Latent tuberculosis: current diagnosis and treatmentLatent tuberculosis infection (LT) affects 23% of the population and constitutes a reservoir of tuberculosis (TB) as 10% progresses to TB. LT is recognized by tests such as tuberculin (PPD or TST) and Interferon gamma release assays (IGRAs). The sensitivity of IGRAs (Quantiferon TB Gold plus version) is 94% and PPD 77%. The specificity of Quantiferon TB Gold Plus is 97% and PPD 68%. The predictive value of progression to active TB of these tests is low (PPD: 1.5%, IGRAs: 2.7%) but improves in people at high risk of contracting TB (PPD: 2.4%, IGRAs: 6.8%). People with negative tests who subsequently turn around (positive) have a higher risk of progression to active TB. These tests are useful in the follow-up of intra-household contacts, foreigners from countries with high rates of TB, immunosuppressed, chronic kidney disease, diabetes, silicosis and pulmonary sequelae of untreated TB. In LT therapy, self-administered isoniazid (H) is used for periods from 6 to 12 months with protective efficacy of 60% and risk of liver toxicity of 2%, but with low adherence (50-70%). The association of H with rifapentine in a single weekly dose for 12 weeks has efficacy of 81%, adherence of 82% and low liver toxicity (0.4%). New LT biomarkers and vaccines that improve immunity in LT are under study. Treatment of LT may reduce the incidence of TB in the long term.
Advances in the treatment of multi-drug resistant tuberculosis Therapy of multi-drug resistant tuberculosis (MDR TB) is based on trials with drugs with highly variable patterns of resistance and non-standardized follow-ups that make it difficult to provide recom- Resumen El tratamiento de las tuberculosis multidrogorresistentes (TBC-MDR) se basa en esquemas de fár-macos con diseños muy variables, en pacientes con patrones de resistencia heterogéneos y seguimientosIntroducción la tBC-MDr (resistente a isoniacida y rifampicina) y la tBC-XDr (resistente además a fluoroquinolonas y drogas inyectables de segunda línea) son consideradas actualmente un grave problema de salud pública a nivel mundial. las tBC multirresistentes son una señal de mal manejo de los programas de control de la tuberculosis, con fallas en la supervisión del tratamiento inicial de los enfermos. la prevención del desarrollo de resistencia bacteriana, por malos tratamientos, es esencial para evitar el desarrollo de resistencia bacteriana. Se predice que habrá un dramático aumento en estas distintas formas de tBC multirresistente en las próximas déca-das en todo el mundo y que los casos derivarán cada vez con más frecuencia de transmisiones persona a persona que de enfermos mal tratados. las terapias tradicionales de las tBC multirresistentes son caras, tóxicas y muy prolongadas, lo que atenta contra su eficacia y la adherencia a los tratamientos. El esquema convencional de la organización Mundial de la salud (oMs), de
Pilot experience with weekly rifapentine-isoniazid treatment for 3 months for latent tuberculosis infection at the Tuberculosis National Program of ChileIntroduction: Prevention of active tuberculosis in risk groups is crucial in tuberculosis control and elimination. Treatment of latent tuberculosis (TITL) with rifapentine and isoniazid in weekly doses for 12 weeks is shorter than other pharmacological treatments, with less liver toxicity, better patient compliance and it is cost-effective. The objective of this study is to evaluate the feasibility to implement this treatment at a programmatic level in Chile. Methods: A pilot intervention was conducted in selected territories between May 2018 and March 2019. Within these territories, the regulated treatment with isoniazid 6 months was replaced by the 12 weeks treatment with weekly rifapentine-isoniazide. Additionally, the target population was expanded to include contacts over 14 years old, currently not included in the national guidelines. Treatment consisted in oral administration of rifapentine and isoniazide together once a week for 12 weeks, under supervision of trained health workers. Results: From 238 patients entered to the protocol, 53% of them were women and 54.2% were older than 14 years-old. Out of the total number of patients, 203 (85.3%) completed treatment, 22 (9.2%) abandoned, 8 (3.4%) had adverse drug reactions, and 5 ended treatment for different causes. Conclusion: Both TITL with rifapentine-isoniazide in 12 supervised weekly doses, and the inclusion of adult contacts in TITL, are feasible to implement at a programmatic level in Chile.
Bacteriological diagnosis of lung tuberculosis through bronchoscopy in HIV-infected patients Tuberculosis can be lethal in HIV infected people. Lung is the organ most frequently involved, but clinical and radiological features are not typical of the disease. Diagnostic certification demands acid-fast bacillus microscopy and mycobacterial cultures on sputum. Some patients need bronchoscopy to obtain samples due to insufficient sputum. We reported a 9.1% diagnostic yield using bronchoscopy. Clinical suspicion before bronchoscopy had low positive predictive value of tuberculosis (10.8%). 47.8% of tuberculosis cases were not suspected before this procedure. Tuberculosis patients showed CD4 ≤ 200 cells/mL (48.8 in average) and less use of ART (antiretroviral therapy). Cultures contributed to the diagnosis of 35% of tuberculosis cases but with a delay of 30 days. Induced sputum is a less costly alternative to bronchoscopy with a similar diagnostic yield.
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