What is the USPSTF recommendation for LTBI screening?

• A. Screen all adults aged 18 and older.
• B. Screen populations at increased risk for LTBI.
• C. Do not screen unless symptoms of active TB appear.
• D. Screen only close contacts of TB patients.

Answer: (B)

Screening for latent TB infection is recommended for people at increased risk. The idea is to identify LTBI in those who are most likely to have it and would benefit from preventive treatment to reduce progression to active TB. Because LTBI usually has no symptoms, universal screening of all adults isn’t the approach—the yield in low-risk populations is low and can lead to unnecessary testing and treatment from false positives. Screening all adults would miss the focus on those at higher risk and would waste resources, while limiting screening only to close contacts of TB patients would miss other groups at elevated risk (such as people from high-prevalence regions, residents of certain facilities, or individuals with immunosuppression). Tests like the tuberculin skin test or an IGRA are used, with treatment offered if positive.