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latent tuberculosis; inactive tuberculosis

Epidemiology: - latent tuberculosis is not transmissible [10] Diagnostic criteria: 1) a positive tuberculin skin test or IFN-gamma release assay without evidence of active tuberculosis infection [3] 2) persons with a history of untreated TB or radiographic evidence of previous TB Laboratory: - tuberculin skin test or IFN-gamma release assay* - screening for HIV1 (all patients with latent tuberculosis) * preferred test for latent tuberculosis [3] * see screening for tuberculosis Radiography: - chest X-ray is normal [3] Management: - isoniazid + rifapentine weekly for 3 months (12 weeks) [7] - isoniazid: 15 mg/kg once weekly; max 900 mg - rifapentine - 10-14 kg: 300 mg weekly - 14-25 kg: 450 mg weekly - 25-32 kg: 600 mg weekly - 32-50 kg: 750 mg weekly - > 50 kg: 900 mg weekly - isoniazid + rifampin daily for 3 months (12 weeks) [7] - rifampin for 4 months duration (HIV negative) [3,7] - 10 mg/kg QD; max 600 mg - rifampin is a better option than isoniazid [6] - Alternative regimens [7] - INH daily for 6 months - INH daily for 9 months - self-administered weekly treatment for latent tuberculosis acceptable strategy in the U.S. [4] - patients should be treated for latent tuberculosis before treatment with a biologic agent (TNF-alpha inhibitor) - patient on TNF-alpha inhibitor found to have latent tuberculosis, should be treated* * apparently not necessary to stop TNF-alpha inhibitor * treat as latent tuberculosis [3]

Related

screening for tuberculosis

General

tuberculosis

References

  1. Horsburgh CR and Rubin EJ. Clinical practice. Latent tuberculosis infection in the United States. N Engl J Med 2011 Apr 15; 364:1441. PMID: 21488766
  2. Getahun H, Matteelli A, Abubakar I et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J 2015 Sep 24 PMID: 26405286
  3. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. Belknap R, Holland D, Feng PJ et al Self-administered Versus Directly Observed Once-Weekly Isoniazid and Rifapentine Treatment of Latent Tuberculosis Infection: A Randomized Trial. Ann Intern Med. 2017. Nov 7. PMID: 29114781 http://annals.org/aim/article-abstract/2661483/self-administered-versus-directly-observed-once-weekly-isoniazid-rifapentine-treatment - Getahun H, Matteelli A. Tailoring Treatment of Latent Tuberculosis to the Needs of Patients and Families. Ann Intern Med. 2017. Nov 7 PMID: 29114744 http://annals.org/aim/article-abstract/2661484/tailoring-treatment-latent-tuberculosis-needs-patients-families - Getahun H et al. Latent Mycobacterium tuberculosis infection. N Engl J Med 2015 May 28; 372:2127 PMID: 26017823 https://www.nejm.org/doi/full/10.1056/NEJMra1405427
  5. Borisov AS, Bamrah Morris S, Njie GJ, et al. Update of Recommendations for Use of Once-Weekly Isoniazid- Rifapentine Regimen to Treat Latent Mycobacterium tuberculosis Infection. MMWR Morb Mortal Wkly Rep 2018;67:723-726 https://www.cdc.gov/mmwr/volumes/67/wr/mm6725a5.htm
  6. Menzies D, Adjobimey M, Ruslami R et al. Four months of rifampin or nine months of isoniazid for latent tuberculosis in adults. N Engl J Med 2018 Aug 2; 379:440. PMID: 30067931PMID: 30067931 https://www.nejm.org/doi/10.1056/NEJMoa1714283 - Diallo T, Adjobimey M, Ruslami R et al. Safety and side effects of rifampin versus isoniazid in children. N Engl J Med 2018 Aug 2; 379:454 PMID: 30067928 https://www.nejm.org/doi/10.1056/NEJMoa1714284
  7. Sterling TR, Njie G, Zenner D, et al. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep 2020;69(No. RR-1):1. https://www.cdc.gov/mmwr/volumes/69/rr/rr6901a1.htm
  8. Kim S, Thal R, Szkwarko D. Management of Latent Tuberculosis Infection. JAMA. 2023;329(5):421-422 PMID: 36656598 https://jamanetwork.com/journals/jama/fullarticle/2800774
  9. Shah M, Dorman SE. Latent Tuberculosis Infection. N Engl J Med. 2021 Dec 9;385(24):2271-2280. PMID: 34879450 Review. https://www.nejm.org/doi/10.1056/NEJMcp2108501
  10. Minnesota Department of Health Tuberculosis (TB) Prevention and Control Program P.O. Box 64975, St. Paul, MN 55164-0975 651-201-5414 Treatment for Latent Tuberculosis (TB) Infection: Levofloxacin. https://www.health.state.mn.us/diseases/tb/basics/factsheets/levoltbi.pdf