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The European Respiratory Journal Jul 2022
Topics: China; Clinical Protocols; Follow-Up Studies; Humans; Latent Tuberculosis; Tuberculosis
PubMed: 35798372
DOI: 10.1183/13993003.00540-2022 -
American Journal of Physiology. Lung... Mar 2022Tuberculosis has been present in the world's population for as long as there has been written language. It is a disease known to the ancient Egyptians, Greeks, Romans,... (Review)
Review
Tuberculosis has been present in the world's population for as long as there has been written language. It is a disease known to the ancient Egyptians, Greeks, Romans, and Hebrews, but its etiology eluded the world for thousands of years. Even after the germ theory was accepted and early scientists hypothesized a pathogen as the cause, the identity of the sleeping killer in society remained a mystery. That is until Robert Koch was able to grow and visualize . Koch introduced his Old Tuberculin solution as a diagnostic therapy of tuberculosis (TB), with the intent to reduce the number of infected persons and stop its spread. Old Tuberculin's ability to treat TB proved minimal, but its diagnostic potential paved the way for more effective tests from von Pirquet, Calmette, Wolff-Eisner, and Mantoux. Florence Seibert set out to identify and purify the active principle in Koch's Old Tuberculin and ended up creating purified protein derivative (PPD) tuberculin which is still used as the standard for the tuberculin skin test (TST). Interferon-γ release assays (IGRAs) are a more modern diagnostic tool for detecting latent TB infection that offer some benefits (and some disadvantages) to TST. TSTs and IGRAs can determine if an individual has been infected with but are equally unable to predict progression to active tuberculosis, the diagnosis of which relies on assessment of clinical symptoms, radiographic imaging, and sample culture.
Topics: Humans; Interferon-gamma Release Tests; Latent Tuberculosis; Mycobacterium tuberculosis; Sensitivity and Specificity; Tuberculin; Tuberculosis
PubMed: 35170334
DOI: 10.1152/ajplung.00217.2021 -
The Journal of Infectious Diseases Feb 2019Latent tuberculosis has been recognized for over a century, but discovery of new niches, where Mycobacterium tuberculosis resides, continues. We evaluated literature on... (Review)
Review
Latent tuberculosis has been recognized for over a century, but discovery of new niches, where Mycobacterium tuberculosis resides, continues. We evaluated literature on M.tuberculosis locations during latency, highlighting that mesenchymal and hematopoietic stem cells harbor organisms in sensitized asymptomatic individuals.
Topics: Hematopoietic Stem Cells; Humans; Latent Tuberculosis; Mesenchymal Stem Cells; Mycobacterium tuberculosis; Phagocytes
PubMed: 30376080
DOI: 10.1093/infdis/jiy579 -
European Respiratory Review : An... Mar 2021The impact of latent tuberculosis infection (LTBI) on health and wellbeing is not well understood. This review aims to evaluate the health and wellbeing of individuals... (Meta-Analysis)
Meta-Analysis Review
The impact of latent tuberculosis infection (LTBI) on health and wellbeing is not well understood. This review aims to evaluate the health and wellbeing of individuals with LTBI. A systematic literature search was performed to assess studies reporting patient-reported outcomes in LTBI management including health-related quality of life (HRQoL), health utilities, disease burden and experience of individuals with LTBI. A pooled analysis was performed to estimate the effect of LTBI on HRQoL.A total of 4464 studies were screened, of which 13 eligible articles describing nine unique studies were included for review. The HRQoL of individuals with LTBI and without tuberculosis (TB) infection were comparable, and better than patients with active TB disease. However, individuals with LTBI reported poorer mental health compared with individuals without TB infection (mean difference -4.16, 95% CI -7.45- -0.87; p=0.01). Qualitative studies suggest the presence of fear, anxiety and stigma in individuals with LTBI.This review highlights potential psychosocial challenges in individuals with LTBI despite the absence of clinical symptoms. While their quality of life was marginally affected, this could be evidence to support LTBI management in preventing TB re-activation and the severe consequences of active TB disease that affect all domains of HRQoL.
Topics: Humans; Latent Tuberculosis; Quality of Life; Tuberculosis
PubMed: 33408089
DOI: 10.1183/16000617.0260-2020 -
International Journal of Infectious... Oct 2019Asia has the highest burden of tuberculosis (TB) and latent TB infection (LTBI) in the world. Optimizing the diagnosis and treatment of LTBI is one of the key strategies... (Review)
Review
Asia has the highest burden of tuberculosis (TB) and latent TB infection (LTBI) in the world. Optimizing the diagnosis and treatment of LTBI is one of the key strategies for achieving the WHO 'End TB' targets. We report the discussions from the Asia Latent TubERculosis (ALTER) expert panel meeting held in 2018 in Singapore. In this meeting, a group of 13 TB experts from Bangladesh, Cambodia, Hong Kong, India, Indonesia, Malaysia, Myanmar, the Philippines, Singapore, Taiwan, Thailand and Vietnam convened to review the literature, discuss the barriers and propose strategies to improve the management of LTBI in Asia. Strategies for the optimization of risk group prioritization, diagnosis, treatment, and research of LTBI are reported. The perspectives presented herein, may help national programs and professional societies of the respective countries enhance the adoption of the WHO guidelines, scale-up the implementation of national guidelines based on the regional needs, and provide optimal guidance to clinicians for the programmatic management of LTBI.
Topics: Antitubercular Agents; Asia; Humans; Latent Tuberculosis
PubMed: 31301458
DOI: 10.1016/j.ijid.2019.07.004 -
Clinical Infectious Diseases : An... Nov 2021Tuberculosis (TB) has been linked to an increased risk of atherosclerotic cardiovascular disease (ASCVD). We assessed whether latent TB infection (LTBI) is associated...
BACKGROUND
Tuberculosis (TB) has been linked to an increased risk of atherosclerotic cardiovascular disease (ASCVD). We assessed whether latent TB infection (LTBI) is associated with subclinical coronary atherosclerosis in 2 TB-prevalent areas.
METHODS
We analyzed cross-sectional data from studies conducted in Lima, Peru, and Kampala, Uganda. Individuals ≥40 years old were included. We excluded persons with known history of ASCVD events or active TB. Participants underwent QuantiFERON-TB (QFT) testing to define LTBI and computed tomography angiography to examine coronary atherosclerosis. A Coronary Artery Disease-Reporting Data System (CAD-RADS) score ≥3 defined obstructive CAD (plaque causing ≥50% stenosis).
RESULTS
113 and 91 persons with and without LTBI, respectively, were included. There were no significant differences between LTBI and non-LTBI participants in terms of age (median [interquartile range]; 56 [51-62] vs 55 [49-64] years; P = .829), male sex (38% vs 42%; P = .519), or 10-year ASCVD risk scores (7.1 [3.2-11.7] vs 6.1 [2.8-1.8]; P = .533). CAD prevalence (any plaque) was similar between groups (29% vs 24%; P = .421). Obstructive CAD was present in 9% of LTBI and 3% of non-LTBI individuals (P = .095). LTBI was associated with obstructive CAD after adjusting for ASCVD risk score, HIV status, and study site (adjusted OR, 4.96; 95% CI, 1.05-23.44; P = .043). Quantitative QFT TB antigen minus Nil interferon-γ responses were associated with obstructive CAD (adjusted OR, 1.2; 95% CI, 1.03-1.41; P = .022).
CONCLUSIONS
LTBI was independently associated with an increased likelihood of subclinical obstructive CAD. Our data indicate that LTBI is a nontraditional correlate of ASCVD risk.
Topics: Adult; Coronary Artery Disease; Cross-Sectional Studies; Humans; Interferon-gamma Release Tests; Latent Tuberculosis; Male; Middle Aged; Peru; Tuberculin Test; Uganda
PubMed: 33388766
DOI: 10.1093/cid/ciaa1934 -
Alimentary Pharmacology & Therapeutics Jul 2022One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of... (Review)
Review
BACKGROUND
One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune-based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence.
AIM
To review the screening, diagnostic practices and medical management of LTBI in patients with IBD.
METHODS
Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD.
RESULTS
Screening for LTBI should be performed proactively and includes assessment of risk factors, an interferon-gamma releasing assay or tuberculin skin test and chest X-ray. LTBI treatment in patients with IBD is scenario-dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD.
CONCLUSIONS
Proactive screening for LTBI is essential in patients with IBD undergoing immune-suppressing therapy and several therapeutic strategies are available. Reporting of real-world experience is essential to refining current management recommendations.
Topics: Humans; Immunosuppression Therapy; Inflammatory Bowel Diseases; Interferon-gamma Release Tests; Latent Tuberculosis; Mass Screening; Tuberculin Test; Tumor Necrosis Factor-alpha
PubMed: 35596242
DOI: 10.1111/apt.16952 -
The Korean Journal of Gastroenterology... Aug 2022Latent tuberculosis (TB) infections (LTBI) impose clinical challenges in terms of the diagnosis and treatment of inflammatory bowel disease (IBD), especially in... (Review)
Review
Latent tuberculosis (TB) infections (LTBI) impose clinical challenges in terms of the diagnosis and treatment of inflammatory bowel disease (IBD), especially in TB-endemic areas. While steroids and biologics have become increasingly useful in the treatment of patients with moderate-to-severe IBD, the risk of reactivation or developing TB is increased due to their potent immunosuppressive effects. Tumor necrosis factor-alpha inhibition may result in the activation of a latent TB infection, and most cases manifest as more severe forms of disseminated TB. All potential users of immunosuppressive therapy should be screened for LTBI, and appropriate measures for the management of latent and active TB should be undertaken with immediate initiation of anti-TB treatment. Biologics should be withheld during TB treatment, and the proper timing for the resumption of IBD therapy during or after TB treatment should be individualized. This review summarizes the latest knowledge on the risk assessment, detection, and management of latent and active TB infections in patients with IBD.
Topics: Biological Products; Humans; Inflammatory Bowel Diseases; Latent Tuberculosis; Tuberculosis; Tumor Necrosis Factor-alpha
PubMed: 36004634
DOI: 10.4166/kjg.2022.086 -
PloS One 2022Tuberculosis is among the leading causes of death among infectious diseases. Regions with a high incidence of tuberculosis, such as sub-Saharan Africa, are...
BACKGROUND
Tuberculosis is among the leading causes of death among infectious diseases. Regions with a high incidence of tuberculosis, such as sub-Saharan Africa, are disproportionately burdened by stillbirth and other pregnancy complications. Active tuberculosis increases the risk of pregnancy complications, but the association between latent tuberculosis infection (LTBI) and pregnancy outcomes is unknown. We explored the effect of latent tuberculosis infection on the risk of stillbirth in women attending antenatal care clinics in Ethiopia, a country with >170 000 annual cases of active tuberculosis.
METHOD
Pregnant women were enrolled from antenatal care at three health facilities in Adama, Ethiopia, during 2015-2018, with assessment for previous and current active tuberculosis and testing for LTBI using QuantiFERON-TB-GOLD-PLUS. Proportions of stillbirth (≥ 20 weeks of gestation) and neonatal death (< 29 days of birth) were compared with respect to categories of maternal tuberculosis infection (tuberculosis-uninfected, LTBI, previous-, and current active tuberculosis). Multivariable logistic regression was performed for stillbirth.
RESULTS
Among 1463 participants enrolled, the median age was 25 years, 10.2% were HIV-positive, 34.6% were primigravidae, and the median gestational age at inclusion was 18 weeks. Four (0.3%) were diagnosed with active tuberculosis during pregnancy, 68 (4.6%) reported previous treatment for active tuberculosis, 470 (32.1%) had LTBI, and 921 (63.0%) were tuberculosis-uninfected. Stillbirth was more frequent in participants with LTBI compared to tuberculosis-uninfected participants, although not reaching statistical significance (19/470, 4.0% vs 25/921, 2.7%, adjusted [for age, gravidity and HIV serostatus] odds ratio 1.38, 95% confidence interval 0.73-2.57, p = 0.30). Rates of neonatal death (5/470, 1.1% vs 10/921, 1.1%) were similar between these categories.
CONCLUSION
Latent tuberculosis infection was not significantly associated with stillbirth or neonatal death in this cohort. Studies based on larger cohorts and with details on causes of stillbirth, as well as other pregnancy outcomes, are needed to further investigate this issue.
Topics: Adult; Cohort Studies; Ethiopia; Female; Humans; Infant, Newborn; Latent Tuberculosis; Perinatal Death; Pregnancy; Pregnancy Complications; Prospective Studies; Stillbirth; Tuberculosis
PubMed: 35404930
DOI: 10.1371/journal.pone.0261972 -
American Family Physician Jun 2014Latent tuberculosis infection refers to an asymptomatic, nontransmissible infection with Mycobacterium tuberculosis, carrying a 5% to 10% lifetime risk of progressing to... (Review)
Review
Latent tuberculosis infection refers to an asymptomatic, nontransmissible infection with Mycobacterium tuberculosis, carrying a 5% to 10% lifetime risk of progressing to active disease. One-half of this risk occurs within the first two years after infection. High-risk groups include recent immigrants from high-incidence countries, health care professionals, persons living or working in institutional settings, and homeless persons. Risk factors for progression to active disease include immunodeficiency, recent exposure to tuberculosis, and chronic kidney disease requiring dialysis. Tuberculin skin testing has several limitations, including the need for multiple office visits and the potential for false-positive results in patients who have received the bacillus Calmette-Guérin vaccine or been exposed to environmental mycobacteria. Interferon-gamma release assays address these deficiencies but are limited by their cost and requirement for blood processing. Interferon-gamma release assays are preferred in immigrants exposed to bacillus Calmette-Guérin and in patients who are not likely to return for interpretation of skin test results. Tuberculin skin testing is preferred for children younger than five years. Active disease should be excluded before initiating treatment. The newest treatment option of 12 weekly doses of isoniazid and rifapentine has similar or better effectiveness than standard nine-month therapy with daily isoniazid. A four-month regimen of daily rifampin is another alternative.
Topics: Antitubercular Agents; Humans; Interferon-gamma Release Tests; Latent Tuberculosis; Risk Factors; Tuberculin Test
PubMed: 25077395
DOI: No ID Found