One of the things I think most physicians do not do enough is screen for tuberculosis. One third of the world’s population is infected with tuberculosis and 15 million of those live in the United States. Two thirds of the cases are found in foreign-born individuals and the states with the highest incidence are New York, California, Florida and Texas. We also need to consider the fact that many individuals have had contact with tuberculosis and may develop active disease sometime in the future. We say that these patients have latent tuberculosis.
Screening for latent tuberculosis, historically, was done with several types of skin tests which needed to be applied by someone skilled in their use. The previous standard, the PPD-Intermediate skin test required that a small amount of liquid be injected in a very specific way under the skin and then interpreted by someone skilled in feeling the skin for a reaction 48 and 72 hours after injection. This complicated procedure is most likely why the test was not done often and why it was frequently misinterpreted.
Recently, a new test for latent tuberculosis is being used. Many patients are surprised that there is now a blood test to help identify patients with previous tuberculosis contact and who are at risk for developing active tuberculosis.
Infectious disease specialists and pulmonary specialists prefer the blood test to help identify patients in an easier and more specific way. Tuberculosis is still a problem for many in America.
