For HCWs With Significant Reactions.Smear and culture examination of at least three sputum specimens collected on different days is the main diagnostic procedure for pulmonary TB. (P.64, MMWR)
During TB screening, it is important to obtain an initial chest
radiograph on those person6 with significant skin-test reactions, those
who convert their skin test, or those who have pulmonary symptoms that
may be due to TB.
There is no need to obtain routine chest films of asymptomatic, tuberculin-negative personnel. After initial chest films of persons with significant reactions, repeated chest x-ray examinations have not been found to be of value. Significant reactors, whether or not they complete preventive treatment, do not need repeat chest films unless they have pulmonary symptoms that may be due to TB.
For positive skin test reactions without evidence of disease, the most current recommendations for chemoprophylaxis as published by the IHS, ATS, and CDC should be considered. Any x-ray change6 and a variety of underlying diseases must be evaluated on a case by case prior to a final decision on preventive therapy.