Wed . 19 Jun 2019

Latent tuberculosis

latent tuberculosis, latent tuberculosis treatment
A diagnosis of latent tuberculosis LTB, also called latent tuberculosis infection LTBI means a patient is infected with Mycobacterium tuberculosis, but the patient does not have active tuberculosis Active tuberculosis can be contagious while latent tuberculosis is not, and it is therefore not possible to get TB from someone with latent tuberculosis The main risk is that approximately 10% of these patients 5% in the first two years after infection and 01% per year thereafter will go on to develop active tuberculosis This is particularly true, and there is added risk, in particular situations such as medication that suppresses the immune system or advancing age

The identification and treatment of people with latent TB is an important part of controlling this disease Various treatment regimens are in use to treat latent tuberculosis, which generally need to be taken for several months

Contents

  • 1 Transmission
    • 11 Latent disease
    • 12 Reactivation
  • 2 Diagnosis
    • 21 Tuberculin Skin Testing
      • 211 Mantoux test
      • 212 Heaf test
      • 213 Tuberculin conversion
      • 214 Boosting
      • 215 Interpretation
      • 216 Interferon-γ IFN-γ testing
    • 22 Drug-resistant strains
    • 23 Multi-drug-resistant TB
    • 24 Extensively drug-resistant TB XDR TB
    • 25 Totally drug-resistant TB TDR TB
  • 3 Treatment
    • 31 Terminology
    • 32 Specific situations
    • 33 Treatment regimens
    • 34 Evidence for treatment effectiveness
    • 35 Treatment efficacy
  • 4 Epidemiology
  • 5 Further reading
  • 6 See also
  • 7 References

Transmission

Latent disease

"TB Bacteria Are Spread Only from a Person with Active TB Disease  In people who develop active TB of the lungs, also called pulmonary TB, the TB skin test will often be positive In addition, they will show all the signs and symptoms of TB disease, and can pass the bacteria to others So, if a person with TB of the lungs sneezes, coughs, talks, sings, or does anything that forces the bacteria into the air, other people nearby may breathe in TB bacteria Statistics show that approximately one-third of people exposed to pulmonary TB become infected with the bacteria, but only one in ten of these infected people develop active TB disease during their lifetimes"

However, exposure to tuberculosis is very unlikely to happen when one is exposed for a few minutes in a store or in a few minutes social contact "It usually takes prolonged exposure to someone with active TB disease for someone to become infected

After exposure, it usually takes 8 to 10 weeks before the TB test would show if someone had become infected" "Depending on ventilation and other factors, these tiny droplets can remain suspended in the air for several hours Should another person inhale them, he or she may become infected with TB The probability of transmission will be related to the infectiousness of the person with TB, the environment where the exposure occurred, the duration of the exposure, and the susceptibility of the host" In fact, "it isn't easy to catch TB You need consistent exposure to the contagious person for a long time For that reason, you're more likely to catch TB from a relative than a stranger"

If a person had latent tuberculosis, they do not have active/contagious tuberculosis Once exposed, people very often have latent tuberculosis To convert to active tuberculosis, the bacteria must become active

People have medical privacy or "confidentiality" and do not have to reveal their active tuberculosis case to family, friends, or co-workers; therefore, the person who gets latent tuberculosis may never know who had the active case of tuberculosis that caused the latent tuberculosis diagnosis for them Only by required testing required in some jobs or developing symptoms of active tuberculosis and visiting a medical doctor who does testing will a person know they have been exposed Because tuberculosis is not common in the United States, doctors may not suspect tuberculosis; therefore, they may not test If a person has symptoms of tuberculosis, it is wise to be tested

Persons with diabetes may have an 18% chance of converting to active tuberculosis In fact, death from tuberculosis was greater in diabetic patients Persons with HIV and latent tuberculosis have a 10% chance of developing active tuberculosis every year "HIV infection is the greatest known risk factor for the progression of latent M tuberculosis infection to active TB In many African countries, 30–60% of all new TB cases occur in people with HIV, and TB is the leading cause of death globally for HIV-infected people"

Reactivation

Once a person has been diagnosed with Latent Tuberculosis LTBI and a medical doctor confirms no active tuberculosis, the person should remain alert to symptoms of active tuberculosis for the remainder of his or her life Even after completing the full course of medication, there is no guarantee that the tuberculosis bacteria have all been killed

"When a person develops active TB disease, the symptoms cough, fever, night sweats, weight loss etc may be mild for many months This can lead to delays in seeking care, and results in transmission of the bacteria to others"

Symptoms include:

  • a cough beginning dry and progressive to productive with possible blood in the sputum
  • flu-like symptoms
  • fever
  • night sweats
  • weight loss
  • fatigue
  • other symptoms such as chest pain, shortness of breath etc

Tuberculosis does not always settle in the lungs If the outbreak of tuberculosis is in the brain, organs, kidneys, joints, or others areas, the patient may have active tuberculosis for an extended period of time before discovering that they are active "A person with TB disease may feel perfectly healthy or may only have a cough from time to time" However, these symptoms do not guarantee tuberculosis, and they may not exist at all, yet the patient may still have active tuberculosis A person with symptoms listed may have active tuberculosis, and the person should immediately see a physician so that tuberculosis is not spread If a person with the above symptoms does not see a physician, ignoring the symptoms can result in lung damage, eye damage, organ damage and eventually death

When tuberculosis settles in other organs rather than lungs or other parts of the body such as the skeletal, symptoms may be different from when it settles in the lungs such as the symptoms listed above Thus, without the cough or flu-like symptoms, a person can have active tuberculosis Other symptoms include back pain, flank pain, PID symptoms, confusion, coma, difficulty swallowing, and many other symptoms that would be a part of other diseases Please see the reference for more information on symptoms Therefore, seeing a physician and asking for a tuberculosis test is absolutely necessary to rule out tuberculosis when a patient has symptoms without a diagnosis of disease

Situations in which tuberculosis may become reactivated are:

  • if there is onset of a disease affecting the immune system such as AIDS or a disease whose treatment affects the immune system such as chemotherapy in cancer or systemic steroids in asthma or Enbrel, Humira or Orencia in rheumatoid arthritis;
  • malnutrition which may be the result of illness or injury affecting the digestive system, or of a prolonged period of not eating, or disturbance in food availability such as famine, residence in refugee camp or concentration camp, or civil war;
  • degradation of the immune system due to aging
  • certain systemic diseases such as diabetes, and "other conditions: debilitating disease especially haematological and some solid cancers, long-term steroids, end-stage renal disease, silicosis and gastrectomy/jejuno-ileal bypass all confer an increased risk
  • "Elderly patients: latent TB may reactivate in elderly patients"
  • The very young

Diagnosis

There are currently two commonly used classes of tests used to identify patients with latent tuberculosis: tuberculin skin tests and IFN-γ Interferon-gamma tests The tuberculin skin tests in use include but are not limited to

  • Mantoux test
  • Heaf test

There are currently three IFN-γ interferon-gamma release assay – IGRA tests available

  • T-SPOTTB
  • QuantiFERON-TB Gold
  • QuantiFERON-TB Gold In-Tube

Tuberculin Skin Testing

The Tuberculin Skin Test TST in its first iteration, the Mantoux Test, was developed in 1908 Conceptually, it's quite simple: tuberculin also called purified protein derivative or PPD is a standardised dead extract of cultured TB, injected into the skin to measure the person's immune response to the bacteria So, if a person has been exposed to the bacteria previously, they should express an immune reaction to the injection, usually a mild swelling or redness around the site There have been two primary methods of TST: the Mantoux test, and the Heaf test The Heaf test was discontinued in 2005 because the manufacturer deemed its production to be financially unsustainable, though it was previously preferred in the UK because it was felt to require less training to administer and involved less inter-observer variation in its interpretation than the Mantoux test The Mantoux test was the preferred test in the US, and is now the most widely used TST globally

Mantoux test

See: Mantoux test

The Mantoux test is now standardised by the WHO 01 ml of tuberculin 100 units/ml, which delivers a dose of 5 units is given by intradermal injection into the surface of the lower forearm subcutaneous injection results in false negatives A waterproof ink mark is drawn around the injection site so as to avoid difficulty finding it later if the level of reaction is small The test is read 48 to 72 hours later The area of induration NOT of erythema is measured transversely across the forearm left to right, not up and down and recorded to the nearest millimetre

Heaf test

See:Heaf test

The Heaf test was first described in 1951 The test uses a Heaf gun with disposable single-use heads; each head has six needles arranged in a circle There are standard heads and pediatric heads: the standard head is used on all patients aged 2 years and older; the pediatric head is for infants under the age of 2 For the standard head, the needles protrude 2 mm when the gun is actuated; for the pediatric heads, the needles protrude 1 mm Skin is cleaned with alcohol, then tuberculin 100,000 units/ml is evenly smeared on the skin about 01 ml; the gun is then applied to the skin and fired The excess solution is then wiped off and a waterproof ink mark is drawn around the injection site The test is read 2 to 7 days later

  • Grade 0: no reaction, or induration of 3 or less puncture points;
  • Grade 1: induration of four or more puncture points;
  • Grade 2: induration of the six puncture points coalesce to form a circle;
  • Grade 3: induration of 5 mm; or more
  • Grade 4: induration of 10 mm or more, or ulceration

The results of both tests are roughly equivalent as follows:

  • Heaf grade 0 & 1 ~ Mantoux less than 5 mm;
  • Heaf grade 2 ~ Mantoux 5–14 mm;
  • Heaf grade 3 & 4 ~ Mantoux 15 or greater

Tuberculin conversion

Tuberculin conversion is said to occur if a patient who has previously had a negative tuberculin skin test develops a positive tuberculin skin test at a later test It indicates a change from negative to positive, and usually signifies a new infection

Boosting

The phenomenon of boosting is one way of obtaining a false positive test result Theoretically, a persons ability to develop a reaction to the TST may decrease over time – for example, a person is infected with latent TB as a child, and is administered a TST as an adult Because there has been such a long time since the immune responses to TB has been necessary, that person might give a negative test result If so, there is a fairly reasonable chance that the TST triggers a hypersensitivity in the person's immune system – in other words, the TST reminds the person's immune system about TB, and the body overreacts to what it perceives as a reinfection In this case, when that subject is given the test again as is standard procedure, see above they may have a significantly larger reaction to the test, giving a very strong positive; this can be commonly misdiagnosed as Tuberculin Conversion This can also be triggered by receiving the BCG vaccine, as opposed to a proper infection Although boosting can occur in any age group, the likelihood of the reaction increase with the person's age

Boosting is only likely to be relevant if an individual is beginning to undergo periodic TSTs Health care workers, for example In this case the standard procedure is called two-step testing The individual is given their first test and in the event of a negative, given a second test in 1 to 3 weeks This is done to combat boosting in situations where, had that person waited up to a year to get their next TST, they might still have a boosted reaction, and be misdiagnosed as a new infection

Here there is a difference in US and UK guidelines; in the US testers are told to ignore the possibility of false positive due to the BCG vaccine, as the BCG is seen as having waning efficacy over time Therefore, the CDC urges that individuals be treated based on risk stratification regardless of BCG vaccination history, and if an individual receives a negative and then a positive TST they will be assessed for full TB treatment beginning with X-ray to confirm TB is not active and proceeding from there Conversely, the UK guidelines acknowledge the potential effect of the BCG vaccination, as it is mandatory and therefore a prevalent concern – though the UK shares the procedure of administering two tests, one week apart, and accepting the second one as the accurate result, they also assume that a second positive is indicative of an old infection and therefore certainly LTBI or the BCG itself In the case of BCG vaccinations confusing the results, Interferon-γ IFN-γ tests may be used as they will not be affected by the BCG

Interpretation

According to the US guidelines, there are multiple size thresholds for declaring a positive result of latent tuberculosis from the Mantoux test: For testees from high risk groups, such as those who are HIV positive, the cutoff is 5 mm of induration; for medium risk groups, 10 mm; for low risk groups, 15 mm The US guidelines recommend that a history of previous BCG vaccination should be ignored For details of tuberculin skin test interpretation, please refer to the CDC guidelines reference given below

The UK guidelines are formulated according to the Heaf test: In patients who have had BCG previously, latent TB is diagnosed if the Heaf test is grade 3 or 4 and have no signs or symptoms of active TB; if the Heaf test is grade 0 or 1, then the test is repeated In patients who have not had BCG previously, latent TB is diagnosed if the Heaf test is grade 2, 3 or 4, and have no signs or symptoms of active TB Repeat Heaf testing is not done in patients who have had BCG because of the phenomenon of boosting For details of tuberculin skin test interpretation, please refer to the BTS guidelines references given below

Given that the US recommendation is that prior BCG vaccination be ignored in the interpretation of tuberculin skin tests, false positives with the Mantoux test are possible as a result of: 1 having previously had a BCG even many years ago, and/or 2 periodical testing with tuberculin skin tests Having regular TSTs boosts the immunological response in those people who have previously had BCG, so these people will falsely appear to be tuberculin conversions This may lead to treating more people than necessary, with the possible risk of those patients suffering adverse drug reactions However, as Bacille Calmette-Guérin vaccine is not 100% effective, and is less protective in adults than pediatric patients, not treating these patients could lead to a possible infection The current US policy seems to a reflect a desire to err on the side of safety

The US guidelines also allow for tuberculin skin testing in immunosuppressed patients those with HIV, or who are on immunosuppressive drugs, whereas the UK guidelines recommend that tuberculin skin tests should not be used for such patients because it is unreliable

Interferon-γ IFN-γ testing

The role of IFN-γ tests is undergoing constant review and various guidelines have been published with the option for revision as new data becomes availableCDC:MMWR Health Protection Agency:UK

There are currently two commercially available interferon-γ release assays IGRAs: QuantiFERON-TB Gold and T-SPOTTB These tests are not affected by prior BCG vaccination, and look for the body's response to specific TB antigens not present in other forms of mycobacteria and BCG ESAT-6 Whilst these tests are new they are now becoming available globally

CDC:

CDC recommends that QFT-G may be used in all circumstances in which the TST is currently used, including contact investigations, evaluation of recent immigrants, and sequential-testing surveillance programs for infection control eg, those for health-care workers

HPA Interim Guidance:

The HPA recommends the use of IGRA testing in health care workers, if available, in view of the importance of detecting latently infected staff who may go on to develop active disease and come into contact with immunocompromised patients and the logistical simplicity of IGRA testing

Drug-resistant strains

It is usually assumed by most medical practitioners in the early stages of a diagnosis that a case of latent tuberculosis is the normal or regular strain of tuberculosis It will therefore be most commonly treated with Isoniazid the most used treatment for latent tuberculosis Only if the tuberculosis bacteria does not respond to the treatment will the medical practitioner begin to consider more virulent strains, requiring significantly longer and more thorough treatment regimens

There are 4 types of tuberculosis recognized in the world today:

  • Tuberculosis TB
  • Multi-drug-resistant tuberculosis MDR TB
  • Extensively drug-resistant tuberculosis XDR TB
  • Totally drug-resistant tuberculosis TDR TB

Multi-drug-resistant TB

Multi-drug-resistant tuberculosis is a strain of tuberculosis that has developed an immunity to Isoniazid or Rifampin, the two most commonly used medications to combat TB MDR can be contracted either by exposure to someone with MDR; or it can be created when a patient does not take their medications correctly, takes one here and there, or takes it for a short time, or stops and starts Inside the body some bacteria die, but some may live through the lighter dosage of drugs and develop a resistance A regimen consisting of ethambutol and PAS has been used before It would appear sensible to choose a combination of antibiotics based on the known sensitivities of the organism The CDC have recommended a combination of pyrazinamide and ethambutol, with either pyrazinamide or fluoroquinolone Immunocompetent contacts should be treated for 6 months; immunocompromised contacts should be treated for 12 months

Extensively drug-resistant TB XDR TB

XDR TB is very similar to MDR, but is significantly more rare The difference is purely in the number of resistances the TB has had a chance or the luck to develop, and is transmitted either by exposure to someone with XDR TB or by incorrectly taking medications prescribed to combat MDR TB XDR TB bacteria have changed enough to circumvent the two best antibiotics, INH and RIF, as well as most of the alternative drugs used against MDR TB These second-line drugs include any fluoroquinolone, and at least one of the other three injectable anti-TB drugs: amikacin, kanamycin, or capreomycin To cure this tuberculosis requires two years of medication

"Drug-resistant TB MDR or XDR is more common in people who:

  • Do not take their TB medicine regularly
  • Do not take all of their TB medicines as prescribed by their doctor
  • Develop TB disease again, after having taken TB medicine in the past
  • Come from areas of the world where drug-resistant TB is common
  • Have spent time with someone known to have drug-resistant TB disease"

Totally drug-resistant TB TDR TB

Totally drug-resistant tuberculosis is the most rare strain, with only about few dozen reports worldwide TDR TB is theoretically completely untreatable, with no options for medications or chemotherapy available TDR TB has not been fully acknowledged to exist by the WHO; the contention is whether or not there are in a fact strains of TB that have developed a resistance to every drug we have, and furthermore whether a new designation is necessary Distinguishing TDR TB from XDR TB would require a series of in vitro drug susceptibility tests DST that would be both tremendously technically challenging and largely unnecessary; there are strains of XDR TB that are so resistant to so many second-line treatments already, that those strains are more or less untreatable already

Treatment

Main article: Tuberculosis treatment

The treatment of latent tuberculosis infection LTBI is essential to controlling and eliminating TB by reducing the risk that TB infection will progress to disease Latent tuberculosis will convert to active tuberculosis in 10% of cases or more in cases of immune compromised patients Taking medication for latent tuberculosis is recommended by many doctors

In the US, the standard treatment is nine months of isoniazid, but this regimen is not widely used outside of the US

Terminology

There is no agreement regarding terminology: the terms preventive therapy and chemoprophylaxis have been used for decades, and are preferred in the UK because it involves giving medication to people who have no disease and are currently well: the reason for giving medication is primarily to prevent people from becoming unwell In the US, physicians talk about latent tuberculosis treatment because the medication does not actually prevent infection: the person is already infected and the medication is intended to prevent existing silent infection from becoming active disease There are no convincing reasons to prefer one term over the other

Specific situations

Main article: tuberculosis treatment

"Populations at increased risk of progressing to active infection once exposed:

  • Persons with recent TB infection
  • Congenital or acquired immunosuppressed patients in particular, HIV-positive patients
  • Illicit intravenous drug users; alcohol and other chronic substance users
  • Children particularly those younger than 4 years old
  • Persons with comorbid conditions ie, chronic renal failure, diabetes, malignancy, hematologic cancers, body weight of at least 10% less than ideal, silicosis, gastrectomy, jejunoileal bypass, asthma, or other disorders requiring long-term use of corticosteroids or other immunosuppressants"

Treatment regimens

It is essential that assessment to rule out active TB be carried out before treatment for LTBI is started To give treatment for latent tuberculosis to someone with active tuberculosis is a serious error: the tuberculosis will not be adequately treated and there is a serious risk of developing drug-resistant strains of TB

There are several treatment regimens currently in use:

  • 9H — isoniazid for 9 months is the gold standard 93% effective, in patients with positive test results and fibrotic pulmonary lesions compatible with tuberculosis
  • 6H — Isoniazid for 6 months might be adopted by a local TB program based on cost-effectiveness and patient compliance This is the regimen currently recommended in the UK for routine use The US guidance excludes this regimen from use in children or persons with radiographic evidence of prior tuberculosis old fibrotic lesions 69% effective
  • 6 to 9H2 — An intermittent twice-weekly regimen for the above 2 treatment regimens is an alternative if administered under Directly observed therapy DOT
  • 4R — rifampicin for 4-months is an alternative for those who are unable to take isoniazid or who have had known exposure to isoniazid-resistant TB
  • 3HR — Isoniazid and rifampin may be given daily for three months
  • 2RZ — The two-month regimen of rifampin and pyrazinamide is no longer recommended for treatment of LTBI because of the greatly increased risk of drug-induced hepatitis and death
  • 3HP – three-month 12-dose regimen of weekly rifapentine and isoniazid The 3HP regimen has to be administered under DOT A self-administered therapy SAT of 3HP is investigated in a large international study

Evidence for treatment effectiveness

A 2000 Cochrane review containing 11 double-blinded, randomized control trials and 73,375 patients examined six and 12 month courses of isoniazid INH for treatment of latent tuberculosis HIV positive and patients currently or previously treated for tuberculosis were excluded The main result was a relative risk RR of 040 95% confidence interval CI 031 to 052 for development of active tuberculosis over two years or longer for patients treated with INH, with no significant difference between treatment courses of six or 12 months RR 044, 95% CI 027 to 073 for six months, and 038, 95% CI 028 to 050 for 12 months

A Cochrane systematic review published in 2013 evaluated four different alternatives regimens to INH monotherapy for preventing active TB in HIV-negative people with latent tuberculosis infection The evidence from this review found no difference between shorter regimens of Rifampicin or weekly, directly observed Rifapentine plus INH compare to INH monotherapy in preventing active TB in HIV-negative people at risk of developing it However the review found that the shorter Rifampicin regimen for four months and weekly directly observed Rifapentine plus INH for three months “may have additional advantages of higher treatment completion and improved safety" However the overall quality of evidence was low to moderate as per GRADE criteria and none of the included trials were conducted in LMIC nations with high TB transmission and hence might not be applicable to nations with high TB transmission

Treatment efficacy

Main article: tuberculosis treatment

There is no guaranteed "cure" for latent tuberculosis "People infected with TB bacteria have a lifetime risk of falling ill with TB" with those who have compromised immune systems, those with diabetes and those who use tobacco at greater risk Although many doctors and professionals may speak of Isoniazid and other TB treatment drugs as a "cure," in the strictest sense it is not This is because while the drugs applied to latent or active Tuberculosis are effective, they are not 100% so; every bacteria has a chance to be resistant to the drug in question When the appropriate treatment is applied to an active case of Tuberculosis and is deemed successful, the patient is "cured" in as much as the patients symptoms will subside – the Tuberculosis itself is not gone, but merely reverted to its latent state

A person who has taken the complete course of Isoniazid or other full course prescription for tuberculosis on a regular, timely schedule may have been cured "Current standard therapy is isoniazid INH which reduce the risk of active TB by as much as 90 per cent in patients with positive LTBI test results and fibrotic pulmonary lesions compatible with tuberculosis if taken daily for 9 months" However, if a person has not completed the medication exactly as prescribed, the "cure" is less likely, and the "cure" rate is directly proportional to following the prescribed treatment specifically as recommended Furthermore, "f you don't take the medicine correctly and you become sick with TB a second time, the TB may be harder to treat if it has become drug resistant" If a patient were to be cured in the strictest definition of the word, it would mean that every single bacterium in the system is removed or dead, and that person cannot get tuberculosis unless re-infected However, there is no test to assure that every single bacterium has been killed in a patient's system As such, a person diagnosed with latent TB can safely assume that, even after treatment, they will carry the bacteria – likely for the rest of their lives Furthermore, " It has been estimated that up to one-third of the world's population is infected with M tuberculosis, and this population is an important reservoir for disease reactivation" This means that in areas where TB is endemic treatment may be even less certain to "cure" TB, as reinfection could trigger activation of latent TB already present even in cases where treatment was followed completely

Once a positive skin test is shown, a patient's body will always react to the tuberculosis test even after treatment This happens because the patient's immune system has already recognized the tuberculosis bacteria as an invader It is unnecessary to get another skin test under any circumstances; a person who has contracted TB either in its latent or active form will always get a positive Blood tests, however, may be effective in determining if there has been any change in a persons diagnosis in cases where reinfection is a possibility, and should be considered if entering a high-risk area

Epidemiology

Tuberculosis exists in all countries in the world Some countries have a larger number of people infected with tuberculosis than others For each 100,000 people, Swaziland has the greatest number 627 of tuberculosis cases in the world Second is Cambodia 560, followed in third position by Zambia 445, fourth is Djibouti 382, fifth is Indonesia 321, sixth is Mali 295, seventh is Zimbabwe 291, eighth is Kenya 291, ninth is Papua New Guinea 283 and tenth is Gambia 283

The United States, Sweden and Iceland have one of the lowest populations of tuberculosis at 2 per 100,000 with Canada, Netherlands, Jamaica, Norway, Malta, Granada and Antigua and Barbuda with 3 per 100,000 In North America, countries over 10:100,000 are Mexico 14, Belize 18, Bahamas 19, Panama 28, El Salvador 36, Nicaragua 35, Honduras 46, Guatemala 48, and the worst is the Dominican Republic 88

Most Western European countries have less than 10 per 100,000 except Spain 14, Estonia 27, Latvia 43, Lithuania 48, while Eastern and Southern European countries have a greater number with Romania 94 being the highest

In South America, the greatest number of cases of tuberculosis are in Bolivia 30 with Guyana 18 and Honduras 15 following with the remaining countries having less than 10:100,000

"One-third of the world’s burden of tuberculosis TB, or about 49 million prevalent cases, is found in the World Health Organization WHO South-East Asia Region"

"About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not yet ill with disease and cannot transmit the disease," and most of those cases are in developing countries

"In the US, over half of all active TB cases occur in immigrants The reported cases of active TB in foreign-born persons has remained at 7000–8000 per year, while the number of cases in US-born people has dropped from 17,000 in 1993 to 6,500 in 2005 As a result, the percentage of active TB cases in immigrants has increased steadily from 29% of all cases in 1993 to 54% in 2005" and most of those cases are in developing countries

Further reading

  • Jasmer, R M; Nahid, P; Hopewell, P C 2002 "Latent tuberculosis infection" New England Journal of Medicine 347 23: 1860–1866 doi:101056/NEJMcp021045 PMID 12466511 
  • Mazurek, G H; Villarino, M E 2003 "Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection" Morbidity and Mortality Weekly Report 52 RR–2: 15–18 
  • Ormerod, P; Skinner, C; Moore-Gillon, J; Davies, P; Connolly, M 2000 "BTS Guidelines: control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000" Thorax Joint Tuberculosis Committee Of The British Thoracic Society 55 11: 887–901 doi:101136/thorax5511887 PMC 1745632  PMID 11050256 

See also

  • Silent disease

References

 This article incorporates public domain material from websites or documents of the Centers for Disease Control and Prevention

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  34. ^ Timothy R Sterling; M Elsa Villarino; Andrey S Borisov; Nong Shang; Fred Gordin; Erin Bliven-Sizemore; Judith Hackman; Carol Dukes Hamilton; Dick Menzies; Amy Kerrigan; Stephen E Weis; Marc Weiner; Diane Wing; Marcus B Conde; Lorna Bozeman; C Robert Horsburgh, Jr; Richard E Chaisson 2011 "Three months of rifapentine and isoniazid for latent tuberculosis infection" New England Journal of Medicine 365: 2155–2166 doi:101056/NEJMoa1104875 PMID 22150035 
  35. ^ Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection cdcgov updated November 22, 2013
  36. ^ Clinical trial number NCT01582711 for "Study 33: Adherence to Latent Tuberculosis Infection Treatment 3HP SAT Versus 3HP DOT iAdhere" at ClinicalTrialsgov
  37. ^ a b Menzies, Dick; Al Jahdali, Hamdan; Al Otaibi, Badriah 2011 "Recent developments in treatment of latent tuberculosis infection" The Indian Journal of Medical Research 133: 257–66 PMC 3103149  PMID 21441678 
  38. ^ a b Flynn, J L; Chan, J 2001 "Tuberculosis: Latency and Reactivation" Infection and Immunity 69 7: 4195–201 doi:101128/IAI6974195-42012001 PMC 98451  PMID 11401954 
  39. ^ Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial International Union Against Tuberculosis Committee on Prophylaxis Bull World Health Organ 1982;604:555-64
  40. ^ a b c d "Countries Compared by Health > Tuberculosis cases > Per 100,000 International Statistics at" Nationmastercom Retrieved 2015-10-05 
  41. ^ "Tuberculosis South America Cause Of Death" Worldlifeexpectancycom Retrieved 2015-10-05 
  42. ^ "WHO | Tuberculosis in the WHO South-East Asia Region" Whoint doi:101136/bmj387384732527C Retrieved 2015-10-05 

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