Latent tuberculosis infection: recent progress and challenges in South Korea

Abstract

Management of latent tuberculosis infection (LTBI) is a critical element in the elimination of tuberculosis (TB). However, the low positive predictive value of the current diagnostic tests and the low acceptance and completion rate of the isoniazid-based regimen are major barriers to the implementation and scale-up of programmatic management of LTBI. In the past decade, there has been some progress in the conception, diagnosis, and treatment of LTBI. LTBI is now understood as a dynamic spectrum rather than the traditional binary distinction between active and latent TB. New insight into LTBI has led to a renewed interest in incipient TB, which would be a potential target for developing new diagnostics and therapeutics of LTBI. Recent studies showed that host transcriptomic signatures could be a potential biomarker for incipient TB. The new shorter rifamycin-based regimens have shown comparable efficacy, but better completion rate and safety compared to the isoniazid-based regimen. In South Korea, LTBI management has been expanded and integrated into key elements of the National Tuberculosis Control Program. For the programmatic approach to LTBI management, the following challenges need to be addressed; target group selection, treatment-related interventions, monitoring and surveillance system, and extending the plan for vulnerable groups.

Experiencia piloto con esquema rifapentina-isoniazida semanal por 3 meses para tratamiento de la infección tuberculosa latente en el Programa Nacional de Tuberculosis de Chile

“…es probable que el riesgo de desarrollar una RaM a este régimen combinado esté relacionado con factores genéticos. estudios realizados en población oriental muestran altos porcentajes de RaM, especialmente síndrome flu-like en países como Taiwan y Corea 24,25 . en el caso de los latinos, el estudio de Sterling et al 23 del año 2015 mostró que los latinos tenían menos efectos adversos sistémicos que los blancos no hispanos, lo que podría explicar los bajos porcentajes de RaM de tipo sistémicos producidos en este ensayo.…”

Frequency and Factors of Indeterminate QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold PLUS Test Results in Rheumatic Diseases

“…Despite the decreasing burden of TB in South Korea, it is still a major concern owing to the higher rates of incidence and prevalence compared to those in Western countries. Furthermore, LTBI was reportedly found in over 30% of the general population according to a recent national TB statistics report [ 18 ]. In the present study, it was found that 20.6% of patients (84 out of 408 patients) had positive IGRA results.…”

Association of accumulated number of underweight with occurrence of tuberculosis

“…Therefore, programmatic management of LTBI is one of the key strategies of national TB control programs, and LTBI management focusing on this strategy has expanded every year. The most important strategy of LTBI management is prioritization of the target population, those who were at high risk of developing TB 22,23 . Based on the results of this study, it is expected that LTBI treatment could be considered in those who have maintained low BMI for several years.…”