Latent tuberculosis infection: Difference between revisions

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Revision as of 02:29, 15 August 2019

Definition

  • Prior exposure to TB
  • Goal is to identify those who are at increased risk of developing active TB and would benefit from treatment

Investigations

  • Tuberculin skin test (TBST)
    • Sens 90%, Spec >95
  • Interferon-gamma release assay (IGRA)
    • Sn 95%, Sp >95%
    • Preferred for those who have received BCG after infancy

Positive TBST

  1. Is it truly positive?
    • Consider IGRA
    • BCG vaccine can be considered a cause of false positive when
      • vaccine given after 12 months of age, and
      • patient has no risk factors, and
      • either Canadian-born non-Aboriginal, or not from endemic country
  2. Rule out active TB
    • signs/symptoms
    • CXR or CT chest
    • Sputum x3 if coughing or cavitary lesions
  3. Evaluate risk of reactivation treatment
    • INH 300 daily x9 mo with pyridoxine
    • baseline liver enzymes and vision testing

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