scholarly journals POS1157 CONCORDANCE BETWEEN THE QUANTIFERON-TB GOLD IN-TUBE AND TUBERCULIN TEST FOR THE DIAGNOSIS OF LATENT TUBERCULOSIS INFECTION IN PATIENTS WITH RHEUMATIC DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 857.1-857
Author(s):  
C. Pávez Perales ◽  
A. Quiles Roger ◽  
E. Grau García ◽  
M. De la Rubia Navarro ◽  
S. Leal Rodriguez ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculin Test ◽  
Tuberculosis Infection ◽  
Categorical Variables ◽  
Ltbi Screening ◽  
Kappa Test ◽  
Receive Treatment

Background:Patients with rheumatic diseases (RD) are at higher risk of latent tuberculosis infection (LTBI) reactivation. To detect and treat it before starting treatment, especially with biological therapies, decrease the reactivation risk. Diagnosis is carried out by the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs), IGRAs might be more specific and sensitive.Objectives:We aim to analyze the concordance between QuantiFERON-TB Gold In-Tube (QTF) and TST for the diagnosis of LTBI in patients with rheumatic diseases.Methods:A retrospective observational study was conducted including patients diagnosed with RD screened for LTBI with both TST and QTF (2014-2018). Demographical and clinical variables at screening and at follow-up were collected. The concordance between both tests has been estimated as categorical variables using Cohen´s Kappa test, considering “poor” if it is ≤ 0,20; “low” if 0,20 < k ≤ 0,40, “moderate” if 0,40 < k ≤ 0,60, “substantial” if 0,60 < k ≤ 0,80 and “optimal” if k > 0,80.Results:167 patients were included (57% women) with a mean age of 52±16 years. 42% of them had systemic autoimmune diseases, 22% spondyloarthropathies and 36% other RD. 2 had history of past active tuberculosis (TB). At the time of screening, 46.11% were treated with GC.LTBI was diagnosed in 35 patients: 15 had both QTF and TST positive, 16 only QTF positive and 4 only TST positive. 12 from 31 QTF positive patients were treated with GC at the time of screening. 3 from 19 TST positive patients were treated with GC at the time of screening.After LTBI screening 62 patients received biological treatment, 4 of them had both test positive, 6 only QTF positive and 2 only TST positive. 11 received LTBI treatment according to the hospital protocol (isoniazid for 6 to 9 months). 10 completed treatment, 1 did not because of intolerance and did not receive other treatment. 1 patient with only TST positive was considered a false positive and did not receive treatment. During follow-up no TB reactivation was reported.23 patients with LBTI received treatment other than biological therapy during follow-up, of them 8 received LBTI treatment. There was no TB reactivation during follow up.The Kappa concordance between QTF and TST was estimated: moderated in the whole sample, poor in the patients treated with GC at screening, and substantial when the patients treated with GC at screening were excluded. Results are shown in Table 1.Table 1.Kappa concordance between QTF and TST.Conclusion:QTF seems to be the most appropriate LTBI screening test in patients with RD treated with GC. Screening and treatment of LTBI in patients with RD treated with or without biological agents was effective in reducing TB reactivation.Disclosure of Interests:None declared.

scholarly journals 1376. Physician Practice Patterns for Screening and Treatment of Latent Tuberculosis Infection in the South Asian Population in Central New Jersey

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S499-S500
Author(s):  
Nupur Gulati ◽  
Sri Ram Pentakota ◽  
Kristina N Feja ◽  
Bishakha Ghoshal ◽  
Rajita Bhavaraju ◽  
...  
Keyword(s):  
New Jersey ◽  
South Asian ◽  
Outcome Measure ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Medical Graduate ◽  
Chi Square ◽  
Ltbi Screening

Abstract Background New Jersey (NJ) has a significant burden of tuberculosis (TB) cases (ranked 8th in the United States) and 22% of the cases are among foreign-born (FB) individuals. We have approximately 33% FB residents in our targeted counties in Central NJ of whom 43% are originally from high TB burden areas of South Asia. Central NJ is home to the county with the second highest TB case rate in NJ. Latent tuberculosis infection (LTBI) treatment remains a key component of the World Health Organization TB elimination strategy. We sought to survey community physicians about their LTBI screening and treatment practices in South Asian (SA) patients. Methods An IRB-approved anonymous survey was distributed online to practicing staff physicians at local hospitals over a 2-month period. The primary outcome measure was whether physicians appropriately screen for LTBI. A secondary outcome measure was whether follow-up after medication initiation was provided. Predictors measured included: age, gender, self -identification of physician as SA, years in practice, and if they were a foreign medical graduate (FMG). Descriptive statistics were provided using counts and proportions. Chi-square tests were used for bivariate analyses to look for factors associated with LTBI screening and treatment. Results A total of 218 physicians responded to the survey; of whom, 137 identified themselves as primary care physicians (i.e., pediatrics (62%), internal medicine (30%), or family medicine (8%)). About half of them were FMG and 40% identify themselves as SA. Three out of four of these physicians (n = 101) indicated they routinely screen their patients for LTBI. Bivariate analyses using chi-square did not find any statistically significant associations with LTBI screening. A quarter of the physicians screened with an IGRA and 60% reported always offering treatment for LTBI. Isoniazid was the most common medication prescribed. A majority of respondents did not report prescribing Rifampin or Rifapentine. Follow-up after initiation of treatment was provided at least every other month by 52.7% of physicians. Conclusion There is wide variability in LTBI screening, treatment, and follow-up among our physician sample. Physicians have not yet adopted newer treatment regimens suggesting the need for an educational intervention. Disclosures All authors: No reported disclosures.

scholarly journals POS1437 LATENT TUBERCULOSIS INFECTION IN RHEUMATIC DISEASES: A REAL-LIFE STUDY OF THREE APULIAN CENTRES. DATA FROM BIOPURE REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1003.1-1003
Author(s):  
M. Fornaro ◽  
D. Goletti ◽  
A. Abbruzzese ◽  
M. G. Anelli ◽  
A. Semeraro ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Latent Tuberculosis Infection ◽  
Real Life ◽  
Latent Tuberculosis ◽  
Study Data ◽  
Tuberculosis Infection ◽  
Tuberculous Infection ◽  
Biologic Treatment

Background:Latent tuberculous infection (LTBI) is very common in the world and screening for it is essential before starting treatment with biotechnological drugsObjectives:The aims of our study were to assess the prevalence in Apulia of LTBI among patients affected with rheumatic disease and to record the cases of tuberculosis (TB) infection among patients treated with biologic agents.Methods:We analysed data of patients included in BIOPURE registry from 2008 to 2018, who underwent Quantiferon (QTF) test as routinely screening for biologic treatment. Demographic and clinical data were recorded at the time of the first QTF assessment and this time point was considered the “baseline” of the study. Data regarding further QTF tests performed during follow-up was also acquired by electronic charts. Prophylaxis administration and bDMARD treatments were recorded for patients with positive QTF test. All tuberculosis infections were recorded during the entire time of follow-up.Results:Three thousand thirty-five patients (female 67.2%, mean age 52 ± 18.3 years) were included in these study, 2692 patients (88.7%) had inflammatory arthritis (28.2% rheumatoid arthritis, 33% psoriatic arthritis and 27.4% spondyloarthritis), 129 (4.2%) patients had connective tissue disease, whereas 214 (7.1%) patients were affected by others rheumatic diseases. The prevalence of LTBI was 10.7% (326 patients) at baseline. Comparisons between positive and negative patients for QTF are reported in Table 1. We acquired data of LTBI prophylaxis of 284 patients; 235 out 265 patients treated with isoniazid completed the treatment, whereas 19 out 19 patients treated with rifampicin completed the prophylaxis regimen. The main cause of isoniazid withdrawal was hypertransaminasemia, but 8 patients then completed prophylaxis with rifampicin. During the entire follow-up (42.6±30.5 months), we recorded 5 (0.02%) cases of primary TB infection in patients on anti-TNFα agents treatment, which had baseline screening negative for LTBI. Data and outcome of these patients are reported in Table 2. The mean time of follow-up of patients on bDMARDs treatment with positive QTF at baseline was 52.7±35.2 months. bDMARD treatment regimens are reported in Table 3. No case of TB reactivation was found among patients with positive baseline QTF. Moreover, of 1563 (51.5%) patients who repeated QTF during follow-up, 62 (4%) of them showed a change in the test result. We observed a change to a positive state in 36 patients with previous negative QTF test, whereas 26 patients with previous positive QTF showed a shift to a negative test during follow-up.Conclusion:Our study shows a prevalence of LTBI of 10.7% in Apulian patients affected with rheumatic disease. bDMARDs therapy appears to be safe in patients with positive QTF test treated according to current recommendations1. However, cases of primary TB infections, especially in patients receiving anti-TNFα drugs, have been observed.References:[1]Cantini F, et al, Guidance for the management of patients with latent tuberculosis infection requiring biologic therapy in rheumatology and dermatology clinical practice, Autoimmun Rev (2015).Disclosure of Interests:None declared

scholarly journals Randomized Controlled Trial of Interventions to Improve Follow-up for Latent Tuberculosis Infection After Release From Jail

2002 ◽  
Vol 162 (9) ◽  
pp. 1044 ◽  
Author(s):  
Mary Castle White ◽  
Jacqueline P. Tulsky ◽  
Joe Goldenson ◽  
Carmen J. Portillo ◽  
Masae Kawamura ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Latent Tuberculosis Infection ◽  
Controlled Trial ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Randomized Controlled

scholarly journals Latent tuberculosis infection and tuberculosis in children and adolescents

2018 ◽  
Vol 16 (3) ◽  
Author(s):  
Cassia Satsuki Ishikawa ◽  
Olivia Mari Matsuo ◽  
Flavio Sarno
Keyword(s):  
Computed Tomography ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculin Test ◽  
Tuberculosis Infection ◽  
Gastric Aspirate ◽  
X Ray ◽  
Qualitative Variables ◽  
Chest X Ray ◽  
Tuberculosis In Children

ABSTRACT Objective: To describe the characteristics of patients diagnosed with tuberculosis and latent tuberculosis infection. Methods: A retrospective study, between 2012 and 2015, with data from patients of Programa Einstein na Comunidade de Paraisópolis. To evaluate possible factors associated with patient's sex and diagnoses of tuberculosis and latent tuberculosis infection, χ2 or Fisher's exact tests were used for qualitative variables, and Mann-Whitney test for quantitative or ordinal qualitative variables. Results: A total of 77 patients were evaluated. Age ranged from 6 months to 13.4 years, with a majority of males (54.5%), aged zero to 4 years (54.5%), diagnosed with latent tuberculosis infection (64.9%), and classified as eutrophic (71.2%). The tuberculin test was positive in 92% and in most cases the values were above 10mm (68.0%). Approximately three-quarters of chest X-ray tests were normal (72.7%). After chest X-ray, computed tomography of thorax was the most ordered exam (29.9%), followed by smear and culture for Mycobacterium tuberculosis in the gastric aspirate (28.6%). The frequencies of altered chest X-ray (70.4% versus 4.0%), computed tomography of thorax requests (55.6% versus 16.0%) and other tests requested (81.5% versus 38.0%) were significantly higher in patients with a diagnosis of tuberculosis, relative to those with latent tuberculosis infection, respectively. Conclusion: In our sample, proportions of altered chest X-ray, and performing computed tomography of thorax and other tests in patients diagnosed with tuberculosis were higher than in those with latent tuberculosis infection.

scholarly journals Latent tuberculosis screening before kidney transplantation in the South of Brazil

2021 ◽  
Author(s):  
Gisele Meinerz ◽  
Cynthia Keitel da Silva ◽  
Damaris Mikaela Balin Dorsdt ◽  
Julia Bertoni Adames ◽  
Julio Pasquali Andrade ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Latent Tuberculosis ◽  
Tuberculin Test ◽  
Tuberculosis Screening ◽  
Post Transplant ◽  
Ltbi Screening ◽  
Interferon Gamma Release Assays ◽  
High Incidence ◽  
South Of Brazil

Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

scholarly journals Systematic review of latent tuberculosis infection research to inform programmatic management in Ireland

2021 ◽  
Author(s):  
James O’Connell ◽  
Eoghan de Barra ◽  
Samuel McConkey
Keyword(s):  
Systematic Review ◽  
Latent Tuberculosis Infection ◽  
Meta Analysis ◽  
Latent Tuberculosis ◽  
Risk Groups ◽  
Tuberculosis Infection ◽  
World Health ◽  
People Living With Hiv ◽  
Knowledge Gaps ◽  
Ltbi Screening

AbstractThe World Health Organisation (WHO) End Tuberculosis (TB) Strategy and the WHO Framework Towards Tuberculosis Elimination in Low Incidence Countries state that latent tuberculosis infection (LTBI) screening and treatment in selected high-risk groups is a priority action to eliminate TB. The European Centre for Disease Prevention and Control (ECDC) advises that this should be done through high-quality programmatic management, which they describe as having six key components. The research aim was to systematically review the literature to identify what is known about the epidemiology of LTBI and the uptake and completion of LTBI screening and treatment in Ireland to inform the programmatic management of LTBI nationally. A systematic literature review was performed according to a review protocol and reported in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Twenty-eight studies were eligible for inclusion and described LTBI screening or treatment performed in one of five contexts, pre-biologic or other immunosuppression screening, people living with HIV, TB case contacts, other vulnerable populations, or healthcare workers. The risk of bias across studies with regard to prevalence of LTBI was generally high. One study reported a complete cascade of LTBI care from screening initiation to treatment completion. This systematic review has described what published research there is on the epidemiology and cascade of LTBI care in Ireland and identified knowledge gaps. A strategy for addressing these knowledge gaps has been proposed.

scholarly journals Immigrant screening for latent tuberculosis infection: numbers needed to test and treat, a Norwegian population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023412 ◽  
Author(s):  
Brita Askeland Winje ◽  
Gry Marysol Grøneng ◽  
Richard Aubrey White ◽  
Peter Akre ◽  
Preben Aavitsland ◽  
...  
Keyword(s):  
Cohort Study ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Population Based ◽  
Tuberculosis Infection ◽  
Number Needed To Treat ◽  
Ltbi Treatment ◽  
Ltbi Screening ◽  
Number Needed To Screen ◽  
Source Countries

ObjectivesTo estimate the number needed to screen (NNS) and the number needed to treat (NNT) to prevent one tuberculosis (TB) case in the Norwegian immigrant latent tuberculosis infection (LTBI) screening programme and to explore the effect of delay of LTBI treatment initiation.DesignPopulation-based, prospective cohort study.ParticipantsImmigrants to Norway.OutcomeIncident TB.MethodsWe obtained aggregated data on immigration to Norway in 2008–2011 and used data from the Norwegian Surveillance System for Infectious Diseases to assess the number of TB cases arising in this cohort within 5 years after arrival. We calculated the average NNS and NNT for immigrants from the top 10 source countries for TB in Norway and by estimated TB incidence rates in source countries. We explored the sensitivity of these estimates with regard to test performance, treatment efficacy and treatment adherence using an extreme value approach, and assessed the effects of emigration, time to TB diagnosis (to define incident TB) and intervention timing.ResultsNNS and NNT were overall high, with substantial variation. NNT showed numerically stronger negative correlation with TB notification rate in Norway (−0.75 [95% CI −1.00 to −0.44]) than with the WHO incidence rate (IR) (−0.32 [95% CI −0.93 to 0.29]). NNT was affected substantially by emigration and the definition of incident TB. Estimates were lowest for Somali (NNS 99 [70–150], NNT 27 [19–41]) and highest for Thai immigrants (NNS 585 [413–887], NNT 111 [79–116]). Implementing LTBI treatment in immigrants sooner after arrival may improve the effectiveness of the programme.ConclusionUsing TB notifications in Norway, rather than IR in source countries, would improve targeting of immigrants for LTBI management. However, the overall high NNT is a concern and challenges the scale-up of preventive LTBI treatment for significant public health impact. Better data are urgently needed to monitor and evaluate NNS and NNT in countries implementing LTBI screening.

Sign in / Sign up

Export Citation Format

Share Document