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Tuberculin Testing  and Treatment of Latent  Tuberculosis Infection Andrew Catanzaro, MD
Targeted Tuberculin Testing  and Treatment of Latent Tuberculosis Infection ,[object Object],[object Object],[object Object]
Outline ,[object Object],[object Object],[object Object]
Latent TB:  Screening and Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
What is Latent TB Infection (LTBI)?  Subclinical Disease ,[object Object],[object Object],[object Object]
TB Pathogenesis ,[object Object],[object Object],[object Object],[object Object],[object Object]
TB Pathogenesis (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LTBI vs. Pulmonary TB Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TB Epidemiology ,[object Object],[object Object],[object Object],[object Object]
Tuberculosis Epidemiology (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TB Epidemiology (3) TB Cases in Immigrants, 2006 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Latent TB:  Screening and Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
TST  Testing Goals ,[object Object]
TST New Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Before you test: Identify Risk Factors That Lead to Development of TB Disease
Persons at Risk for Developing TB Disease ,[object Object],[object Object],Persons at high risk for developing TB disease fall into 2 categories
Recent Infection as a  Risk Factor (1) ,[object Object],[object Object],[object Object],Persons more likely to have been recently infected include
Recent Infection as a  Risk Factor (2) ,[object Object]
Increased Risk for Progression to TB Disease  (1) ,[object Object],[object Object],Persons more likely to progress from LTBI to TB disease include
Increased Risk for Progression to TB Disease  (2) ,[object Object],[object Object]
Increased Risk for Progression to TB Disease (3) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculin Testing
Mantoux Tuberculin Skin Test ,[object Object],[object Object],[object Object],[object Object]
Reading the TST (1) ,[object Object],[object Object],[object Object],[object Object]
Pretesting (2) ,[object Object],[object Object],[object Object]
TST Interpretation (1) ,[object Object],[object Object],[object Object],[object Object]
TST Interpretation (3) ,[object Object],[object Object],[object Object],[object Object]
TST Interpretation (4) ,[object Object],[object Object],[object Object]
TST Interpretation (5) ,[object Object],*Although skin testing programs should be conducted only among high-risk groups, certain individuals may require TST for employment or school attendance. Diagnosis and treatment of LTBI should always be tied to risk assessment. 15-mm induration is interpreted as positive in ____________________________________________________
BCG Vaccination ,[object Object],[object Object],[object Object]
Factors That May Cause  False-Negative TST Reactions (2)  ,[object Object],[object Object],[object Object],[object Object]
LTBI Treatment Regimens
Treatment Guidelines ,[object Object],[object Object],[object Object]
Treatment of LTBI ,[object Object],[object Object],[object Object],[object Object]
Initiating Treatment  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rifampin Regimens (1)  ,[object Object],[object Object]
Regimens (2) ,[object Object],[object Object],[object Object],[object Object]
Completion of Therapy ,[object Object]
Management of Patient Who Missed Doses ,[object Object],[object Object],[object Object]
Monitoring  During Treatment - Risk
Clinical Monitoring (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],Instruct patient to report signs or symptoms of adverse drug reactions
Clinical Monitoring (2) ,[object Object],[object Object],[object Object],[object Object],Monthly visits should include a brief physical exam and a review of
Clinical Monitoring (3) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Monitoring (1) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Monitoring (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical/Laboratory Monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Monitoring (3) ,[object Object],[object Object],[object Object],7 MMWR June 9, 2000; 49(No. RR-6): 39
Summary: TB Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Guidelines Available Online ,[object Object],[object Object],[object Object],[object Object]

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Latent Tuberculosis: Identification and Treatment

Notas do Editor

  1. Introduction The Centers for Disease Control and Prevention (CDC) and American Thoracic Society (ATS) issued revised guidelines for targeted tuberculin testing and the treatment of latent tuberculosis infection (LTBI). The guidelines were published in the June 9, 2000 issue of the Morbidity and Mortality Weekly Report (MMWR) and in the American Journal of Respiratory and Critical Care Medicine (2000;161:S221–S247). In addition to changes in treatment and monitoring recommendations, an emphasis was placed on testing only those who may have recently been infected with tuberculosis (TB) and those at risk for progression from latent infection to active disease. This slide set includes the recommendations in the 2000 guidelines and updates to the recommendations published before November 2004. Key areas covered in this slide set include: • Brief history of LTBI treatment • Concept of targeted testing • Risk factors for LTBI • Tuberculin skin testing and QuantiFERON®-TB Test • Treatment recommendations for LTBI • Case studies Target audience: The target audience for this slide set is the primary healthcare provider. Supporting references and resources have been included in the slide set. Adapting the presentation: The slide can be used in its entirety or in sections depending on audience needs. If the slides are altered, the CDC and HHS logos must be removed. Use of case studies: The slide set contains three case studies to reinforce the importance of targeted testing and the identification individuals at risk for LTBI. The case study slides may be incorporated at the presenter’s discretion. The question and answer slides following the case slides can be used to encourage group participation and discussion. Alternatively, the presenter can present the cases and highlight the main educational points without group discussion.
  2. :
  3. Relative risk of developing active TB for persons with certain clinical conditions: Silicosis 30 times greater Diabetes 2-4 times greater Chronic renal failure/hemodialysis 10-25 times greater Gastrectomy 2-5 times greater Jejunoileal bypass 27-63 times greater Kidney transplant 37 times greater Heart transplant 20-74 times greater Cancer of head/neck 16 times greater