13.5  Case finding

Now it’s important you learn about how to identify a person with suspected TB and confirm a TB case in the community and at a health facility.

Detection of the most infectious cases of tuberculosis (sputum smear-positive pulmonary cases) is a critical step in the control of TB in the community where you are working. The process of determining a TB case is known as case finding. The objective of case finding is to identify the source of infection in the community, that is, individuals who are discharging large numbers of TB bacteria, so that they can receive prompt treatment, which in turn will cut the chain of transmission (stop the spread) and therefore lower the prevalence and mortality of TB.

The identification of people with suspected TB (or TB suspects) is the first step in case finding. The second step involves the laboratory investigation of the TB suspect’s sputum samples to confirm those who have active TB. This process is called TB screening. When selecting people for TB screening you should always be aware that certain individuals are at high risk of becoming infected and developing tuberculosis, in particular, contacts of those who are in prison, drug abusers, diabetic patients and People Living with HIV (PLHIV). You should educate the general public about the need for these high risk groups to be screened for TB regularly to reduce the burden of TB in the community. It is your responsibility to identify people in such groups at all times and to regularly refer them for sputum examination. It is also important to ask all household contacts of smear-positive TB patients whether they have been coughing and for how long they have been doing so. All children under the age of five years, anyone who is HIV-positive and any TB suspects among them in the family, or in prison should also be screened for TB.