بسم الله الرحمن الرحيم. A 25 year old Saudi male applied to work as paramedic. He has no symptoms or history of contact with sick patients. His physical.

Slides:



Advertisements
Similar presentations
TB Disease and Latent TB Infection
Advertisements

VDH TB Control and Prevention Program
Immunization and RSV/Palivizumab Clinic Update Advances in preventative care for our pediatric population.
A typical day in the TB clinic You see the following patients in the TB clinic. All have normal CXRs: 1. A 35 year old man from Hartford with a 16 mm positive.
QuantiFERON®-TB Gold Test
Tuberculosis 101 JAMES R. GINDER, MS, WEMT,PI, CHES
Topic Review: Screening for Latent Tuberculosis (LTB). Author: Peter R. McNally, DO, FACP, FACG Center for Human Simulation University of Colorado – Denver,
By: Haya M. Al-Malaq Clinical pharmacy department KSU
3 Self-Study Modules on Tuberculosis Targeted Testing and
Continuity Clinic Tuberculosis. Continuity Clinic Objectives Know current epidemiologic trends in TB Know indications for testing for TB exposure and.
1 Tuberculosis: The Epidemiology, Diagnosis and Prevention Assisted Living Residence Advisory Committee Meeting Mary Goggin, RN, MPH April 28,2011.
TB chemoprophylaxis Graham Bothamley Clinical Director, NE London TB Network.
Tuberculosis Control What’s New. TB Regional Nurse Update Teri Lee Dyke, RN, BSN, CIC Julie McCallum, RN, MPH Regional TB Nurse Consultants.
Wyoming Department of Health Communicable Diseases
Screening of Latent Tuberculosis before treatment with TNF  blockers Ori Elkayam M.D Tel Aviv Medical Center.
TB. Areas of Concern TB cases continue to be reported in every state Drug-resistant cases reported in almost every state Estimated million persons.
Fundamentals of Tuberculosis (TB)
TB Testing Current Thinking
Latent Tuberculosis among Displaced Populations Rapid Diagnosis and Control Nikolaou Aristidis MD, MSc.
Tuberculosis (TB) PHCL 442 Lab Discussion Jamilah Al-Saidan, M.Sc.
4/25/2014 Mantoux Skin Testing Joan E. McMahon, RN, MPH Tuberculosis Educator Breathe Pennsylvania.
This is a global infectious disease.
October 3, Serial Testing of Health Care Workers for Tuberculosis Using Interferon-γ Assay Madhukar Pai, et. al. American Journal of Respiratory.
TB or not TB ? Mahmoud Abu-Shakra Rheumatic disease Unit
Diagnosing and Treating Latent TB Infection (LTBI)
Allen Kraut, MD, FRCPC Medical Director, Occupational Health WRHA
 Pulmonary Tuberculosis BY: MOHAMED HUSSEIN. Cause  Caused by Mycobacterium tuberculosis (M. tuberculosis)  Gram (+) rod (bacilli). Acid-fast  Pulmonary.
Prevention of tuberculosis. Targeted Tuberculin Skin Testing
Update on Tuberculosis contact investigation
Johns Hopkins Center for Tuberculosis Research
TB (Infection) or not TB? Who should we screen and treat? Primary Care Conference August 31, 2005 K. Mae Hla, M.D., M.H.S.
Fundamentals of Tuberculosis. 2 Reported TB Cases United States, Year No. of Cases.
Module 2 - Epidemiology of Tuberculosis
Tuberculosis The evolution of a bacterium. 2 World Health Organization (WH.O. declared TB a global health emergency in cases per 100,
Screening for TB.
1 Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection, 2005 Applying CDC/ATS Guidelines in Your Clinical Practice Division of Tuberculosis.
IGRAs: Should they replace the TST in the identification of latent tuberculosis? Objectives Describe how interferon-gamma release assays (IGRAs) work.
Health Organization The Challenges Facing Tuberculosis Control Blantyre Hospital, Malawi: TB Division, 3 patients per bed.
CDC Guidelines for Use of QuantiFERON ® -TB Gold Test Philip LoBue, MD Centers for Disease Control and Prevention Division of Tuberculosis Elimination.
Mantoux tuberculin skin test
Module 2 TB Disease Transmission & Prevention. Pulmonary Tuberculosis Extra -Pulmonary TB an infectious disease caused by a microorganism called Mycobacterium.
A Self Study Powerpoint
3 Diagnosis of Latent Tuberculosis Infection and Tuberculosis Disease.
 There are no disclosures  The purpose of this presentation is to awaken an awareness and continued existence of tuberculosis in our world and community.
Tuberculosis Dr Hafsa Raheel, MBBS, MCPS, FCPS Department of Family and Community Medicine KSU.
Tuberculosis August 17, 2010 Tuberculosis Mycobacterium tuberculosis – Fastidious, aerobic, acid-fast bacillus Tremendous increase in incidence over.
Contact Investigation Dr. Essam Elmoghazy. Contact Investigations – A Crucial Prevention Strategy On average, 10 contacts are identified for each person.
Tuberculosis By Fion Kung. Objective  Describe tuberculosis  Describe sigh and symptoms of tuberculosis  Describe the nursing diagnosis for tuberculosis.
Tuberculosis in Children and Young Adults
James R. Ginder, MS, WEMT,PI, CHES Health Education Specialist Jeremy D. Hamilton Health Education Intern Hamilton County Health Department
Comparison of a New ESAT-6/ CFP-10 Peptide-Based Gamma Interferon Assay to Tuberculin Skin Test for Tuberculosis Screening in a Moderate Risk Population.
LATENT TB IN ADULTS by Assoc. Prof. Pang Yong Kek 1.
Diagnosis of pulmonary tuberculosis
Depart. of Pulmonology R4 백승숙. 1. INTRODUCTION 2. BACKGROUND 3. DIAGNOSIS OF LATENT TB INFECTION 4. CHEMOPROPHYLAXIS 5. RISKS OF TUBERCULOSIS AND OF DRUG-INDUCED.
Depart. of Pulmonology 백승숙. More than 80% of cases of tuberculosis in the United States –The result of reactivated latent infection –Nearly all these.
TB: The Elispot In The Room Dr Jessica Potter TB Research Registrar Barts Health NHS Trust.
Transmission and Pathogenesis
TB Disease and Infection
Tuberculosis (TB) PHCL 442 Lab Discussion 4 Raniah Al-Jaizani M.Sc.
Tuberculosis Screening
Tuberculosis: The Epidemiology, Diagnosis and Prevention
14/02/1396.
Applying CDC/ATS Guidelines in Your Clinical Practice
Treatment of Latent TB Infection (LTBI)
This is an archived document.
CDC Guidelines for Use of QuantiFERON®-TB Gold Test
بسم الله الرحمن الرحيم.
Tb: Screening & Diagnosis (1)
Presentation transcript:

بسم الله الرحمن الرحيم

A 25 year old Saudi male applied to work as paramedic. He has no symptoms or history of contact with sick patients. His physical examination is unremarkable. His CBC, U&E, LFTs, urinalysis and CXR were all normal. Tuberculin skin test led to an induration of 12 mm after 48 hours. What is your diagnosis? What is your plan of management?

Latent Tuberculosis Outline: During this talk the following will be discussed: Pathogenesis of latency in tuberculosis Diagnosis of latent TB infection (LTBI) Role of interferon gamma assays in the diagnosis

Latent Tuberculosis Very common (2 billion people) Asymptomatic ( dormant ) A major source of active TB In healthy; risk of reactivation is 0.1% /yr In recent converters; risk is 5 – 10% in 2-5 yrs Risk is increased by immunosuppression and chronic diseases Diagnosis is difficult to confirm

Latent Tuberculosis: Pathogenesis After infection: 10% develop active TB Primary infections leads to hematogenous dissemination and metastatic foci Is post primary TB always due to reactivation?

Evidence of latency Autopsy studies PPD and CXR surveys Lower rate of drug resistance in elderly Relapses after effective chemotherapy INH prohylaxis decreases reactivation

Evidence of latency MacCune et al experiment on Cornell model: - Infected mice treated for 12 weeks with INH & PZA - At end of therapy: no m. TB could be cultured - after 3 months: m. TB cultured from 65% of mice ( 100% if given cortisone for 3 wks )

Latent Tuberculosis: Pathogenesis But: most primary foci become sterile in few years Within granuloma: environment is microaerophilic, acidic & & & contain toxic oxygen and nitrogen radicals How does M. TB survive such stressful environment?

Latent Tuberculosis: Pathogenesis Studies showed that m. TB cannot survive anerobic conditions for prolonged periods Possibly: m. TB can go into a state of dormancy with low metabolic activity for a long time How to explain INH effect?

Latent TB : Diagnosis TST is the standard test for diagnosis PPD contains > 200 antigens BCG vaccinated: more likely to have +ve TST Low specificity in BCG vaccinated Low sensitivity with impaired immunity Interpret in view of pretest risk

Table 1. Interpretation of Tuberculin Testing Diameter of Induration Groups Considered Positive (CDC) 5 mm HIV positive Recent contact with infectious TB case Abnormal chest x-ray suggestive of TB Immunosuppressed receiving the equivalent of 15 mg/day of prednisone for 1 month* 10mm Recent immigrant (within last 5 years) from high-prevalence country Injection drug users Residents and employees† in high-risk settings (nursing homes and other long-term facilities for the elderly, prisons etc) Medical risk factors (silicosis, diabetes mellitus, chronic renal failure, leukemias and lymphomas, carcinoma ….. Mycobacteriology laboratory personnel Children younger than 4 years old, or infants,children, and adolescents exposed to adult at high risk 15 mm All persons with no known risk factors

Alternative tests No gold standard to diagnose LTBI Test performance in high risk individuals IGRA tests: - T-spot TB assay - Quantiferon TB test Specific IGRA tests: - Quantiferon TB Gold

IGRA Tests Quantiferon TB evaluated in 216 healthy Japanese nursing students, no TB exposure. All had BCG. - TST +ve (>10 mm) in 64.6% - Quantiferon TB +ve in 1.9% Quantiferon TB Gold studied in 99 healthy Korean adults, no TB exposure. BCG in 90%. - TST +ve in 51% - Quantiferon TB +ve in 4%

IGRA tests in contact tracing T-spot TB test evaluated in 535 secondary school students exposed to infectious TB case. Most had BCG. - T-spot TB test was as sensitive as TST. - It correlated better with degree of exposure.

Can IGRA tests predict development of TB Diel et al evaluated 601 contacts of TB patient: 278(46%) had BCG. TST +ve in 243(40%). Quantiferon +ve in 66(11%). INH offered to contacts with +ve Quantiferon. 41 contacts declined to take INH. FU for 2 years : 6 contacts developed TB, all were Quantiferon +ve

Can IGRA tests predict development of TB Higushi et al: 88 TST +ve contacts were followed up for 3.5 years. Only 4 were quantiferon +ve. None of 84 Quantiferon -ve contacts developed TB.

Role of IGRA tests in diagnosis of LTBI Do IGRA test replace or complement TST? IGRA tests are more expensive ($40/test) More specific CDC suggested replacing TST by Quantiferon In UK (and Europe) IGRA tests are used as confirmatory in TST +ve s. Most cost effective approach in contact evaluation. Other areas remain controversial.

Thank you

Latent Tuberculosis: Pathogenesis

Latent Tuberculosis