Multi-drug-resistant tuberculosis secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Secondary prevention for tuberculosis includes methods for screening and early diagnosis, such as tuberculin skin test (TST) and IGRAs; and to guarantee the correct treatment regimen at the right time to prevent disease progression.

Secondary Prevention

Screening

Tuberculin Skin Test
  • Children with close contact with a TB confirmed case should be evaluated for tuberculosis infection.
  • TST is the test of choice for screening for tuberculosis infection.

Interferon-Gamma Release Assays (IGRAs)

  • IGRA can be used in place of (but not in addition to) TST in screening for M. tuberculosis infection in the following conditions:[1]
  • A patient have received BCG vaccination
  • Groups that historically have poor rates of return for TST reading.
  • TST preferred compared to IGRA for TB screening due to its low cost and high accessibility.[2]

Early Diagnosis

  • Early detection of tuberculosis disease is important to give treatment at the appropriate time and prevent complications.
  • All patients should be routinely asked about:[3]
  • History of TB exposure, infection, or disease
  • Symptoms or signs of TB disease
  • Medical conditions that increase their risk for TB disease
  • Patients with the following characteristics should be tested for tuberculosis:[3]

Prompt Treatment

  • Empiric therapy should be started as soon as a patient has tuberculosis disease confirmed.
  • Sputum specimens should be sent for culture and DST before starting treatment.

DOTS-Plus Strategy

WHO has devised a new strategy to manage MDR-TB using the second line of drugs wihin the DOTS strategy in middle and low income countries. They must be implemented in well functioning national TB programs . The best way to avoid future MDR- TB epidemics is through prevention of development of future drug resistance.


References

  1. "CDC Interferon-Gamma Release Assays (IGRAs) - Blood Tests for TB Infection".
  2. Hong-Van Tieu, Piyarat Suntarattiwong, Thanyawee Puthanakit, Tawee Chotpitayasunondh, Kulkanya Chokephaibulkit, Sunee Sirivichayakul, Supranee Buranapraditkun, Patcharawee Rungrojrat, Nitiya Chomchey, Simon Tsiouris, Scott Hammer, Vijay Nandi & Jintanat Ananworanich (2014). "Comparing interferon-gamma release assays to tuberculin skin test in thai children with tuberculosis exposure". PloS one. 9 (8): e105003. doi:10.1371/journal.pone.0105003. PMID 25121513.
  3. 3.0 3.1 "CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005".

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