Section 696.160  Diagnosis and Management of Persons with Suspected or Confirmed Tuberculosis Disease

a)         Diagnostic Evaluation.  The evaluation of persons with suspected or confirmed TB disease shall include but not be limited to:

1)         Medical History;

2)         Physical Examination;

3)         TB Screening Test;

4)         Chest Radiograph; and

5)         Bacteriologic Examinations on Available Specimens (e.g., smears, cultures and other tests for M. tuberculosis, and drug susceptibility tests).

            AGENCY NOTE:  TB is sometimes overlooked in the differential diagnosis of pulmonary conditions (e.g., pneumonia), especially in the elderly.

b)         Clinical Management of Persons with Suspected or Confirmed TB Disease.

1)         Infection Control Measures.  If infectious TB disease is suspected, precautions shall be taken to prevent transmission in accordance with the incorporated publications:  Guidelines for Health-Care Settings and OSHA Instruction.

A)        In settings that serve infectious TB patients, precautions that shall be implemented include early identification and isolation of patients with suspected or confirmed TB disease.  Infection control measures shall be maintained until it is determined that the patient is not infectious.

i)          Precautions shall include the use of ventilation systems in TB isolation rooms to maintain negative pressure and to exhaust air in such a manner to prevent transmission of M. tuberculosis.

ii)         Personal respirators that meet the requirements in the incorporated publication, OSHA Instruction, shall be used by workers in areas (e.g., TB isolation rooms, rooms where cough-inducing procedures are done) where exposure cannot be avoided or there is an increased risk of exposure.  Patients may be masked with a surgical mask if they must leave the isolation room while they are infectious and coughing.

iii)         In in-patient settings, continuous isolation should be considered for patients with multiple drug-resistant TB.

B)        Infectious TB patients may be confined to their homes in order to prevent transmission of disease.  Personal respirators that meet the requirements in the incorporated publication, OSHA Instruction, shall be used by workers when in the homes of patients with infectious TB and when transporting infectious patients.

C)        Once determined to be infectious, a person is considered infectious until medically determined to be not infectious and likely not to become infectious again, as evidenced by compliance with a multiple-drug treatment regimen to which the organisms are susceptible.  When a consensus cannot be reached concerning the infectious or not infectious status of a suspected or confirmed case of TB, a final decision of infectiousness will be made only by the Department.

2)         Treatment of Suspected or Confirmed TB Disease.  Suspected or confirmed TB disease shall be treated with multiple drugs in accordance with the incorporated publication, Treatment of TB and TB Infection.

            Agency Note:  TB disease in infants and children younger than four years of age and in immunosuppressed individuals (such as HIV/AIDS patients) is more likely to spread throughout the body and progress rapidly with severe consequences; prompt and vigorous treatment is appropriate as soon as TB is suspected.

A)        Directly Observed Therapy (DOT).  Treatment of all patients with TB should be conducted by DOT.

B)        Monitoring for Response to Antituberculosis Chemotherapy.  Persons with M. tuberculosis identified in sputum shall be monitored by sputum smears and cultures until conversion is documented. Drug susceptibility testing shall be done initially on culture positive specimens.

i)          Sputum smears should be repeated until three consecutive negative sputum smear results are obtained from sputum collected on different days.

ii)         Sputum cultures should be monitored at least monthly until negative cultures are obtained.  Patients whose cultures have not become negative or whose symptoms do not resolve after two months of therapy shall be reevaluated for drug-resistant disease, as well as for failure to adhere to the regimen. For patients receiving self-administered therapy, the remainder of treatment should be directly observed.

iii)         In patients with multiple drug-resistant disease, sputum cultures should be monitored monthly for the entire course of treatment.

C)        Monitoring for Adverse Reactions.   Adults treated for TB disease should have baseline tests to detect any abnormality that would complicate treatment or require a modified regimen.  Baseline tests, except visual acuity, are unnecessary in children unless a complicating condition is known or clinically suspected.  At a minimum, patients should be seen monthly during treatment and evaluated for adverse reactions.  If symptoms suggesting drug toxicity occur, then appropriate laboratory testing should be performed to confirm or exclude such toxicity.  (See the incorporated publication, Treatment of TB and TB Infection.)

c)         Contact Investigation.  Close contacts to suspected or confirmed cases of TB disease shall obtain a TB screening test to identify infection. Close contacts shall be retested three months after the last exposure if their reaction to the first TB screening test was negative.  A high priority should be given to evaluating contacts who are children or contacts infected with HIV/AIDS. (See Section 696.150(a)(3) for information regarding preventive therapy.)

(Source:  Amended at 32 Ill. Reg. 4010, effective February 29, 2008)