Latent tuberculosis infection - Revision history

Aidan: /* Management */

2026-03-20T14:14:29Z

Management

← Older revision		Revision as of 14:14, 20 March 2026
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	\|hepatotoxicity, peripheral neuropathy, drug-drug interactions		\|hepatotoxicity, peripheral neuropathy, drug-drug interactions
	\|-		\|-
	! colspan="4" \|Under Development		! colspan="4" \|Other/Under Development
	\|-		\|-
	\|1HP		\|1HP
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	\|isoniazid and rifapentine daily		\|isoniazid and rifapentine daily
	\|		\|
			\|-
			\|
			\|??
			\|fluoroquinolone-based therapy (levofloxacin or moxifloxacin)
			\|not well studied, may be useful in cases of MDRTB exposure and seroconversion, or in transplant patients where DDIs and hepatotoxicity from RIF/INH would be intolerable
	\|}		\|}

Aidan at 14:15, 23 September 2024

2024-09-23T14:15:05Z

← Older revision		Revision as of 14:15, 23 September 2024
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	=== Timing of Treatment ===		=== Timing of Treatment ===
	* For pregnancy, either delay treatment until after delivery or prefer 4R regimen		* For pregnancy, either delay treatment until after delivery or prefer 4R regimen
	* For medical immunosuppression, most guidelines recommend delaying immunosuppression until after the first month of LTBI treatment, where possible, though there is variation in this recommendation<ref name=":0">Hasan T, Au E, Chen S, Tong A, Wong G. Screening and prevention for latent tuberculosis in immunosuppressed patients at risk for tuberculosis: a systematic review of clinical practice guidelines. BMJ Open. 2018 Sep 12;8(9):e022445. doi: [~~https~~:~~//doi.org/10.1136/bmjopen-2018-022445 10.1136/bmjopen-2018-022445]. PMID~~: ~~[https://pubmed.ncbi.nlm.nih.gov/30209157/ 30209157~~]~~; PMCID: [http://www.ncbi.nlm.nih.gov/pmc/articles/pmc6144320/ PMC6144320~~]~~.</ref>~~		* For medical immunosuppression, most guidelines recommend delaying immunosuppression until after the first month of LTBI treatment, where possible, though there is variation in this recommendation[[CiteRef::hasan2018sc]]
	* For transplantation, guidelines recommend starting treatment while they are still on the transplant list, and that treatment should not delay transplantation~~<ref name="~~:~~0" />~~		* For transplantation, guidelines recommend starting treatment while they are still on the transplant list, and that treatment should not delay transplantation[[CiteRef::hasan2018sc]]
	* For patients with HIV, no specific recommendations, likely can start LTBI and HIV treatment concurrently~~<ref name="~~:~~0" />~~		* For patients with HIV, no specific recommendations, likely can start LTBI and HIV treatment concurrently[[CiteRef::hasan2018sc]]

	==Further Reading==		==Further Reading==

Aidan at 14:13, 15 April 2024

2024-04-15T14:13:51Z

← Older revision		Revision as of 14:13, 15 April 2024
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	* May be indicated in some situations		* May be indicated in some situations
	* If high risk, but the initial test was negative, then the alternative may be ordered to increase sensitivity		* If high risk, but the initial test was negative, then the alternative may be ordered to increase sensitivity
	* If low suspicion of LTBI but TST positive, follow-up IGRA may be reasonable		* If low suspicion of LTBI but TST positive (i.e. possible false-positive), follow-up IGRA may be reasonable
	* If high suspicion of false positive TST, follow-up IGRA may be reasonable
	* Patients with discordant results are still at higher risk of progression to active TB		* Patients with discordant results are still at higher risk of progression to active TB

Aidan at 11:20, 5 March 2024

2024-03-05T11:20:25Z

← Older revision		Revision as of 11:20, 5 March 2024
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	\|}		\|}

			=== Timing of Treatment ===
	* For pregnancy, either delay treatment until after delivery or prefer 4R regimen		* For pregnancy, either delay treatment until after delivery or prefer 4R regimen
			* For medical immunosuppression, most guidelines recommend delaying immunosuppression until after the first month of LTBI treatment, where possible, though there is variation in this recommendation<ref name=":0">Hasan T, Au E, Chen S, Tong A, Wong G. Screening and prevention for latent tuberculosis in immunosuppressed patients at risk for tuberculosis: a systematic review of clinical practice guidelines. BMJ Open. 2018 Sep 12;8(9):e022445. doi: [https://doi.org/10.1136/bmjopen-2018-022445 10.1136/bmjopen-2018-022445]. PMID: [https://pubmed.ncbi.nlm.nih.gov/30209157/ 30209157]; PMCID: [http://www.ncbi.nlm.nih.gov/pmc/articles/pmc6144320/ PMC6144320].</ref>
			* For transplantation, guidelines recommend starting treatment while they are still on the transplant list, and that treatment should not delay transplantation<ref name=":0" />
			* For patients with HIV, no specific recommendations, likely can start LTBI and HIV treatment concurrently<ref name=":0" />

	==Further Reading==		==Further Reading==

Aidan at 01:05, 2 April 2023

2023-04-02T01:05:19Z

Show changes

Aidan: /* Investigations */

2020-07-26T20:06:44Z

Investigations

Show changes

Aidan: Text replacement - "Category:TB" to "Category:Tuberculosis"

2020-06-01T16:55:41Z

Text replacement - "Category:TB" to "Category:Tuberculosis"

← Older revision		Revision as of 16:55, 1 June 2020
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	* [http://www.bcgatlas.org/ BCG World Atlas], which has a listing of every country's BCG vaccination policies		* [http://www.bcgatlas.org/ BCG World Atlas], which has a listing of every country's BCG vaccination policies

	[[Category:TB]]		[[Category:Tuberculosis]]

Aidan: /* Management */ added menzies citation

2019-11-19T18:50:21Z

Management: added menzies citation

← Older revision		Revision as of 18:50, 19 November 2019
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	** Nine months of isoniazid with daily vitamin B6		** Nine months of isoniazid with daily vitamin B6
	* Alternative shorter courses:		* Alternative shorter courses:
	** 4RIF (10 mg/kg [600 mg maximum]): ~~not yet in guidelines, but likely preferred. Slightly higher risk of hepatitis.~~		** 4RIF (10 mg/kg [600 mg maximum])[[CiteRef::menzies2018fo]]
			*** Not yet in guidelines, but likely preferred. Slightly higher risk of hepatitis.
	** 6INH		** 6INH
	** 3-4INH/RMP		** 3-4INH/RMP

Aidan: /* Interferon-gamma release assay (IGRA) */

2019-11-19T18:44:13Z

Interferon-gamma release assay (IGRA)

← Older revision		Revision as of 18:44, 19 November 2019
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	* Doesn't crossreact with BCG (uses ESAT-6 and CFP-10) but can crossreact with other non-tuberculous mycobacteria ([[Mycobacterium intracellulare]], [[Mycobacterium chelonae]], and [[Mycobacterium fortuitum]])		* Doesn't crossreact with BCG (uses ESAT-6 and CFP-10) but can crossreact with other non-tuberculous mycobacteria ([[Mycobacterium intracellulare]], [[Mycobacterium chelonae]], and [[Mycobacterium fortuitum]])
	* Preferred for those who have received BCG after infancy		* Preferred for those who have received BCG after infancy
			* May be more useful in patients who are unlikely to follow up in 48 hours, or who need urgent immunosuppression and need a faster result
	* QuantiFERON-TB Gold Plus (QFT-Plus) likely has better PPV than TST in a low-prevalence population		* QuantiFERON-TB Gold Plus (QFT-Plus) likely has better PPV than TST in a low-prevalence population

Aidan: /* Background */ added risk factors

2019-11-19T18:39:06Z

Background: added risk factors

← Older revision		Revision as of 18:39, 19 November 2019
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	** Compared to smallpox, which forms a crater		** Compared to smallpox, which forms a crater
	* Receipt of the BCG vaccine affects interpretation of the tuberculin skin test		* Receipt of the BCG vaccine affects interpretation of the tuberculin skin test

			=== Risk for progression to active tuberculosis ===
			* HIV
			* Transplantation
			* End-stage renal disease
			* Specific biologics, including TNFa-α inhibitors
			* Corticosteroids

	== Investigations ==		== Investigations ==