvement, AND□ At least 2 consecutive and all subsequent sputum specimens negative on culture for M.TB 00□ 3 consecutive and all subsequent respiratory specimens++ negative for acid-fast bacilli (AFB) on smear microscopy (collected on separate days including 1 early morning specimen), ++ Respiratory specimens include: 3 sputa (preferably induced), OR 2 sputa (preferably induced) and 1 bronchoalveolar lavage (BAL); at least 1 sputum should be collected after BAL– AND –□ Clinical and radiographic improvement, AND□ At least 2 consecutive and all subsequent sputum specimens negative on culture for M.TB 2024380670687000895350618553500-673104570730□ 3 consecutive sputum specimens negative for acid-fast bacilli (AFB) on smear microscopy (collected 8–24 hours apart including 1 early morning specimen), AND□ Evidence of clinical improvement00□ 3 consecutive sputum specimens negative for acid-fast bacilli (AFB) on smear microscopy (collected 8–24 hours apart including 1 early morning specimen), AND□ Evidence of clinical improvement38766753047365□ Request a direct genetic test for rifampin and other drug resistance, through state public health lab00□ Request a direct genetic test for rifampin and other drug resistance, through state public health lab345122536004500026003253333750If direct genetic testing is negative 00If direct genetic testing is negative 4024630270510000-75565-76200Flow Diagram Criteria for placing detainees in general population following evaluation for TB disease with respiratory specimens positive for AFB§00Flow Diagram Criteria for placing detainees in general population following evaluation for TB disease with respiratory specimens positive for AFB§600329028232100035528254152900□ At least 14 days effective multidrug treatment for MDR as recommended by expert consultation, taken by DOT, and tolerated00□ At least 14 days effective multidrug treatment for MDR as recommended by expert consultation, taken by DOT, and tolerated47726602305685□ Known MDR TB00□ Known MDR TB534352528232100027324052385060□ Increased risk for MDR TB§§00□ Increased risk for MDR TB§§21983703600450008420102305685□ No risk factor for MDR TB00□ No risk factor for MDR TB141414528232100014141454105275005257803260725□ At least 14 days standard multidrug anti-TB treatment taken by DOT and tolerated00□ At least 14 days standard multidrug anti-TB treatment taken by DOT and tolerated-755656558915General population, ANDContinue effective multidrug treatment taken by DOT and tolerated00General population, ANDContinue effective multidrug treatment taken by DOT and tolerated5343525497713000 ................
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