Saudi guidelines for testing and treatment of latent tuberculosis infection

Jahdali, Hamdan H. Al; Baharoon, Salim; Abba, Abdullah A.; Memish, Ziad A.; Alrajhi, Abdulrahman A.; Albarrak, Ali; Haddad, Qais; Hajjaj, Mohammad Al; Menzies, Dick

doi:10.5144/0256-4947.59373

Cited by 4 publications

(5 citation statements)

References 75 publications

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“…Four deal specifically with renal transplantation [4,[152][153][154], two with SOT in general [4,30], including some specific information on liver and lung transplants, and one with HSCT [138]. In addition, there are four further statements relating to TB and transplantation: one on general testing and treatment of LTBI [156]; a conference update briefly covering cardiac transplantation [157]; a general statement [158]; and a review of the evidence for preventive chemotherapy/chemoprophylaxis [31].…”

Section: Published National Guidelinesmentioning

confidence: 99%

“…A chest radiograph is recommended, to be supplemented by a TST and/or an IGRA by all guidelines. The more recent guidelines [4,138,[154][155][156] include IGRA testing, with or without TST. All suggest screening pre-transplant, preventive therapy for LTBI with isoniazid plus pyridoxine (vitamin B6), monitoring of liver enzymes and full treatment for active TB.…”

Section: Points Of Agreementmentioning

confidence: 99%

See 1 more Smart Citation

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

228

261

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Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-c based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking. KEYWORDS: Guideline, management, Mycobacterium tuberculosis, transplantation, tuberculosis T uberculosis (TB) is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Only a minority of individuals who develop an adaptive immune response following infection with M. tuberculosis will ever develop TB, with the actual risk depending on the extent to which the host immune system provides a successful or inadequate response [1,2]. Therefore, individuals with impaired immune response, such as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are more prone to develop TB than immunocompetent persons. TB in transplant recipients is more frequent compared to the general population (estimates from the last decades state 20-74 times as frequent in SOT [3,4] and twice as frequent in HSCT [5]), and more often fatal (up to 31% in SOT [6] and up to 50% in HSCT recipients [7]), thus adding effectiveness to interventions for its prevention, even in the face of difficulties, with treatment related to adverse drug events and drug-drug interactions. Active TB in transplant recipients can result from latent infection with M. tuberculosis (LTBI) in the transplant candidate or in the donor tissue, or from de novo post-transplant infection. These various scenarios prompt for targeted pre-transplant screening of both recipient and, if possible, donors to allow focused management of recipients selected for preventive intervention in the pre-and/or posttransplant period. The term ''preventive chemotherapy'' is used to denote treatmen...

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Section: Published National Guidelinesmentioning

confidence: 99%

Section: Points Of Agreementmentioning

confidence: 99%

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

228

261

View full text Add to dashboard Cite

show abstract

“…Second, adalimumab was introduced to the study site at the same time as RMMs were introduced; hence, it was difficult to assess their effectiveness in promoting TB screening for this drug. Third, our study only considers CXR or a QuantiFERON test as a TB screening test but in most hospitals in Saudi Arabia, TST remains the primary screening test for TB [14] and the most widely used [15].…”

Section: Discussionmentioning

confidence: 99%

“…The outcome of interest was the proportion of patients that received TB screening, which was defined as the completion of a CXR or a QuantiFERON test within 1 month before the anti‐TNF‐α index date. The hospital adopt QuantiFERON test in place of TST because it is increasingly used to diagnose LBTI due to its high specificity in Bacillus Calmette‐Guérin (BCG)‐vaccinated individuals and in immunocompromised patients who may present false‐positive TST results [14].…”

Section: Methodsmentioning

confidence: 99%

Implementation of risk minimization measures to reduce the risk of tuberculosis among tumor necrosis factor medication users

Al‐Fadel,

Almutairi,

Aldhirgham

et al. 2023

Pharmacoepidemiology and Drug

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PurposeTo examine the adherence to risk minimization measures (RMMs) in newly treated patients with anti‐tumor necrosis factor‐alpha (anti‐TNF‐α) medications at one of the largest tertiary care hospitals in Saudi Arabia.MethodsWe included patients who had at least one prescription of infliximab or adalimumab. The index date was the first recorded date of infliximab or adalimumab prescription. New users of anti‐TNF‐α were divided into pre‐ and post‐RMM implementation groups. The outcome of interest was the proportion of patients that received tuberculosis (TB) screening, including a chest X‐ray (CXR) or a QuantiFERON test within 1 month prior to the index date.ResultsA pre‐post RMM implementation comparison of TB screening among infliximab users showed a significant increase in the rates of CXR tests (from 7.5% before RMM implementation to 13.8% after RMM implementation, p < 0.001) and the rates of QuantiFERON tests (4.5% before RMM implementation to 24.1% after RMM implementation, p < 0.001). RMMs were introduced to the study site at the same time as adalimumab was approved and the proportion of patients receiving TB screening was 25.2%.ConclusionTB screening prior to initiation of infliximab or adalimumab was not optimal. However, we noted an improvement in TB screening after the implementation of RMMs for infliximab. Future research may address reasons for low adherence to testing requirements for TB prior to initiation of anti‐TNF‐α medications.

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“…32,33 As a consequence, a 2-step approach (TST-IGRA) has been followed in many countries in terms of cost-effectiveness and diagnostic accuracy, but the TST cutoff value and target group population in the guidelines varies in different countries. 6,34,35 As a high TB burden country, it is also not feasible to screen tuberculosis infection using both methods simultaneously in China instantly. The latest expert consensus on LTBI screening and preventive treatment for children in China in 2020 supports using IGRA and TST for diagnosing LTBI, with IGRA given preference in economically developed areas.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Latent Tuberculosis Infection Among Healthy Young Children and Adolescents and a Two-step Approach for the Diagnosis of Tuberculosis Infection in Chengdu, China

Jia

Chen

Liu

et al. 2021

Pediatric Infectious Disease Journal

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Background: China has a high burden of tuberculosis and latent tuberculosis infection (LTBI). The aim of this study was to estimate the prevalence of LTBI among healthy young children and adolescents and test a 2-step approach to explore the threshold for the diagnosis of tuberculosis infection in Chengdu, China. Methods: Healthy preschool children and school-going children in Chengdu, Sichuan Province, were screened for LTBI using the tuberculin skin test (TST). Preschool children with TST ≥ 5 mm also underwent interferon-γ release assay (IGRA) to explore the threshold of this 2-step approach. Results: In total, 5667 healthy young children and adolescents completed TST test between July 2020 and January 2021 and were included in the present analysis. The age of the participants ranged from 2.4 to 18 years (median 7.25 ± 4.514 years), of which 2093 (36.9%) were younger than 5 years. The overall prevalence of LTBI was 6.37% and 6.64% in children younger than 5 years old. Fourteen of the 341 preschool children with TST ≥5 mm were interferon-γ release assay positive, of which 4 showed a TST result of 5–10 mm, and 6 preschool children received preventive treatment for LTBI. Conclusions: Healthy young children and adolescents should also be considered as important target populations for LTBI screening. TST can be recommended for first-line screening as part of a 2-step approach for LTBI screening using a positive threshold of 5 mm.

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Saudi guidelines for testing and treatment of latent tuberculosis infection

Cited by 4 publications

References 75 publications

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Implementation of risk minimization measures to reduce the risk of tuberculosis among tumor necrosis factor medication users

Prevalence of Latent Tuberculosis Infection Among Healthy Young Children and Adolescents and a Two-step Approach for the Diagnosis of Tuberculosis Infection in Chengdu, China

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