Tuberculosis Screening

A tuberculosis screening test checks to see if you have the bacteria (germs) that cause tuberculosis (TB) in your body. TB is a bacterial infection that mainly attacks the lungs. But it can also affect other parts of the body, including the brain, spine, and kidneys. TB spreads from person to person when a someone who is sick with TB coughs or sneezes.

TB germs cause two types of conditions:

• Inactive (latent) TB infection happens when you have TB germs in your body, but you’re not sick because the germs aren’t active. You don’t have symptoms and you can’t spread the disease to others. But the germs could start to grow (multiply) and make you sick in the future. So, inactive TB infection is usually treated to prevent you from getting sick with active TB.
• Active TB disease means that TB germs are actively growing in your body and making you sick. If TB germs grow in your lungs or throat, you can spread the disease to other people. TB disease can almost always be cured with antibiotics. But without treatment, it can cause serious illness or even death.

A TB screening test checks to see if you have TB germs in your body. But it can’t show whether you have an inactive TB infection or active TB disease. If a TB screening test finds signs of TB germs, you’ll need other tests to find out which type of TB you have so you can get the right treatment.

There are two types of TB tests used for screening: a TB skin test and a TB blood test. Your health care provider or your local health department can let you know which test is best for you.

Other names: TB test, TB skin test, purified protein derivative (PPD) test, latent TB infection test, Mantoux tuberculin skin test; IGRA test, TB blood test

TB screening is used to look for signs of TB germs in people who have been exposed to someone with active TB disease or who have a high risk of exposure. The screening can show whether you have TB germs in your body and need more testing. It does not show if you have an inactive infection or active disease.

You may need a TB skin test or TB blood test if you were exposed to someone with active TB disease or if you have a high risk of exposure.

Your risk of exposure is higher if you:

• Are a health care worker
• Work or live in a place where TB is more common, such as jails, nursing homes, and shelters for people without homes
• Were born in or often travel to countries where TB disease is common

You may need a TB screening test if have symptoms of active TB disease, including:

• A cough that lasts longer than three weeks
• Coughing up blood or sputum (a thick mucus from the lungs)
• Chest pain
• Night sweats (heavy sweating during sleep)
• Losing weight without trying
• Loss of appetite
• Weakness or fatigue

You may need a TB screening test if you have a health condition that increase your risk for getting active TB disease. These conditions include:

• HIV or another disease that weakens your immune system. If you have both HIV and inactive TB, the TB can quickly become active TB disease. You will need treatment for the inactive TB as soon as possible to prevent active TB disease.
• Diabetes.
• Having an organ transplant.
• Use of illegal drugs that are injected with needles.

You may get a TB screening test at your provider’s office, a health clinic, or hospital. You will have either be a TB skin test or a TB blood test, depending on your health and medical history. TB skin tests are used more often, but blood tests for TB are becoming more common.

For a TB skin test (also called a Mantoux tuberculin skin test), you will need two visits to complete the test. The first visit is for doing the test and the second visit is for reading the results.

On the first visit:

• A health care professional will use a tiny needle to place a small amount of fluid under the skin in the lower part of your arm. The fluid is called tuberculin. It contains a protein that comes from the bacteria that cause TB. It cannot make you sick.
• The fluid will make a small bump on your arm.
• The test spot will be left uncovered.
• You will need to avoid touching the test spot or putting lotions on it. It’s okay to get it wet. If it itches, you can put an ice cube or cold cloth on it.

After two to three days, you will return for the second visit. A health care professional will look at the test spot on your arm to see if your skin reacted. If there is a bump of hard skin, the professional will measure the bump. The meaning of the bump depends on how large it is, your risk of exposure to TB germs, and your risk for developing active TB disease. The professional will let you know whether or not the bump means that you’re likely to have TB germs in your body.

For a TB test in blood (also called an IGRA test), a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

There is very little risk to having a TB skin test or blood test. For a TB skin test, you may feel a pinch when the fluid is placed under your skin.

For a blood test, you may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

Your TB skin or blood test results will usually be positive or negative.

A positive result means that you have been infected with TB bacteria. You will need more tests to find out if you have an inactive TB infection or TB disease. These tests may include a chest x-ray or a sputum culture. If you had a positive result on a TB skin test, you may have a TB blood test to confirm the result.

A negative result means that your skin or blood did not react to the test. You are unlikely to have an inactive TB infection or TB disease. But you may still need more testing if you:

• Have symptoms of TB
• Were tested sooner than six to eight weeks after an exposure to TB
• Have HIV
• Had a TB skin test after being around someone with TB disease

Sometimes a TB blood test result will be “borderline,” which means the test could not show for sure whether you have a TB infection. If this happens, you will likely be tested again.

Overall, TB screening tests tend to be accurate. But TB blood tests are more accurate than TB skin tests. Your provider will consider whether anything about your health history might affect the accuracy of your test results.

If you have questions about your results, talk with your health care provider.