Issues in the management of contacts of patients with active pulmonary tuberculosis

The evidence regarding the transmission of tuberculosis and risk of infection and disease in several specific clinical situations has been reviewed. There is considerable epidemiologic evidence that contagiousness is not an all-or-nothing phenomenon and is affected by several factors, only one of which is the bacteriologic status of the patient's sputum. Although untreated smear negative, culture positive patients are less contagious on average, they still may transmit infection to their close and casual contacts. Compared with contacts with tuberculin conversion, persons who are already tuberculin positive have much lower risk of developing active tuberculosis after exposure, and persons with prior BCG vaccination are at somewhat lower risk. Preventive therapy will be of less benefit, but should still be recommended for contacts who are heavily exposed or are immune compromised. Epidemiologic studies using RFLP techniques could provide more precise answers to the questions in this review.