Screening and Treatment of Latent Tuberculosis: A Systematic Review of Current Evidence
Keywords:Latent tuberculosis, Screening, Treatment, TST, IGRA
Introduction: Latent tuberculosis is an infection by the bacteria Mycobacterium tuberculosis where the individual affected does not have active infection or symptoms of tuberculosis infection. Individuals with latent tuberculosis infection (LTBI) remain asymptomatic and non-infectious until the bacteria become reactivated. The purpose of screening and treating LTBI is to prevent reactivation and active disease. The aim of this review is to examine the current screening criteria for LTBI, their validity, and specificity for diagnosis by looking at the currently accepted treatment options and the evidence that supports their efficacy.
Methods: Articles for review were sourced from the academic databases EMBASE and PubMed. Results were screened using PICOS criteria looking at a population of latent TB infected patients screened using a variety of screening tools.
Results: Initial database searches identified 476 articles. 19 articles fit the eligibility criteria and were included for analysis. Current screening procedures include the tuberculin skin test (TST), T-SPOT.TB, and QuantiFERON-TB (QFTGIT) tests. Evidence showed that the T-SPOT.TB was the most cost-effective test to perform although its accuracy is not as reliable as the IGRA. Treatment plans for those with LTBI are diverse and can be beneficial in a variety of settings. The most effective treatments include isoniazid for 6 or 9 months, rifampicin for 3 to 4 months and isoniazid and rifampicin for 3 to 4 months.
Conclusion: Overall, IGRAs are the most reliable screening tests but are advised to be used in conjunction with TSTs as the TST alone has been determined to be less accurate. There are different treatment regimens, all of similar efficacy. Longer regimes were as effective than those of a shorter duration, but shorter regimes showed higher completion rates.
2. Carvalho I, Goletti D, Manga S, Silva DR, Manissero D, Migliori G.Managing latent tuberculosis infection and tuberculosis in children.Pulmonology. 2018;24:106-114.
3. NIH. https://www.nhlbi.nih.gov/health-topics/study-quality-assessmenttools.2021.
4. Evidence, O., 2020. OCEBM Levels of Evidence — Centre For Evidence-Based Medicine (CEBM), University Of Oxford. [online] Cebm.ox.ac.uk.Available at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence.
5. Gualano G, Mencarini P, Lauria FN, et al. Tuberculin skin test - Outdatedor still useful for Latent TB infection screening? Int J Infect Dis.2019;80S:S20-S22.
6. Seddon JA, Paton J, Nademi Z, et al. The impact of BCG vaccination ontuberculin skin test responses in children is age dependent: evidenceto be considered when screening children for tuberculosis infection.Thorax. 2016;71:932-939.
7. Kahwati LC, Feltner C, Halpern M, et al. Primary Care Screening andTreatment for Latent Tuberculosis Infection in Adults: Evidence Reportand Systematic Review for the US Preventive Services Task Force. JAMA.2016;316:970-983.
8. Getahun H, Matteelli A, Abubakar I, et al. Management of latentMycobacterium tuberculosis infection: WHO guidelines for lowtuberculosis burden countries. Eur Respir J. 2015;46:1563-1576.
9. Menzies D, Pai M, Comstock G. Meta-analysis: new tests for thediagnosis of latent tuberculosis infection: areas of uncertainty andrecommendations for research. Ann Intern Med. 2007;146:340-354.
10. Pai M, Denkinger CM, Kik SV, et al. Gamma interferon release assays fordetection of Mycobacterium tuberculosis infection. Clin Microbiol Rev.2014;27:3-20.
11. Kleinert S, Tony HP, Krueger K, et al. Screening for latent tuberculosisinfection: performance of tuberculin skin test and interferon-γ releaseassays under real-life conditions. Ann Rheum Dis. 2012;71:1791-1795.
12. Du F, Xie L, Zhang Y, et al. Prospective Comparison of QFT-GIT andT-SPOT.TB Assays for Diagnosis of Active Tuberculosis. Sci Rep.2018;8:5882.
13. Sargın G, Şentürk T, Ceylan E, Telli M, .ildağ S, Doğan H. TST,QuantiFERON-TB Gold test and T-SPOT.TB test for detecting latenttuberculosis infection in patients with rheumatic disease prior to anti-TNF therapy. Tuberk Toraks. 2018;66:136-143.
14. Pease C, Hutton B, Yazdi F, et al. A systematic review of adverse eventsof rifapentine and isoniazid compared to other treatments for latenttuberculosis infection. Pharmacoepidemiol Drug Saf. 2018;27:557-566.
15. Njie GJ, Morris SB, Woodruff RY, Moro RN, Vernon AA, Borisov AS.Isoniazid-Rifapentine for Latent Tuberculosis Infection: A SystematicReview and Meta-analysis. Am J Prev Med. 2018;55:244-252.
16. Stagg HR, Zenner D, Harris RJ, Mu.oz L, Lipman MC, Abubakar I.Treatment of latent tuberculosis infection: a network meta-analysis. AnnIntern Med. 2014;161:419-428.
17. Sterling TR, Njie G, Zenner D, et al. Guidelines for the Treatment ofLatent Tuberculosis Infection: Recommendations from the NationalTuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep.2020;69:1-11.
18. Lobue P, Menzies D. Treatment of latent tuberculosis infection: Anupdate. Respirology. 2010;15:603-622.
19. Harding E. WHO global progress report on tuberculosis elimination.Lancet Respir Med. 2020;8:19.
20. Rao M, Ippolito G, Mfinanga S, et al. Latent TB Infection (LTBI) -Mycobacterium tuberculosis pathogenesis and the dynamics of thegranuloma battleground. Int J Infect Dis. 2019;80S:S58-S61.
21. Pease C, Hutton B, Yazdi F, et al. Efficacy and completion rates ofrifapentine and isoniazid (3HP) compared to other treatment regimensfor latent tuberculosis infection: a systematic review with network metaanalyses.BMC Infect Dis. 2017;17:265.
22. Nienhaus A, Schablon A, Costa JT, Diel R. Systematic review of cost andcost-effectiveness of different TB-screening strategies. BMC Health ServRes. 2011;11:247.
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