Article Text

Download PDFPDF
Tuberculosis (NICE clinical guideline 33)
  1. Louise Turnbull,
  2. Christine Bell,
  3. Fran Child
  1. Paediatric Respiratory Department, Royal Manchester Children's Hospital, Manchester, UK
  1. Correspondence to Dr Louise Turnbull, Paediatric Respiratory Department, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK; Louise.turnbull{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


The UK has one of the highest rates of tuberculosis (TB) in Western Europe.1 If current trends continue, with over 7500 cases per year,2 England will overtake the whole of the USA in the annual number of TB notifications within the next 2 years.3 TB disease in UK children is relatively rare with <5% cases affecting patients under the age of 15 years.2 Outside large conurbations, most paediatricians will see very few children with TB. However, the risk of progression from latent TB to TB disease and of TB meningitis or miliary TB is much higher in children, especially those under the age of 2 years.4 It is, therefore, important that paediatricians recognise children at risk of TB disease and the symptoms and signs with which they present.

This article summarises the recently updated National Institute for Health and Care Excellence (NICE) guideline ‘Tuberculosis’ (NG33)5 ,6 published in 2016 (box 1). Several areas of this guideline are controversial and we will highlight these.

Box 1


National Institute for Health and Care Excellence (NICE) guideline—NG33 Tuberculosis

Collaborative TB Strategy, Public Health England

Information for the public (NICE)

Key recommendations in the updated guideline:

  • A Mantoux test induration of ≥5 mm is defined as positive irrespective of prior BCG.

  • Screen all contacts of pulmonary or laryngeal TB cases and new entrants from high incidence areas for latent TB infection (LTBI) (box 2).

  • Interferon-γ release assays (IGRAs) alone should only be used in children and young people if Mantoux not available or is impractical (eg, situations where large numbers need to be tested).

  • The upper age limit for testing for latent TB is increased from 35 to 65 years.

Box 2

Glossary of terms

Mycobacterium tuberculosis complex (MTB complex)—A genetically related group of mycobacteria that can cause TB disease in …

View Full Text


  • Contributors LT, CB and FC researched the topic and wrote and edited the article.

  • Competing interests Qiagen QuantiFERON-TB GOLD have provided sponsorship for educational and stakeholder meetings.

  • Provenance and peer review Commissioned; externally peer reviewed.