HJAR Jan/Feb 2026

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2026 35 Jennifer Dillaha, MD Director Arkansas Department of Health • Residents or workers in high-risk con- gregate settings such as jails, prisons, nursing homes, and shelters for people experiencing housing insecurity. • People born in areas outside the United States where TB rates are high. • Anyone with diabetes, cancer, organ transplants, kidney disease, HIV, or a weakened immune system. • Healthcare workers, who may encoun- ter undiagnosed cases. If screening for TB identifies a high-risk person, they should be tested for TB infec- tion using a TB skin test or an IGRA (interfer- on gamma release assay) blood test. Routine annual testing is no longer recommended for most people (adults and children) in low- risk settings. When someone tests positive for TB in- fection, they must be evaluated to rule out active disease. This includes a clinical exam and chest X-ray. If active TB is ruled out, treatment for LTBI is highly effective in preventing progression to disease. It can reduce the risk of developing active TB by over 90 percent. The most common LTBI treatment regimen is 3HP, which involves taking once-a-week medication of isoniazid (H) and rifapentine (P) for 12 weeks. Treatment for active TB disease requires a more intensive approach: a four-drug regi- men for a minimum of four to six months — all given by directly observed therapy (DOT) through ADH local health unit nurses. Be- cause of the resources it takes to provide care for TB patients, the ADH manages all active and latent TB treatment statewide. Diagnosing and Treating Active TB It is important to “Think TB,”especially if a patient’s cough isn’t improving, if symp- toms don’t align well with common diag- noses, or if imaging shows unexplained abnormalities. TB is known as “the great imitator.”It can mimic many other conditions. It can cause pulmonary disease, meningitis, pleural effusions, eye disease, abdominal TB that resembles inflammatory bowel disease, bone or joint infections, and genital-urinary tract infections. Clinicians should remain alert to atypical presentations, especially in patients with prolonged or unexplained illness. InArkansas, missed or delayed diagnoses often arise from: • Chronic cough that is wrongly attributed to “recurrent pneumonia or bronchitis” or chronic obstructive pulmonary disease (COPD). • Lung nodules or masses that are presumed to be cancer. • Not seeking medical care or having a primary care doctor. • Frequent visits to the emergency department but seeing a different doctor each time. • Failure to consider TB because it is thought to be “rare.” Nationwide, most TB cases occur in peo- ple born outside the United States. However, inArkansas, the opposite is true. Over 50% of TB cases occur in people born in Arkan- sas, where there are persistent pockets of TB in rural communities that have never been fully eliminated. A Recent Rise in Pediatric TB Historically, Arkansas has seen fewer than 10 pediatric TB cases per year. However, in 2023, 28 children with TB were identified, and in 2024, that number climbed to 38. Fortunately, the number of pediatric cases in 2025 appears to be returning to baseline. Children typically do not transmit TB, but they are much more vulnerable to severe, rapidly progressing illness, including disseminated TB and meningitis, especially in those under the age of five years. Many of these pediatric cases likely resulted from delayed diagnosis of infectious adults during and following the COVID-19 pandemic, when adults were less likely to seek timely care for respiratory symptoms. The American Academy of Pediatrics recommends three annual screening questions for all children: 1. Was the child born outside the U.S.? 2. Has the child been exposed to someone with TB or a chronic cough? 3. Has the child spent time in a high-risk setting (e.g., shelter, jail, nursing home)? If the response to any of these three questions is yes, then the child should be tested for TB infection. Improving Detection: Tools and Resources Several tools can help reduce missed diagnoses: • Built-in screening templates for TB in electronic medical records for child and adult wellness visits. • Rapid PCR testing for TB, now available through theADH public health labora- tory. This test can detect TB DNA— and some genetic markers for drug resis- tance — in about a day, significantly faster than traditional culture, which can require up to eight weeks. • Consultation resources through the ADH TB Program. Nurse consul- tants and physicians are available to assist with clinical evaluation and management. To learn more about TB or for consultation, contact theADH TB Program at 501-661-2152. More information is also available by visiting these websites: healthy.arkansas.gov cdc.gov/tb n