NEL Guidance for primary care clinicians for patients with suspected active Tuberculosis
North East London (NEL) Guidance for primary care clinicians for patients with suspected active Tuberculosis (TB) – as per NICE Guidelines 2016: Investigations | Diagnosis | Tuberculosis | CKS | NICE
If you suspect a patient has symptoms or signs suggestive of active tuberculosis based on history and physical examination, please complete the following:
- Chest X-ray
- 3xSputum samples for TB culture AFB (Acid Fast Bacilli) – if expectorating
- Urgent referral to local TB service.
Please note: an interferon gamma release assay (IGRA) test should NOT be used within primary care as part of the investigation of patients with suspected active TB, either pulmonary or extra-pulmonary. This also includes patients with a cough, fevers, night sweats, weight loss (or for any other active symptoms). It is not a diagnostic test for an active disease process.
North East London (NEL) Guidance for primary care clinicians on use of interferon gamma release assay (IGRA) tests
The ONLY indication for IGRA testing within primary care for latent tuberculosis infection (LTBI) is as part of the national screening programme for recent arrivals to the UK
Patients should be offered testing for LTBI if they fulfil ALL the following criteria:
- Aged 16-35 years
- Born or spent >6 months in high TB incidence country (150 cases per 100,000 or more/Sub-Saharan Africa)
- Entered the UK within the last 5 years (including where entry was via other countries (eg within EU/EEA)
- No previous history of TB or LBTI
- Not previously screened for LTBI in the UK
More information here: NHS England » National latent tuberculosis infection testing and treatment programme
Please note that ordering blood tests to look for TB infection in patients outside of nationally agreed criteria can lead to unnecessary anxiety and distress, particularly amongst individuals who are tested, but not eligible for treatment for latent tuberculosis infection. Please be aware that TB services may reject referrals for patients tested outside the agreed criteria above.
The above clinical guidance has been produced by the NEL Respiratory secondary care consultant team in collaboration with the Newham GP Clinical Lead, Dr Duncan Trathen.
June 2024
For any management issues, please contact your respective borough representative:
City and Hackney: Helen Crane, Helen.Crane1@nhs.net
Newham: Ryan Suyat, Ryan.Suyat@nhs.net
Tower Hamlets: Zereen Rahman-Jennings, Zereen.Rahman-Jennings@towerhamlets.gov.uk
Redbridge: Natalie Keefe, Natalie.Keefe@nhs.net
Waltham Forest: Sue Dart, Susandart1@nhs.net