Latent tuberculosis infection
From IDWiki
- Prior exposure to TB leading to persistent latent tuberculosis, usually contained within lung ganulomas
- 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
- 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
- Rule out active TB
- signs/symptoms
- CXR or CT chest
- Sputum x3 if coughing or cavitary lesions
- Evaluate risk of reactivation treatment
- INH 300 daily x9 mo with pyridoxine
- baseline liver enzymes and vision testing
Management
- Standard regimen (9INH):
- Nine months of isoniazid with daily vitamin B6
- Alternative shorter courses:
- 6INH
- 3-4INH/RMP
- 4RIF, maybe
Further Reading
Tools
References
- a b c Tasnim Hasan, Eric Au, Sharon Chen, Allison Tong, Germaine Wong. Screening and prevention for latent tuberculosis in immunosuppressed patients at risk for tuberculosis: a systematic review of clinical practice guidelines. BMJ Open. 2018;8(9):e022445. doi:10.1136/bmjopen-2018-022445.
