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Archivos de Bronconeumologia Feb 2020
Topics: Humans; Latent Tuberculosis; Mycobacterium tuberculosis
PubMed: 31405608
DOI: 10.1016/j.arbres.2019.07.009 -
Microbiology Spectrum Dec 2016Treatment with biologic agents, in particular tumor necrosis factor alpha (TNF-α) inhibitors, is associated with an increased risk of tuberculosis (TB), and screening... (Review)
Review
Treatment with biologic agents, in particular tumor necrosis factor alpha (TNF-α) inhibitors, is associated with an increased risk of tuberculosis (TB), and screening and treatment for latent TB infection (LTBI) in patients undergoing such treatment is therefore indicated. The risk of TB associated with different biologics varies significantly, with the highest relative risks, 29.3 and 18.6, associated with adalimumab and infliximab, respectively. The risk of TB with newer TNF-α inhibitors and other biologics appears to be lower. Performance of LTBI screening tests is affected by immune-mediated inflammatory diseases and immunosuppressive therapy in patients due to commence TNF-α inhibitor treatment. Interferon gamma release assays (IGRAs) have a higher specificity than the tuberculin skin test (TST) in patients with Bacillus Calmette-Guérin (BCG) vaccination and have probably a better sensitivity than TST in immunosuppressed patients. LTBI screening programs prior to commencement of anti-TNF-α treatment significantly reduce the incidence of TB, but the optimal screening algorithm, in particular the question of whether a combination of IGRA and TST or a single test only should be used, is a matter of ongoing debate. Use of TST in combination with IGRA is justified to increase sensitivity. Repeat testing for LTBI should be limited to patients at increased risk of TB. If TB develops during anti-TNF-α treatment, it is more likely to be disseminated and extrapulmonary than are other TB cases. Discontinuation of anti-TNF-α treatment in patients diagnosed with TB is associated with an increased risk of immune reconstitution inflammatory syndrome, which is probably best managed by reintroduction of anti-TNF-α treatment.
Topics: Biological Factors; Diagnostic Tests, Routine; Humans; Immunosuppressive Agents; Latent Tuberculosis; Mass Screening
PubMed: 28084208
DOI: 10.1128/microbiolspec.TNMI7-0026-2016 -
The Korean Journal of Internal Medicine Mar 2020Management of latent tuberculosis infection (LTBI) is a critical element in the elimination of tuberculosis (TB). However, the low positive predictive value of the... (Review)
Review
Management of latent tuberculosis infection (LTBI) is a critical element in the elimination of tuberculosis (TB). However, the low positive predictive value of the current diagnostic tests and the low acceptance and completion rate of the isoniazid- based regimen are major barriers to the implementation and scale-up of programmatic management of LTBI. In the past decade, there has been some progress in the conception, diagnosis, and treatment of LTBI. LTBI is now understood as a dynamic spectrum rather than the traditional binary distinction between active and latent TB. New insight into LTBI has led to a renewed interest in incipient TB, which would be a potential target for developing new diagnostics and therapeutics of LTBI. Recent studies showed that host transcriptomic signatures could be a potential biomarker for incipient TB. The new shorter rifamycin-based regimens have shown comparable efficacy, but better completion rate and safety compared to the isoniazid-based regimen. In South Korea, LTBI management has been expanded and integrated into key elements of the National Tuberculosis Control Program. For the programmatic approach to LTBI management, the following challenges need to be addressed; target group selection, treatment-related interventions, monitoring and surveillance system, and extending the plan for vulnerable groups.
Topics: Antitubercular Agents; Humans; Isoniazid; Latent Tuberculosis; Republic of Korea; Tuberculosis
PubMed: 32131570
DOI: 10.3904/kjim.2020.029 -
Diabetes mellitus and latent tuberculosis infection: an updated meta-analysis and systematic review.BMC Infectious Diseases Nov 2023Previous studies have demonstrated an association between diabetes mellitus (DM) and latent tuberculosis infection (LTBI). This study was conducted to update the current... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies have demonstrated an association between diabetes mellitus (DM) and latent tuberculosis infection (LTBI). This study was conducted to update the current understanding of the association between DM and LTBI. By conducting a systematic review and meta-analysis using adjusted odds ratios (aOR) or risk ratios (aRR), we aimed to further explore the association between DM and LTBI and provide essential reference for future research.
METHODS
We conducted comprehensive searches in Embase, Cochrane Library, and PubMed without imposing any start date or language restrictions, up to July 19, 2022. Our study selection encompassed observational research that compared from LTBI positive rates in both DM and non-DM groups and reported aRR or aOR results. The quality of the included studies was assessed utilizing the Newcastle-Ottawa Scale. Pooled effect estimates were calculated using random-effects models, along with their associated 95% confidence intervals (CI).
RESULTS
We included 22 studies involving 68,256 subjects. Three cohort studies were eligible, with a pooled aRR of 1.26 (95% CI: 0.71-2.23). Nineteen cross-sectional studies were eligible, with a pooled aOR of 1.21 (95% CI: 1.14-1.29). The crude RR (cRR) pooled estimate for three cohort studies was 1.62 (95% CI: 1.03-2.57). Among the cross-sectional studies we included, sixteen studies provided crude ORs, and the crude OR (cOR) pooled estimate was 1.64 (95% CI: 1.36-1.97). In the diagnosis of diabetes, the pooled aOR of the HbA1c group was higher than that of self-reported group (pooled aOR: 1.56, 95% CI: 1.24-1.96 vs. 1.17, 95% CI: 1.06-1.28).
CONCLUSION
Our systematic review and meta-analysis suggest a positive association between DM and LTBI. Individuals with DM may have a higher risk of LTBI compared to those without DM. These findings provide important insights for future research and public health interventions in managing LTBI in diabetic populations.
Topics: Humans; Latent Tuberculosis; Cross-Sectional Studies; Diabetes Mellitus; Tuberculin Test; Cohort Studies; Risk Factors; Observational Studies as Topic
PubMed: 37940866
DOI: 10.1186/s12879-023-08775-y -
American Family Physician Jun 2014
Topics: Humans; Latent Tuberculosis; Tuberculosis, Pulmonary
PubMed: 25077404
DOI: No ID Found -
Revista Brasileira de Enfermagem Nov 2022
Topics: Humans; Brazil; Latent Tuberculosis
PubMed: 36449979
DOI: 10.1590/0034-7167.2023760101 -
Cold Spring Harbor Perspectives in... Jun 2015The post-2015 World Health Organization global tuberculosis strategy recognizes that elimination requires a focus on reducing the pool of latently infected individuals,... (Review)
Review
The post-2015 World Health Organization global tuberculosis strategy recognizes that elimination requires a focus on reducing the pool of latently infected individuals, an estimated 30% of the global population, from which future tuberculosis cases would be generated. Tackling latent tuberculosis infection requires the identification and treatment of asymptomatic individuals to reduce the risk of progression to active disease. Diagnosis of latent tuberculosis infection is based on the detection of an immune response to Mycobacterium tuberculosis antigens using either the tuberculin skin test or interferon-γ release assays. Current treatment requires the use of antibiotics for at least 3 months. In this article, we review the current knowledge of the natural history, immunology, and pathogenesis of latent tuberculosis, describe key population groups for screening and risk assessment, discuss clinical management in terms of diagnosis and preventative treatment, and identify areas for future research.
Topics: Antitubercular Agents; Humans; Latent Tuberculosis; Mycobacterium tuberculosis
PubMed: 26054858
DOI: 10.1101/cshperspect.a017830 -
International Journal of Molecular... Dec 2021Latent tuberculosis infection (LTBI) represents a major challenge to curing TB disease. Current guidelines for LTBI management include only three older drugs and their... (Review)
Review
Latent tuberculosis infection (LTBI) represents a major challenge to curing TB disease. Current guidelines for LTBI management include only three older drugs and their combinations-isoniazid and rifamycins (rifampicin and rifapentine). These available control strategies have little impact on latent TB elimination, and new specific therapeutics are urgently needed. In the present mini-review, we highlight some of the alternatives that may potentially be included in LTBI treatment recommendations and a list of early-stage prospective small molecules that act on drug targets specific for latency.
Topics: Drug Therapy, Combination; Humans; Isoniazid; Latent Tuberculosis; Rifampin
PubMed: 34948114
DOI: 10.3390/ijms222413317 -
Clinical Infectious Diseases : An... Mar 2017Despite the well-documented association between diabetes and active tuberculosis, evidence of the association between diabetes and latent tuberculosis infection (LTBI)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Despite the well-documented association between diabetes and active tuberculosis, evidence of the association between diabetes and latent tuberculosis infection (LTBI) remains limited and inconsistent.
METHODS
We included observational studies that applied either the tuberculin skin test or the interferon gamma release assay for diagnosis of LTBI and that provided adjusted effect estimate for the association between diabetes and LTBI. We searched PubMed and EMBASE through 31 January 2016. The risk of bias of included studies was assessed using a quality assessment tool modified from the Newcastle-Ottawa scale.
RESULTS
Thirteen studies (1 cohort study and 12 cross-sectional studies) were included, involving 38263 participants. The cohort study revealed an increased but nonsignificant risk of LTBI among diabetics (risk ratio, 4.40; 95% confidence interval [CI], 0.50-38.55). For the cross-sectional studies, the pooled odds ratio from the random-effects model was 1.18 (95% CI, 1.06-1.30), with a small statistical heterogeneity across studies (I2, 3.5%). The risk of bias assessment revealed several methodological issues, but the overall direction of biases would reduce the positive causal association between diabetes and LTBI.
CONCLUSIONS
Diabetes was associated with a small but statistically significant risk for LTBI. Findings from this review could be used to inform future cost-effectiveness analysis on the impact of LTBI screening programs among diabetics.
Topics: Cohort Studies; Cross-Sectional Studies; Diabetes Complications; Diabetes Mellitus; Humans; Latent Tuberculosis; Odds Ratio; Publication Bias
PubMed: 27986673
DOI: 10.1093/cid/ciw836 -
The Journal of Infectious Diseases Jun 2022While an increased risk of active and latent tuberculosis infection (LTBI) in people with type-2 diabetes (DM) has been demonstrated, it is less well characterized...
While an increased risk of active and latent tuberculosis infection (LTBI) in people with type-2 diabetes (DM) has been demonstrated, it is less well characterized whether LTBI is associated with an increased risk of developing DM. We investigated the link between LTBI and DM in people living with HIV in the Swiss HIV Cohort Study via time-dependent Cox proportional hazards models. We found that LTBI significantly increased the risk of developing DM (HR = 1.47), which was robust across different adjustment and censoring techniques. Our results thus suggest that LTBI may be associated with an increased risk of developing DM.
Topics: Cohort Studies; Diabetes Mellitus, Type 2; HIV Infections; Humans; Latent Tuberculosis
PubMed: 35172332
DOI: 10.1093/infdis/jiac054