DOCSLIB.ORG

TB Monograph

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
TB Monograph GUIDELINESGUIDELINES FORFOR THETHE DIAGNOSISDIAGNOSIS OFOF LATENTLATENT TUBERCULOSISTUBERCULOSIS INFECTIONINFECTION inin thethe 21st21st CenturyCentury CME Certified Monograph 2nd Edition PO Box 1709 • 225 Warren Street • Newark, NJ 07101-1709 GUIDELINES FOR THE DIAGNOSIS OF LATENT TUBERCULOSIS INFECTION IN THE 21st CENTURY CONTINUING EDUCATION CERTIFIED MONOGRAPH Sponsored by the University of Medicine & Dentistry of New Jersey (UMDNJ), and the New Jersey Medical School Global Tuberculosis Institute Original Release Date: June 2002 • Activity Update: April 1, 2008 • Expiration Date: March 31, 2010 Nursing credit for this activity will be provided through March 31, 2010 This activity is supported by educational grants from Monarch Pharmaceuticals for the first edition release and JHP Pharmaceuticals for the release of the second edition. TARGET AUDIENCE This activity is designed for internists, pediatricians, pulmonologists, infectious disease specialists, public health and preventive medicine specialists, nurses, and other health personnel interested or involved in tuberculosis diagnosis, treatment and prevention of tuberculosis and latent tuberculosis infection. LEARNING OBJECTIVES Upon the completion of this activity, participants should be able to: I Describe the role of tuberculin testing in low prevalence countries I Review how tuberculins are developed, manufactured and validated I Recognize minor disparities in commercially available tuberculins and the necessity of serial testing with the same antigen I Explain the protocol for administering and reading tuberculin skin tests I Correctly interpret repeated tuberculin skin tests I Examine the role of tuberculin reactions produced by cross reactions with non-tuberculous mycobacteria I Differentiate the use of interferon-γ release assays when compared to tuberculin skin testing I Discuss the role of the nurse in the diagnosis of latent TB infection METHOD OF INSTRUCTION Participants should read the learning objectives and the activity in its entirety. After reviewing the material, complete the post-test consisting of a series of multiple-choice questions. Upon completing this activity as designed and achieving a passing score 70% or more on the post-test, participants will receive a continuing education credit letter and test answer key four weeks after receipt of the registration and evaluation materials. Estimated time to complete this activity as designed is 3.5 hours. c1 ACCREDITATION Physicians: UMDNJ–Center for Continuing and Outreach Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing education for physicians. UMDNJ–Center for Continuing and Outreach Education designates this educational activity for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Nurses: UMDNJ–Center for Continuing and Outreach Education is an approved provider of continuing nursing education by NJSNA, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is awarded 3.5 contact hours (60 minute CH). Provider approved by the California Board of Registered Nursing, Provider Number CEP 13780. This activity was peer-reviewed for relevance, accuracy of content and balance of presentation by Lee B. Reichman, MD, MPH and Rajita Bhavaraju, MPH; and pilot-tested for time required for participation by Anju Budhwani, MD, Henry S. Fraimow, MD, DJ McCabe, RN, MSN, and Lillian Pirog, RN, PNP. DISCLOSURE In accordance with the disclosure policies of UMDNJ and to conform with ACCME and FDA guidelines, individuals in a position to control the content of this education activity are required to disclose to the activity participants: 1) the existence of any financial interest or other relationships with propriety entities producing health care goods and services, with the exemption of non-profit or government organizations and non-health care related companies, within the past 12 months; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved. The faculty and editors listed below have declared that they have no significant financial relationships or affiliations to disclosure: John-Manuel Andriote, MS Kitty Lambregts, MD, PhD, MPH Rajita Bhavaraju, MPH Alfred Lardizabal, MD George Comstock, MD, DrPH Richard Menzies, MD, MSc Karen Galanowsky, RN, MPH Sheldon L. Morris, PhD Elsa Villarino, MD, MPH Lee B. Reichman, MD, MPH is a consultant for and shareholder of Cellestis, Inc. The pilot-testers listed below have declared that they have no significant financial relationships or affiliations to disclosure: Anju Budhwani, MD DJ McCabe, RN, MSN Henry S. Fraimow, MD Lillian Pirog, RN, PNP OFF-LABEL USAGE DISCLOSURE This publication contains information about the test, T-SPOT.TB, which has not been approved by the U.S. Food and Drug Administration for the detection of M. tuberculosis as of the date of this publication. DISCLAIMER The views expressed in this publication are those of the faculty. It should not be inferred or assumed that they are expressing the views of Monarch and JHP Pharmaceuticals, any other manufacturer of pharmaceuticals, or UMDNJ. The drug selection and dosage information provided in this publication are believed to be accurate. However, the reader is urged to consult the full prescribing information on any drug mentioned in this publication for recommended dosage, indications, contraindications, warnings, precautions, and adverse effects before prescribing any medication. This is particularly important when a drug is new or infrequently prescribed. Copyright © 2008 UMDNJ-Center for Continuing and Outreach Education. All rights reserved including translation into other languages. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval systems, without permission in writing from UMDNJ-Center for Continuing and Outreach Education. To review UMDNJ’s privacy policy: http://ccoe.umdnj.edu/general/privacypolicy.html. Please direct continuing education related questions to UMDNJ at 800-227-4852 or email [email protected]. –––––––––––––––––––––– This activity is accessible via Internet Explorer and Netscape browsers. A high speed connection is highly recommended. You must have Adobe Acrobat Reader version 4 or above installed on your computer to view PDF files. If you do not have Acrobat Reader, you can download it for free at Adobe.com. Page composition and typography by Williams Production Group, Annandale, Virginia. GUIDELINES FOR THE DIAGNOSIS OF LATENT TUBERCULOSIS INFECTION in the 21st Century Continuing Education Certified Monograph 2nd Edition Edited by Lee B. Reichman, MD, MPH John-Manuel Andriote, MS (First Edition) Rajita Bhavaraju, MPH (Second Edition) GUIDELINES FOR THE DIAGNOSIS OF LATENT TUBERCULOSIS INFECTION IN THE 21st CENTURY Introduction Lee B. Reichman, M.D., M.P.H. Relevance of the Tuberculin Test in Low-Prevalence Countries Kitty Lambregts, M.D., Ph.D, M.P.H. Developing a Clinical Tuberculin Test: Tuberculin Characteristics, Reactivity and Potency Sheldon L. Morris, Ph.D. Randomized Clinical Trials of Specificities of Commercially Available Tuberculins Elsa Villarino, M.D., M.P.H. Administering and Reading Tuberculin Skin Tests; Interpreting Repeated Tuberculin Skin Tests Richard Menzies, M.D., M.Sc. Tuberculin Sensitivity Produced by Mycobacteria Other than the Mycobacterium Tuberculosis Complex George Comstock, M.D., Dr.P.H. Interferon-γ Release Assay for Detection of Tuberculosis Infection Alfred Lardizabal, M.D. The Role of the Nurse in Diagnosing Latent TB Infection Karen Galanowsky, R.N., M.P.H. A special symposium was held in Miami Beach, Florida. It was chaired by Lee B. Reichman, M.D., M.P.H., and the faculty featured six distinguished authorities on the diagnosis of latent tuberculosis infection. This monograph presents suggested guidelines that emerged from the meeting, which are intended for the practicing clinician, and emphasize the administration and interpretation of tuberculin tests as part of the diagnosis and treatment of latent tuberculosis infection. The symposium and monograph was supported by an unrestricted educational grant from Monarch Pharmaceuticals. Due to unprecedented interest, authors were asked to revise and update chapters for a second edition, which was supported by an unrestricted educational grant from JHP Pharmaceuticals. John-Manuel Andriote was the technical editor of the original monograph. Rajita Bhavaraju revised the 2nd edition. SUGGESTED CITATION To Cite the Entire Monograph Reichman LB, Bhavaraju R, eds.Guidelines for the Diagnosis of Latent Tuberculosis Infection in the 21st Century, 2nd Edition. Newark: New Jersey Medical School Global Tuberculosis Institute, 2008. To Cite a Specific Chapter Menzies R. Interpreting Repeated Tuberculin Skin Tests. pages 38-46. in Reichman LB, Bhavaraju R, eds: Guidelines for the Diagnosis of Latent Tuberculosis Infection in the 21st Century, 2nd Edition. Newark: New Jersey Medical School Global Tuberculosis Institute, 2008. Dedication to George Comstock, M.D., Dr.P.H. George Comstock, M.D., Dr.P.H. passed away on July 15, 2007 after a long illness. We were particularly gratified that even though quite ill, Dr. Comstock saw fit to bring his chapter, “Tuberculin Sensitivity
Load more

Recommended publications
  • Roadmap to Prevent and Combat Drug-Resistant Tuberculosis
    Roadmap to prevent and combat drug-resistant tuberculosis ROADMAP TO PREVENT AND COMBAT DRUG-RESISTANT TUBERCULOSIS The Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 2011-2015 Abstract In response to the alarming problem of multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB) in the WHO European Region, and in order to scale up a comprehensive response and to prevent and control M/XDR-TB, a consolidated action plan has been developed for 2011–2015 for all 53 Member States of the WHO European Region and partners. The Plan was endorsed by the sixty-first session of the WHO Regional Committee in Baku on 15 September 2011. It has six stra- tegic directions and seven areas of intervention. The strategic directions are cross-cutting and highlight the corporate priori- ties of the Region. The areas of intervention are aligned with the Global Plan to Stop TB 2011–2015 and include the same targets as set by the Global Plan and World Health Assembly resolution WHA62.15, to provide universal access to diagnosis and treatment of MDR-TB. The implementation of the Consolidated Action Plan would mean that the emergence of 250 000 new MDR-TB patients and 13 000 XDR-TB patients would be averted, an estimated 225 000 MDR-TB patients would be diagnosed and at least 127 000 of them would be successfully treated thus interrupting the transmission of M/XDR-TB, and 120 000 lives would be saved. The cost of implementing the Plan is estimated at US$ 5.2 billion.
    [Show full text]
  • The Msinga Experience Lessons Learnt from South Africa 2005–2009 Contents
    TUBERCULOSIS MDR/XDR The Msinga Experience Lessons learnt from South Africa 2005–2009 Contents Summary 2 Introduction 4 The MDR/XDR TB epidemic 7 Addressing MDR/XDR TB 10 Turning the tide 15 MDR/XDR TB cases decrease 17 The way forward 20 Endnotes 21 Published in partnership with Umzinyathi District Management January 2009 TUBERCULOSIS MDR/XDR The Msinga Experience Lessons learnt from South Africa 2005–2009 © Pg-images/Dreamstime.com 1 Factors behind the decline in drug resistant TB in Msinga: Summary • The commitment of the Umzinyathi health district management team ensured that TB control was placed at the top of Drug resistant tuberculosis has emerged as a serious public the district’s agenda and that adequate resources health issue around the world. Recent global estimates put were allocated to tackle the number of reported cases for 2006 at close to half a the disease. million. This represents 4.8 percent of all notified TB cases • The management of TB worldwide. An estimated 1.5 million people died from TB in patients was aggressively 2006. addressed by providing In 2006, an outbreak of a deadly and almost incurable refresher training for form of TB was reported in Msinga, Umzinyathi district, a nurses and introducing remote and rural part of KwaZulu-Natal province in South appointment diaries to Africa. The extensively drug-resistant TB or ‘XDR TB’ as it track patients. became known largely occurred among HIV-infected • An increase in the nurse- people, in particular those with terminal AIDS. to-patient ratio also played Patients who were co-infected with XDR TB and HIV an important role in improv- stood little chance of survival.
    [Show full text]
  • Tuberculosis Diagnosis Xpert MTB/Rif®
    Tuberculosis Diagnosis Xpert MTB/Rif® Xpert MTB/Rif®: New technology to diagnose TB and rifampicin resistance Fully automated molecular test. It simultaneously detects Mycobacterium tuberculosis and rifampicin resistance. Results in less than two hours from sample reception, allows health personnel to prescribe proper treatment on the same day. It has minimal bio-safety and training requirements for laboratory staff. The test benefits outweigh its cost: early diagnosis allowing adequate treatment (shortens the transmission, reduces the risk of death and provides equity in diagnosis). Countries using Xpert MTB/Rif® 2013 Countries with purchase order with differential prices* for Xpert MTB/Rif® 2014 By 2013: Brazil, Colombia, Costa Rica, Haiti, Guatemala, Guyana, Paraguay, Surinam, Mexico, Panama, El Salvador and Venezuela implemented Xpert MTB/Rif® requested Xpert MTB/Rif®. No Xpert MTB/Rif® requested Does not qualify for differential prices * Differential prices for low and middle income countries Source: www.stoptb.org Source: PAHO/WHO 2013 regional data PAHO/WHO recommendations for Xpert MTB/Rif® use for the programmatic management of MDR-TB in the Americas Patient characteristics Xpert MTB/Rif® indication Xpert MTB/Rif® location‡ MDR-TB: As diagnostic test for TB and • Hospitals Adult or child** with suspected MDR- MDR-TB • Health facilities with high demand TB Strong recommendation HIV: As 1st diagnostic test for TB and • Health facilities with high demand Adult or child** with HIV and MDR-TB • Healthcare centers for HIV patients suspected TB or MDR-TB and/or populations at high risk for Strong recommendation TB TB suspect* with: As additional diagnostic test for • Health facilities with high demand.
    [Show full text]
  • Latent Tuberculosis Infection
    © National HIV Curriculum PDF created September 27, 2021, 4:20 am Latent Tuberculosis Infection This is a PDF version of the following document: Module 4: Co-Occurring Conditions Lesson 1: Latent Tuberculosis Infection You can always find the most up to date version of this document at https://www.hiv.uw.edu/go/co-occurring-conditions/latent-tuberculosis/core-concept/all. Background Epidemiology of Tuberculosis in the United States Although the incidence of tuberculosis in the United States has substantially decreased since the early 1990s (Figure 1), tuberculosis continues to occur at a significant rate among certain populations, including persons from tuberculosis-endemic settings, individual in correctional facilities, persons experiencing homelessness, persons who use drugs, and individuals with HIV.[1,2] In recent years, the majority of tuberculosis cases in the United States were among the persons who were non-U.S.-born (71% in 2019), with an incidence rate approximately 16 times higher than among persons born in the United States (Figure 2).[2] Cases of tuberculosis in the United States have occurred at higher rates among persons who are Asian, Hispanic/Latino, or Black/African American (Figure 3).[1,2] In the general United States population, the prevalence of latent tuberculosis infection (LTBI) is estimated between 3.4 to 5.8%, based on the 2011 and 2012 National Health and Nutrition Examination Survey (NHANES).[3,4] Another study estimated LTBI prevalence within the United States at 3.1%, which corresponds to 8.9 million persons
    [Show full text]
  • Tuberculosis in Infants Less Than 3 Months Ofage
    Archives of Disease in Childhood 1993; 69: 371-374 371 Tuberculosis in infants less than 3 months of age Arch Dis Child: first published as 10.1136/adc.69.3.371 on 1 September 1993. Downloaded from H S Schaaf, R P Gie, N Beyers, N Smuts, P R Donald Abstract identified from a register of cases proved by The clinical and radiological features in 38 culture. infants less than 3 months of age with A history of contact with adult pulmonary tuberculosis proved by culture are tuberculosis, the presenting symptoms and described and may aid early diagnosis of their duration, and clinical features such as this often fatal condition. Respiratory lymphadenopathy, respiratory signs, and the symptoms, cough in 33 (87%) and tachyp- presence of hepatosplenomegaly were noted. noea in 31 (82%), were the commonest Tuberculin testing was either by Mantoux test presenting symptoms. Twenty five infants 5 units purified protein derivative or Tine test (66%) had hepatomegaly and 20 (53%) (Lederle) with an induration of > 15 mm or a splenomegaly. Mantoux testing gave an confluent reaction respectively being regarded induration of >15 mm in three of 17 (18%) as significant. infants. In a further five a Tine test gave The chest radiographs of 27 (71%) of the 38 confluent response. Chest radiography in infants were assessed systematically by a panel 27 infants showed miliary tuberculosis in consisting of all the authors. Particular seven (26%) and hilar or paratracheal attention was paid to the presence of miliary adenopathy in 14 (52%) and 10 (37%) tuberculosis, the presence of hilar or para- respectively.
    [Show full text]
  • Chest X-Ray Finding of Pulmonary Tuberculosis and Nontuberculous Mycobacterial Lung Diseases in Patients with Acid-Fast Bacilli Smear-Positive Sputum
    Open Access Austin Tuberculosis: Research & Treatment Special Article - Tuberculosis Screening Chest X-Ray Finding of Pulmonary Tuberculosis and Nontuberculous Mycobacterial Lung Diseases in Patients with Acid-Fast Bacilli Smear-Positive Sputum Yuan MK1,2, Lai YC3, Chang CY4 and Chang SC3,5* 1Department of Radiology, Zuoying Branch of Kaohsiung Abstract Armed Forced General Hospital, Taiwan Aim: The early diagnosis of Pulmonary Tuberculosis (PTB) and non- 2College of Health and Nursing, Meiho University, Taiwan tuberculous mycobacterial lung diseases (NTM-LD) are important clinical issues. 3Department of Internal Medicine, National Yang-Ming The present study aimed to compare and identify chest X-ray characteristics University Hospital, Taiwan that help to distinguish NTM-LD from PTB in patients with Acid-Fast Bacilli 4Department of Internal Medicine, Far Eastern Memorial (AFB) smear-positive sputum. Hospital, Taiwan 5Department of Critical Care Medicine, National Yang- Methods: From January 2008 to April 2012, we received 578 AFB smear- Ming University Hospital, Taiwan positive sputum specimens. The typical chest X-ray findings of mycobacterial diseases such as pleural effusion and lesions, consolidation, cavity formation, *Corresponding author: Chang Shih-Chieh, reticulonodular infiltration, atelactasis, miliary nodules and honeycombing were Department of Internal Medicine, National Yang-Ming analyzed. University Hospital, #152, Xin-Min Road, Yilan City 260, Taiwan Results: A total of 133 patients had proven PTB and 25 proven NTM-LD. Seventy two (72) patients with PTB (54.1%) had consolidation vs. 5 (20.0%) in Received: September 20, 2017; Accepted: November patients with NTM (P = 0.002). Four (4) patients with NTM lung diseases (16.0%) 27, 2017; Published: December 06, 2017 had a honeycomb appearance vs.
    [Show full text]
  • Diagnosis of Active and Latent Tuberculosis
    PRACTICE GUIDELINES Diagnosis of active and latent tuberculosis: summary of NICE guidance Ibrahim Abubakar,1 Chris Griffiths,2 Peter Ormerod,3 on behalf of the Guideline Development Group 1Research Department of Infections Tuberculosis is a major preventable infectious cause of six weeks and repeat the Mantoux test to reduce the and Population Health, University morbidity and mortality globally, which has re-emerged rate of false negative results for latent infection. College London, London 2 in high risk groups such as migrants, homeless people, Centre for Primary Care and Public 1 Health, Queen Mary University of problem drug users, and prisoners in the UK. This arti- Household contacts younger than 2 years and older than London cle summarises the most recent recommendations (2011) 4 weeks 3Royal Blackburn Hospital, from the National Institute for Health and Clinical Excel- • If contact was with a person whose sputum smear is Blackburn, UK lence (NICE)2 on the diagnosis of latent tuberculosis positive for acid fast bacilli: Correspondence to: I Abubakar [email protected] (including the use of new tests) and of active tuberculo- – For children not vaccinated with BCG, perform a Cite this as: BMJ 2012;345:e6828 sis. Although this summary focuses on diagnosis, the full Mantoux test and offer isoniazid doi: 10.1136/bmj.e6828 guidelines cover the public health and clinical manage- – If the Mantoux test is positive, assess the child ment of tuberculosis and replaced the guidelines pub- for active tuberculosis. If active tuberculosis is This is one of a series of BMJ 3 summaries of new guidelines lished in 2006.
    [Show full text]
  • A Cross Study of Cutaneous Tuberculosis: a Still Relevant Disease in Morocco (A Study of 146 Cases)
    ISSN: 2639-4553 Madridge Journal of Case Reports and Studies Research Article Open Access A Cross study of Cutaneous Tuberculosis: A still relevant Disease in Morocco (A Study of 146 Cases) Safae Zinoune, Hannane Baybay, Ibtissam Louizi Assenhaji, Mohammed Chaouche, Zakia Douhi, Sara Elloudi, and Fatima-Zahra Mernissi Department of Dermatology, University Hospital Hassan II, Fez, Morocco Article Info Abstract *Corresponding author: Background: Burden of tuberculosis still persists in Morocco despite major advances in Safae Zinoune its treatment strategies. Cutaneous tuberculosis (CTB) is rare, and underdiagnosed, due Doctor Department of Dermatology to its clinical and histopathological polymorphism. The purpose of this multi-center Hassan II University Hospital retrospective study is to describe the epidemiological, clinical, histopathological and Fès, Morocco evolutionary aspects of CTB in Fez (Morocco). E-mail: [email protected] Methods: We conducted a cross-sectional descriptive multicenter study from May 2006 Received: March 12, 2019 to May 2016. The study was performed in the department of dermatology at the Accepted: March 18, 2019 University Hospital Hassan II and at diagnosis centers of tuberculosis and respiratory Published: March 22, 2019 diseases of Fez (Morocco). The patients with CTB confirmed by histological and/or biological examination were included in the study. Citation: Zinoune S, Baybay H, Assenhaji LI, et al. A Cross study of Cutaneous Tuberculosis: Results: 146 cases of CTB were identified. Men accounted for 39.8% of the cases (58 A still relevant Disease in Morocco (A Study of 146 Cases). Madridge J Case Rep Stud. 2019; patients) and women 60.2% (88 cases), sex-ratio was 0.65 (M/W).
    [Show full text]
  • Diagnosis of Tuberculosis in Adults and Children David M
    Clinical Infectious Diseases IDSA GUIDELINE Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children David M. Lewinsohn,1,a Michael K. Leonard,2,a Philip A. LoBue,3,a David L. Cohn,4 Charles L. Daley,5 Ed Desmond,6 Joseph Keane,7 Deborah A. Lewinsohn,1 Ann M. Loeffler,8 Gerald H. Mazurek,3 Richard J. O’Brien,9 Madhukar Pai,10 Luca Richeldi,11 Max Salfinger,12 Thomas M. Shinnick,3 Timothy R. Sterling,13 David M. Warshauer,14 and Gail L. Woods15 1Oregon Health & Science University, Portland, Oregon, 2Emory University School of Medicine and 3Centers for Disease Control and Prevention, Atlanta, Georgia, 4Denver Public Health Department, Denver, Colorado, 5National Jewish Health and the University of Colorado Denver, and 6California Department of Public Health, Richmond; 7St James’s Hospital, Dublin, Ireland; 8Francis J. Curry International TB Center, San Francisco, California; 9Foundation for Innovative New Diagnostics, Geneva, Switzerland; 10McGill University and McGill International TB Centre, Montreal, Canada; 11University of Southampton, United Kingdom; 12National Jewish Health, Denver, Colorado, 13Vanderbilt University School of Medicine, Vanderbilt Institute for Global Health, Nashville, Tennessee, 14Wisconsin State Laboratory of Hygiene, Madison, and 15University of Arkansas for Medical Sciences, Little Rock Downloaded from Background. Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuber- culosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain.
    [Show full text]
  • The Diagnosis of Tuberculosis
    ESPID REPORTS AND REVIEWS CONTENTS The Diagnosis of Tuberculosis EDITORIAL BOARD Co-Editors: Delane Shingadia and Irja Lutsar Board Members David Burgner (Melbourne, Australia) Nicol Ritz (Basel, Switzerland) Tobias Tenenbaum (Mannhein, Germany) Luisa Galli (Rome, Italy) Ira Shah (Mumbai, India) Marc Terbruegge (Southampton, UK) Christiana Nascimento-Carvalho Matthew Snape (Oxford, UK) Marceline van Furth (Amsterdam, (Bahia, Brazil) George Syrogiannopoulos The Netherlands) Ville Peltola (Turku, Finland) (Larissa, Greece) Anne Vergison (Brussels, Belgium) The Diagnosis of Tuberculosis Delane Shingadia, MPH, MRCP, FRCPCH Abstract: Childhood tuberculosis accounts for a ESTABLISHED DIAGNOSTIC in place. Nasopharyngeal aspiration (NPA) significant proportion of the global tuberculosis METHODS has also been used to obtain respiratory sam- disease burden. However, tuberculosis in children ples, as the passage of a nasal cannula may is difficult to diagnose, because disease tends to be Microscopy and Culture elicit a cough reflex. The culture yield from paucibacillary and sputum samples are often not Microscopic examination of respira- NPA (19/64; 30%) was similar to that of easy to obtain. The diagnosis of tuberculosis in tory samples for acid-fast bacilli using the gastric aspirates (24/64; 38%) among Peru- 8 children is traditionally based on chest radiogra- Ziehl-Neelsen and fluorochrome stains, such vian children. However, subsequent studies phy, tuberculin skin testing, and mycobacterial as the auramine and rhodamine, have been have shown relatively poor yields from staining/culture from appropriate samples. Newer the standard and rapid diagnostic tools for NPA samples compared with gastric aspi- 1,2 9,10 diagnostic strategies have included improved bacte- tuberculosis (TB) diagnosis. Recent ad- rate. Since young children tend to swal- vances in light-emitting diode (LED) tech- riologic and molecular methods, as well as new low their sputum rather than expectorate it, nology have widened the applicability of methods for sample collection from children.
    [Show full text]
  • TB Policies in 24 Countries a Survey of Diagnostic and Treatment Practices About Médecins Sans Frontières
    Out of Step 2015 TB Policies in 24 Countries A survey of diagnostic and treatment practices About Médecins Sans Frontières Médecins Sans Frontières (MSF) is an independent international medical humanitarian organisation that delivers medical care to people affected by armed conflicts, epidemics, natural disasters and exclusion from healthcare. Founded in 1971, MSF has operations in over 60 countries today. MSF has been involved in TB care for 30 years, often working alongside national health authorities to treat patients in a wide variety of settings, including chronic conflict zones, urban slums, prisons, refugee camps and rural areas. MSF’s first programmes to treat multidrug-resistant TB opened in 1999, and the organisation is now one of the largest NGO treatment providers for drug-resistant TB. In 2014, the organisation started 21,500 patients on first-line TB treatment across projects in more than 20 countries, with 1,800 patients on treatment for drug-resistant TB. About the MSF Access Campaign In 1999, on the heels of MSF being awarded the Nobel Peace Prize – and largely in response to the inequalities surrounding access to HIV/AIDS treatment between rich and poor countries – MSF launched the Access Campaign. Its sole purpose has been to push for access to, and the development of, life- saving and life-prolonging medicines, diagnostics and vaccines for patients in MSF programmes and beyond. About Stop TB Partnership The Stop TB Partnership is leading the way to a world without TB, a disease that is curable but still kills three people every minute. Founded in 2001, the Partnership’s mission is to serve every person who is vulnerable to TB and to ensure that high-quality treatment is available to all who need it.
    [Show full text]
  • Health Care Provider Information
    Health Care Provider Information NOTE: This page is a resource for Whatcom County clinicians dealing with tuberculosis: recognizing active disease and screening for and treating latent infection. The Whatcom County Health Department provides this as a tool/resource in our collaboration with community clinicians, and we welcome feedback and suggestions for additions and changes that improve its usefulness. (Contact Info) Distinguishing Active TB Disease from Latent Infection TB life cycle/Transmission: Tuberculosis (TB) is a disease caused by bacteria (Mycobacteria tuberculosis, or Mtb) transmitted from people with active pulmonary or laryngeal TB disease as aerosolized particles that are suspended in air. Other people may inhale these infectious particles and become infected with Mtb. In the vast majority of cases, their immune system responds to the infection and walls it off, resulting in a latent tuberculosis infection with no disease (and not contagious). When the infected person is immunosuppressed (e.g., HIV/AIDS) or has an immature immune system (young child), the infection may progress to primary active disease without latency. Immune response: The asymptomatic, noncontagious cases are identified by measuring their immune response to tuberculosis, using a TB skin test (TST) or a blood test (interferon gamma release assay, or IGRA). Progression to disease: About 5% of those with latent infection progress to active tuberculosis disease in the first two years after becoming infected. The risk for progression after that is about 0.1% per year (1% per decade of remaining lifetime). The risk of progression increases with conditions that suppress the immune system. This progression can occur with initial infection (primary disease) or after a latent period (reactivation disease).
    [Show full text]