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Testing for tuberculosis (TB), using chest radiography for screening and microbiology for confirmation, is indicated in everyone considered to be at high risk of TB disease or with signs and symptoms of TB.
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Chest radiography is an integral part of the TB diagnostic algorithm but is not specific for the diagnosis of pulmonary TB (PTB) and cannot provide a conclusive diagnosis on its own.
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Every effort should be made to obtain a microbiological diagnosis, which requires demonstration of acid-fast bacilli (AFB) on smear microscopy and/or culture or requires detection of Mycobacterium tuberculosis (M. tuberculosis) nucleic acids using nucleic acid amplification tests (NAATs).
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Phenotypic drug susceptibility testing (DST) should be routinely performed for first positive culture isolates obtained from each new TB patient.
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Presence of AFB on smear microscopy, positive TB culture or NAAT in patients not previously diagnosed with TB represent laboratory critical values and should immediately be reported to the submitting clinician.
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All patients newly diagnosed with active TB should be reported to public health authorities.
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The use of tuberculin skin test (TST) or interferon gamma release assays (IGRA) for the diagnosis of TB disease in adults is not recommended.
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NAAT testing is not recommended for monitoring treatment response or determining contagiousness after treatment has been initiated.
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Rapid molecular tests should be performed to predict drug resistant-TB (DR-TB) on new positive cultures and/or samples with a new positive NAAT. The use of these tests does not eliminate the need for conventional phenotypic DST.
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