De-isolation of patients with pulmonary tuberculosis after start of treatment - clear, unequivocal guidelines are missing

•Being Mycobacterium tuberculosis (M.tb) sputum culture positive is not equivalent to the patient being in need of isolation.•Transmission of M.tb declines rapidly after effective and appropriate treatment is started.•Effective treatment for MDR-TB needs rapid determination of resistance by genotype resistance testing.•Negative pressure isolation rooms are a scarce resource.•De-isolation should be based on the likely infectivity of the case and length of effective treatment, not on bacteriological endpoints.•International guidelines lacks clear advice concerning de-isolation of patients. Patients on effective treatment do not pose a risk to the community if treatment response and adherence are closely monitored.

The study review guidelines on isolation of patients with tuberculosis, TB, from the World Health Organization, WHO, Centers for Disease Control and Prevention, CDC, and the European Center for Disease Control, ECDC. The review found that unequivocal guidelines for removing patients out of negative-pressure isolation and de-isolation patients from either single rooms or isolation at home is needed. Studies show that the time of effective treatment is the key parameter to follow to determine if patients are contagious to others or not. This means that standard treatment of multi-drug resistant, MDR, TB will not result in the patient being non-infectious. Thus it is important right from the time of diagnosis to know if the patient is infected with MDR TB or not. Thus the early use of molecular techniques to reveal drug susceptibility is important. Clear guidelines stating if patient with microscopy negative sputum no matter infected with fully susceptible or MDR TB, no matter HIV positive or not is needed.