An update of management of latent tuberculosis infection and active disease in patients with chronic kidney disease

OBJECTIVE: To determine the prevalence of latent tuberculosis infection (LTBI) and the risk of infection in patients with chronic kidney disease treated at a hemodialysis center. METHODS: We included 307 patients with chronic kidney disease undergoing hemodialysis at the Mineiro Institute of Nephrology, located in the city of Belo Horizonte, Brazil. All of the patients were submitted to tuberculin skin tests (TSTs). We investigated the booster effect and TST conversion. If the initial TST (TST1) was negative, a second TST (TST2) was performed 1-3 weeks later in order to investigate the booster effect. If TST2 was also negative, a third TST (TST3) was performed one year after TST2 in order to determine whether there was TST conversion. RESULTS: When we adopted a cut-off induration of 5 mm, the prevalence of LTBI was 22.2% on TST1, increasing by 11.2% on TST2. When we adopted a cut-off induration of 10 mm, the prevalence of LTBI was 28.5% on TST1, increasing by 9.4% on TST2. The prevalence of LTBI increased significantly from TST1 to TST2 (booster effect), as well as from TST2 to TST3 (p < 0.01 for both). In our sample, the mean annual risk of infection was 1.19%. CONCLUSIONS: In the population studied, the prevalence of LTBI was high, and the mean annual risk of infection was similar to that reported for the general population of Brazil, which suggests recent infection.

Download Full-text

Comparison of the Prevalence of Latent Tuberculosis Infection among Non-Dialysis Patients with Severe Chronic Kidney Disease, Patients Receiving Dialysis, and the Dialysis-Unit Staff: A Cross-Sectional Study

PLoS ONE ◽

10.1371/journal.pone.0124104 ◽

2015 ◽

Vol 10 (4) ◽

pp. e0124104 ◽

Cited By ~ 11

Author(s):

Chin-Chung Shu ◽

Chia-Lin Hsu ◽

Chih-Yuan Lee ◽

Jann-Yuan Wang ◽

Vin-Cent Wu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Cross Sectional Study ◽

Sectional Study ◽

Dialysis Patients ◽

Cross Sectional ◽

Dialysis Unit ◽

Severe Chronic Kidney Disease

Download Full-text

Short-course regimens of rifapentine plus isoniazid to treat latent tuberculosis infection in older Chinese patients: a randomised controlled study

European Respiratory Journal ◽

10.1183/13993003.01470-2018 ◽

2018 ◽

Vol 52 (6) ◽

pp. 1801470 ◽

Cited By ~ 12

Author(s):

Lei Gao ◽

Haoran Zhang ◽

Henan Xin ◽

Jianmin Liu ◽

Shouguo Pan ◽

...

Keyword(s):

Adverse Effects ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Tuberculosis Infection ◽

World Health ◽

Controlled Study ◽

Short Course ◽

Significant Difference ◽

Randomised Controlled ◽

Active Disease

Latent tuberculosis infection (LTBI) management is now a critical component of the World Health Organization's End TB Strategy.In this randomised controlled trial (Chinese Clinical Trial Registry identifier ChiCTR-IOR-15007202), two short-course regimens with rifapentine plus isoniazid (a 3-month once-weekly regimen and a 2-month twice-weekly regimen) were initially designed to be evaluated for rural residents aged 50–69 years with LTBI in China.Due to the increasingly rapid growth and unexpected high frequency of adverse effects, the treatments were terminated early (after 8 weeks for the once-weekly regimen and after 6 weeks for the twice-weekly regimen). In the modified intention-to-treat analysis on the completed doses, the cumulative rate of active disease during 2 years of follow-up was 1.21% (14 out of 1155) in the untreated controls, 0.78% (10 out of 1284) in the group that received the 8-week once-weekly regimen and 0.46% (six out of 1299) in the group that received the 6-week twice-weekly regimen. The risk of active disease was decreased, with an adjusted hazard ratio of 0.63 (95% CI 0.27–1.43) and 0.41 (95% CI 0.15–1.09) for the treatments, respectively. No significant difference was found in the occurrence of hepatotoxicity (1.02% (13 out of 1279) versus 1.17% (15 out of 1279); p=0.704).The short regimens tested must be used with caution among the elderly because of the high rates of adverse effects. Further work is necessary to test the ultrashort regimens in younger people with LTBI.

Download Full-text

Persistently Deficient In Vitro Anti-Mycobacterial Immunity Despite Highly Successful Long-Term (> years) HAART: Differential Impact of Latent Tuberculosis Infection and Previous Active Disease

Clinical Immunology ◽

10.1016/j.clim.2007.03.266 ◽

2007 ◽

Vol 123 ◽

pp. S31-S32

Author(s):

Gil Benard ◽

Marcelo Mendonça ◽

Léia C. Rodrigues Silva ◽

Guilherme G. Silveira ◽

Maury M. Tanji ◽

...

Keyword(s):

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Tuberculosis Infection ◽

Differential Impact ◽

Active Disease

Download Full-text

Latent tuberculosis infection and the EndTB Strategy: ethical tensions and imperatives

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.17.0756 ◽

2020 ◽

Vol 24 (5) ◽

pp. 21-26

Author(s):

J. T. Denholm ◽

J. C. Millan-Marcelo ◽

K. Fiekert

Keyword(s):

Management Practices ◽

Ethical Issues ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Multidrug Resistant ◽

Tuberculosis Infection ◽

Critical Element ◽

Risk Of Progression ◽

Poor Outcomes ◽

Active Disease

Latent tuberculosis infection (LTBI) is increasingly recognised as central to programmatic TB activity, and a critical element in global progress towards TB elimination. LTBI affects a much larger group of people than active disease, who by definition are asymptomatic. Furthermore, while LTBI represents a state of risk, there remains significant uncertainty regarding which individuals will progress to active disease. Therefore, the development and implementation of LTBI management policies within the End TB Strategy requires careful ethical consideration. This article reviews ethical issues related to developments in LTBI diagnosis and management, including new tools and emerging policies and practice. Implications of LTBI management practices in specific settings are discussed, including healthcare worker infection and management of likely multidrug-resistant (MDR) LTBI. Better prediction of progression to active disease and less burdensome treatments would allow ethically appropriate expansion of testing programmes in future. However, even with existing tools there is a strong ethical imperative to provide the most effective and least burdensome therapy possible to those with LTBI, particularly those at highest risk of progression and/or poor outcomes from active disease. Greater community engagement is required in designing optimal LTBI management programmes, and ensure harms and benefits are appropriately balanced in specific settings.

Download Full-text