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David N. Rose, MD

Arch Intern Med. 2000;160:1513-1521.

Background  The benefits of screening for latent Mycobacterium tuberculosis infection are unknown for most people, because screening has not been studied in clinical trials and preventive therapy has not been tested in all risk groups for whom it is recommended.

Method  A MEDLINE search was performed to determine tuberculosis risk. A Markov model was used to analyze tuberculin skin test screening and preventive therapy for 3-year-old and 30-year-old persons with positive test results. Outcome measures were lifetime and 10-year tuberculosis risk, including spread to others, life expectancy extension, and number needed to screen and number needed to treat to prevent 1 case and 1 death during 10 years.

Results  The benefits of screening and preventive therapy outweigh the risks for all groups tested, although the benefits range from large to small. The number needed to screen to prevent 1 case is 10 to 6888, and the number needed to treat is 2 to 179. Persons with human immunodeficiency virus infection, intravenous drug abuse, or end-stage renal disease treated with transplantation and children exposed to high-risk adults have the highest tuberculosis rates and the lowest number needed to screen and number needed to treat to prevent cases and deaths. The range of risks found in the literature for some risk groups, such as persons with silicosis, leukemia or lymphoma, end-stage renal disease treated with dialysis, or prolonged corticosteroid therapy, is wide and, as a result, the benefits of screening are uncertain.

Conclusions  The benefits of screening and preventive therapy vary widely, although the benefits outweigh the risks for all risk groups. The benefits are large for some risk groups and uncertain for others.

From the Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, and the Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.

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