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. São Luis, State of Maranhão, Brazil, in 2013. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the identified cutoff points. (19) demonstrated that 70.3% of contacts were identified as positive using QuantiFERON-TB Gold In TUBE(r) while only 52.5% were detected by TST. Dans l’attente d’un test sanguin spécifique et sensible3, la détection de la tuberculose latente continue à se faire au moyen du test à la tuberculine. L'hépatite est moins fréquente avec la RIF qu'avec l'INH, mais les interactions pharmacologiques sont courantes. 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. It is hoped that this study to analyze the performance of the TST in the diagnosis of LTBI as the incorporation of IGRAs in clinical practice seem unfeasible due to its high cost. Kipfer et al(33), identified a correlation between proximity/exposure time and LTBI following the detection of pulmonary TB in a Swiss army training camp. The diagnosis of latent tuberculosis infection (LTBI), namely in healthcare workers, has been done by tuberculin skin test (TST). The full text of this article is available in PDF format. Silva PF, Moura GS, Caldas AJM. "HIV infection is the greatest known risk factor for the progression of latent M. tuberculosis infection to active TB. (24) Biometrics 1977; 33:363-374. LTBI detection is a well established TB control strategy recommended by the World Health Organization (WHO)(1); it enables infected individuals who are at greater risk of progression to active disease to commence with drug treatment. – Ask Dr. Weil", "Weekly rifapentine/isoniazid or daily rifampin/pyrazinamide for latent tuberculosis in household contacts", "Three months of rifapentine and isoniazid for latent tuberculosis infection", Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection, "Recent developments in treatment of latent tuberculosis infection", "Countries Compared by Health > Tuberculosis cases > Per 100,000. International Statistics at", "Tuberculosis South America Cause Of Death", "WHO | Tuberculosis in the WHO South-East Asia Region", "Shorter treatment found for latent tuberculosis", "Revisiting the timetable of tuberculosis", "Is Mycobacterium tuberculosis infection life long? Contacts with positive results were referred for consultation with a medical specialist at the referral hospital. There are no convincing reasons to prefer one term over the other. Interferon-γ release assays for active pulmonary tuberculosis diagnosis in adults in low- and middle-income countries: systematic review and meta-analysis. The study included all asymptomatic household contacts aged over 18 years of both sexes with no history of TB or prior treatment with isoniazid. Des tests particuliers existent pour les formes non pulmonaires de tuberculose. The results of this study indicate that the 5mm cutoff exhibited enhanced sensitivity, predictive values, and accuracy. PLos Med 2010; 5:1-10. Comstock GW. [The relevance of diagnostic criteria for latent tuberculosis before initiation of TNF-alpha inhibitors in psoriasis patients.]. There are 4 types of tuberculosis recognized in the world today: 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. [ Links ], 20. Adetifa IM, Ota MO, Walther B, Hammond AS, Lugos MD, Jeffries DJ et al. [ Links ], 14. Only by required testing (required in some jobs) [5] or developing symptoms of active tuberculosis and visiting a medical doctor who does testing will a person know they have been exposed. Because of the limitations of TST, interferon-gamma release assays (IGRAs), which measure the production of interferon-gamma (IFN-γ) in response to stimulation by specific MTB antigens (ESAT-6, CFP-10, and TB7.7), have been developed. [ Links ], 23. European Centre for Disease Prevention and Control (ECDC). The cutoff points for TST were determined using a Receiver Operating Characteristic (ROC) curve (Figure 2). Dans l’attente d’un test sanguin spécifique et sensible3, la détection de la tuberculose latente continue à se faire au moyen du test à la tuberculine. Lienhardt C, Fielding K, Hane AA, Niang A, Ndao CT, Karam F, et al. Ce test cutané, vieux de cent ans et peu précis, consiste à mesurer l’induration Latent tuberculosis infection (LTBI) is defined as the period between infection with Mycobacterium tuberculosis (MBT) and the onset of tuberculosis (TB) disease. In people who develop active TB of the lungs, also called pulmonary TB, the TB skin test will often be positive. [ Links ], 4. A person with symptoms listed may have active tuberculosis, and the person should immediately see a physician so that tuberculosis is not spread. Montréal – Le traitement de la tuberculose latente devrait se transformer après que deux études de l’Institut de recherche du Centre universitaire de santé McGill(IR‑CUSM) eurent révélé que, comparativement au traitement standard, un traitement administré sur une période plus courte était plus sécuritaire et plus efficace, et ce, tant chez les enfants que chez les adultes. Intérêt du diagnostic sérologique pour le diagnostic de tuberculose infection chez les sujets immunodéprimés* * Piana F. et al. Préambule : l’infeCtion tuBerCuleuse latente, un nouvel enjeu dans le Contrôle de la tuBerCulose selon l’oMs, l’incidence de la tuberculose (tBC) devrait diminuer de 90% entre 2015 et 2035 pour If a person has symptoms of tuberculosis, it is wise to be tested. [36], The United States, Sweden and Iceland have one of the lowest populations of tuberculosis at 2 per 100,000. The limitation of this study is that TST was not repeated eight weeks later in contacts that had an induration ≤5mm; initially negative contacts could present an increase of 10mm compared to their first results, which could explain the positive results obtained using QuantiFERON-TB Gold In TUBE(r) (IGRA) and the negative TST results. Diretrizes Clínicas na Saúde Suplementar. The Kappa test was interpreted according to Landis and Koch(18): < 0.40, weak agreement; 0.40 to 0.75, moderate agreement; > 0.75, good agreement. A blood sample of each contact was taken for interferon-gamma release assay (IGRA) and subsequently performed the TST. This is the regimen currently recommended in the UK for routine use. 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. However, although TST has been extensively studied, there is still some discrepancy between the optimal TST cutoff point for LTBI diagnosis and subsequent isoniazid treatment recommended by the Ministry of Health (≥ 5mm)(11) and the professional practice (≥ 10mm). 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. Estimated incidence, prevalence, and mortality by country. The objective of this study was compare the performance of tuberculin skin testing (TST) with QuantiFERON-TB Gold In TUBE(r) in the diagnosis of LTBI in contacts of patients with active TB. 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. Contact with patients with active pulmonary TB increases the risk of infection, especially when the diagnosis is delayed. Golub JE, Bur S, Cronin WA, Gange S, Baruch N, Comstock GW et al. During consultation with the specialist doctor (pulmonologist), the index cases were instructed on the importance of evaluating their household contacts and meetings were scheduled with these contacts. Participantes: Conde MB, Mello F, Lima MA, Guerra RL, Miranda SS, Galvão TS, Pinheiro VG, Laurindo IM, Carvalho NB. [ Links ], 34. HIV positive and patients currently or previously treated for tuberculosis were excluded. The tuberculin test was positive in 92% and in most cases the values were above 10mm (68.0%). Le diagnostic de la tuberculose latente s’est renforcé par les tests in vitro de libération de l’interféron gamma, palliant ainsi le manque de spécificité de l’intradermoréaction à la tuberculine. Cross-sectional analytical study with 60 contacts of patients with active pulmonary TB. Although there is no gold standard detection method for LTBI, QuantiFERON-TB Gold In TUBE(r) was used in this study to elucidate the operational characteristics of IGRA and TST. TST: tuberculin skin testing; PPV: positive predictive value; NPV: negative predictive value. Les symptômes sont respiratoires … 2010. hal-01731883 Approximately 30% of those who come in contact with pulmonary TB patients are infected; of these, 5% develop active TB within two years and another 5% develop the disease 2 years post infection(6) 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. 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. "[2] "Depending on ventilation and other factors, these tiny droplets [from the person who has active tuberculosis] can remain suspended in the air for several hours. Tuberculose latente em profissionais de saúde: Outros títulos: Latent tuberculosis (LTB) in healthcare workersAgreement between two diagnostic tests: Autor: Shapovalova, Olena Sacadura-Leite, Ema Mendonça Galaio, Luís Pereira, Isabel Rocha, Regina Uva, António de Sousa: Palavras-chave: Healthcare workers Interferon-λ release assays 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. August 03, 2015; Accepted: ILTB is diagnosed when the individual has a positive tuberculin test (TT) associated with exclusion of active disease. World Health Organization (WHO). 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. If a person had latent tuberculosis, they do not have active/contagious tuberculosis. Flowchart of study design. [ Links ], 25. La source antigénique utilisée est la tuberculine. Tuberk Toraks 2011; 59:43-47. In total, the study sample consisted of 60 household contacts. Objetivo:: Descrever as características de pacientes com diagnóstico de tuberculose e de infecção latente por tuberculose. Active tuberculosis can be contagious while latent tuberculosis is not, and it is therefore not possible to get TB from someone with latent tuberculosis. [ Links ], 3. Revue des Maladies Respiratoires - Vol. 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 available.CDC:MMWR Health Protection Agency:UK. The current US policy seems to reflect a desire to err on the side of safety. [ Links ], 6. Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N et al. Individuals who remain infected exhibit positive tuberculin skin testing (TST) but are asymptomatic. All contacts who agreed to participate in the study signed an Informed Consent form and subsequently underwent a chest X-ray and a rapid HIV test (Rapid Check(r) HIV 1/2). In this case, when that subject is given the test again (as is standard procedure, see above) they may have a significantly greater reaction to the test, giving a very strong positive; this can be commonly misdiagnosed as Tuberculin Conversion. [ Links ], 30. [8]. [ Links ], 29. Secretaria de Vigilância Epidemiológica. MMWR Recomm Rep 2005; 54:49-55. Should another person inhale them, he or she may become infected with TB. L’IDR est le seul test validé qui met en évidence l’existence d’une immunité à médiation cellulaire à l’égard de M. tuberculosis. The results of both tests are roughly equivalent as follows: 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. In addition, TST appears to be the most viable option in low-and middle-income countries because of its low cost(22) All patients with active pulmonary TB and positive sputum smear microscopy were considered as index cases(11). However, IGRAs has a specificity > 95% in the diagnosis of LTBI(22) The test is read 48 to 72 hours later. Le diagnostic de la tuberculose pulmonaire est réalisé à l’aide de tests qui recherchent la présence du bacille tuberculeux dans les crachats. Some countries have a larger number of people infected with tuberculosis than others. Swiss Med Wkly 2008; 138:267-272. In addition, they will show all the signs and symptoms of TB disease, and can pass the bacteria to others. Ann Dermatol Venereol 2010; 137: 437 – 443. Recently, Interferon‐¿ Release Assays (IGRA tests) have been introduced. )(11) and abandonment (9.1%)(34). There have been two primary methods of TST: the Mantoux test, and the Heaf test. The study was evaluated and approved by the Ethics Committee in Research of the University Hospital of the Federal University of Maranhão (CEP/UFMA) under embodied opinion n. 240/11, in accordance with Resolutions 196/96 and 466/12. Theoretically, a person's 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. Rangaka MX, Wilkinson KA, Glynn JR, Ling D, Menzies D, Mwansa-Kambafwile J et al. 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). Subsequently, changes in procedure were introduced such as the institution of booster doses in 1994, a practice that was then banned in 2006. (10). Eur Respir J 2011; 37:100-111. Sociedade Brasileira de Infectologia. (13) The U.S. guidance excludes this regimen from use in children or persons with radiographic evidence of prior tuberculosis (old fibrotic lesions) (69% effective). "[38], "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,"[8] and most of those cases are in developing countries. The need To address lTBi belgium is classified as a low-incidence country according to the definition of the Who (8) because the annual incidence of tb is less than 10 per 100,000 inhabitants. Repeat Heaf testing is not done in patients who have had BCG (because of the phenomenon of boosting). Cad Saude Publica 2014; 30:1745-1754. Pai M, Menzies D. Interferon-gama release assays for diagnosis of latente tuberculosis infection: Systematic review. Le diagnostic ainsi que la prophylaxie restent insuffisamment pratiqués, notamment chez les personnes à risque accru de réactivation tuberculeuse à la faveur d’une immunosuppression. Bull World Health Organ. Ferreira CMP. Phone: 55 98 98125-0200 e-mail: tatafurtadof@hotmail.com, The authors declare that there is no conflict of interest, This is an open-access article distributed under the terms of the Creative Commons Attribution License. There are two classes of tests commonly used to identify patients with latent tuberculosis: tuberculin skin tests and IFN-γ (Interferon-gamma) tests. Diagnostic de tuberculose latente chez des patients atteints de rhumatisme inflam-matoire chronique candidats à une biothérapie: facteurs infuençant le résultat d’un test de libération d’interféron gamma (T-SPOT.TB®). 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. The agreement between the QuantiFERON-TB Gold In TUBE(r) and TST results was evaluated using the Kappa coefficient. [33], 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. 4Departamento de Enfermagem, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil. PLoS One 2010; 5:e12502. International Union Against Tuberculosis Committee on Prophylaxis. Stockholm: ECDC; 2011. O objetivo deste estudo foi avaliar os casos de ILTB atendidos num centro de referência do município de Londrina-PR. The U.S. guidelines recommend that a history of previous BCG vaccination should be ignored. Publisher: Même si la tuberculose latente et la tuberculose sont souvent considérées comme des maladies étrangères, le dispensateur canadien de soins des enfants les observera souvent dans bien des situations cliniques. [37], "One-third of the world’s burden of tuberculosis (TB), or about 4.9 million prevalent cases, is found in the World Health Organization (WHO) South-East Asia Region. Table 1 details the sensitivity, specificity PPV, NPV, and accuracy for the different TST cutoff points. (Master's Dissertation). For the standard head, the needles protrude 2 mm when the gun is actuated; for the pediatric heads, the needles protrude 1 mm. "Populations at increased risk of progressing to active infection once exposed: It is essential that assessment to rule out active TB be carried out before treatment for LTBI is started. The prevalence of LTBI determined using QuantiFERON-TB Gold In TUBE(r) was calculated as the number of participants with positive results, divided by the total number of participants, multiplied by one hundred [(number of positive participants/total number of participants) x 100]. Latent tuberculosis infection (LTBI) is defined as the period between infection with Mycobacterium tuberculosis (MBT) and the onset of tuberculosis (TB) disease. São Luis, State of Maranhão, Brazil, in 2013. Associação Médica Brasileira e Agência Nacional de Saúde Suplementar; 2014. A significance level of 5% was adopted. The TST reading was performed 48 hours post application using a specific millimeter ruler and measuring the largest transverse diameter of induration perpendicular to the forearm; the results were recorded in millimeters, even in the absence of induration(11). Latent tuberculosis will convert to active tuberculosis in 10% of cases (or more in cases of immune compromised patients). Next, TST was conducted using the antigen and technique recommended by the Ministry of Health of Brazil(11). Furthermore, "[I]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. Contacts with a result ≥ 5mm were considered as LTBI carriers by TST. Pai M, Menzies D. Diagnosis of latente tuberculosis infection (tuberculosis screening) in HIV-negative adults: Systematic review. [ Links ], 22. [ Links ], 12. "[8] and most of those cases are in developing countries. [18] The test uses a Heaf gun with disposable single-use heads; each head has six needles arranged in a circle. [ Links ], 16. [ Links ], 8. Contacts with an abnormal chest X-ray and/or positive rapid HIV test were excluded from the study. Kipfer B, Reichmuth M, Büchler M, Meisels C, Bodmer T. Tuberculosis in a Swiss army training camp: contact investigation using an Interferon gamma release assay. Landis JR, Koch GG. Previous studies have shown that the sensitivity of QuantiFERON-TB Gold In TUBE(r) and TST is approximately 80%(26). This finding corroborates with the results of previous studies; Gazzetta et al(32) demonstrated that 69.3% of contacts had a very close degree of kinship to the index case (father, mother, children, siblings, and partner) and that because of their proximity to the focus they were at high risk of becoming infected. Le traitement de la tuberculose latente (qui n'est pas abordé dans cette revue) est aussi efficace lors de co-infections pour prévenir la progression de la tuberculose latente en tuberculose active. (5). False-negative TST results can be explained by exposure time; a period of 6-8 weeks post exposure to MBT is necessary for LTBI screening. Examen direct d’un prélèvement respiratoire : mise en évidence de bacilles acido-alcoolo résistants (BAAR), un examen direct négatif n’élimine pas le diagnostic 9. Studies comparing the two tests (IGRAs and TST) have demonstrated that IGRAs exhibit higher specificity and limited sensitivity, but cannot distinguish between active TB and LTBI, especially in populations subject to BCG vaccination, and therefore are more recommended for the diagnosis of LTBI(12) "[34] 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. [6] Persons with HIV and latent tuberculosis have a 10% chance of developing active tuberculosis every year. (31). Environ 2 milliards de personnes sont infectées de la tuberculose et cette affection tue presque 3 millions de personnes, chaque année, dans le monde. WHO Report; 2008. Time interval to conversion of interferon-gamma release assay after exposure to tuberculosis. ROC curve for determination of TST cut-off point (in millimeters). Up to two contacts were selected per index case to avoid selection bias. Fatores associados ao abandono do tratamento da tuberculose pulmonar no Maranhão, Brasil, no período de 2001 a 2010. The specificity of TST is affected by previous BCG vaccination; specificity ​​values reach 97% in unvaccinated populations, while in populations extensively vaccinated with BCG, it is approximately 60%(22). PPV denotes the probability of a true infection; the higher the risk of exposure, as in cases of close contact with patients with active TB, the greater the PPV(29). An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Background. The agreement between the TST and QuantiFERON-TB Gold In TUBE(r) results was 76.7% (Kappa coefficient = 0.5270; p value ≤ 0.001; Table 2)(18). (Accessed 2015 March 12). [ Links ], 15. Tuberculose infecção latente: diagnóstico (Elaboração Final: 31 de janeiro de 2011). Le patient traité pour une tuberculose latente doit avoir reçu pour consigne d'arrêter son traitement s'il présente tout nouveau symptôme, en particulier une fatigue inexpliquée, une perte d'appétit ou des nausées. [citation needed], Persons with diabetes may have an 18% chance of converting to active tuberculosis. Le diagnostic de l’infection tuberculeuse latente a aussi gagné en sensibilité, spécificité, et valeur prédictive positive, grâce aux tests au γ-interféron, qui tendent à remplacer – sauf pour les jeunes enfants – le test tuberculinique. "People infected with TB bacteria have a lifetime risk of falling ill with TB..." [8] with those who have compromised immune systems, those with diabetes and those who use tobacco at greater risk.[8]. Sester M, Sotgiu G, Lange C, Giehl C, Girardi E, Migliori GB et al. 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. For the airport, see, {{For example, if you work in the Retirement Home industry in Ontario, Canada you are required by law to have a TB test to confirm that you do not have active TB cite - Ontario Regulation 166/11 s. 27 (8) (b). Most infections show no symptoms, in which case it is known as latent tuberculosis. BCG: Bacillus Calmette-Guérin; TST: tuberculin skin testing. Analysis of discordance between the tuberculin skin test and the interferon-gamma release assay. 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 (e.g., those for health-care workers). Estes contactos próximos normalmente deben recibir tratamento para tuberculose latente mesmo cando nin os test de tuberculina ou os raios X do tórax suxiran tuberculose.