TB Manual

There are certain individuals whose immunocompromising conditions or immunosuppressive therapy places them at higher risk of progression from TB infection to disease. They include HIV-infected individuals, transplant patients and people undergoing anti-tumor necrosis factor therapy. While TB incidence rates in patients with end-stage kidney disease are higher than those in the general population and symptoms of respiratory TB may be atypical, case numbers are low.⁷⁸ Providing care for immune-compromised patients requires a higher index of suspicion for TB and increased vigilance to prevent its transmission before diagnosis. Screening for latent TB infection is recommended for selected high-risk populations (see Chapter 4: Diagnosis of Tuberculosis Infection and Chapter 10: Treatment of Active Tuberculosis in Special Populations).