Article information
Resumo
O diagnóstico e tratamento da infecção latente por Mycobacterium tuberculosis reduz significativamente o risco de desenvolvimento de tuberculose activa e a transmissão da doença na comunidade. O rastreio da tuberculose infecção latente deve passar pela exclusão de doença activa (inquérito de sintomas e radiografia pulmonar) e avaliação da resposta imunológica ao M. tuberculosis através dos testes actualmente ao dispor, como o teste tuberculínico e os testes IGRA (interferon-gamma release assay). A escolha do esquema de tratamento deve ter em linha de conta a eficácia, a adesão e os efeitos colaterais associados ao mesmo Este documento actualiza as recomendações sobre tratamento da tuberculose infecção latente. São apresentadas indicações sobre quem deve ser rastreado e revistos os esquemas de tratamento.
Palavras-chave:
Tuberculose
tuberculose infeccao latente
tratamento
preventivo
Abstract
Diagnosis and treatment of latent infection with Mycobacterium tuberculosis (LTBI), significantly reduces the risk of developing active tuberculosis and the transmission of the disease in the community. LTBI screening must pass by the exclusion of active disease (symptoms enquiry and chest radiography) and assessment of immune response to Mycobacterium tuberculosis testing with the tests currently available – tuberculin skin test and interferon-gamma release assay (IGRA). The choice of treatment must take into account the efficacy and side effects associated with the same. This document provides updated recommendations on latent tuberculosis infection treatment. Topics covered include whom to test for TB and reviewed LTBI treatment regimens.
Key words:
Tuberculosis
latent tuberculosis infection
treatment
preventive
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Bibliografia
[1.]
American Academy of Pediatrics, Pediatric Tuberculosis Collaborative Group. Targeted tuberculin skin testing and treatment of latent tuberculosis infection in children and adolescents. Pediatrics 2004; 114: 1175-1201.(disponivel em: http://www.pediatrics.org/cgi/content/full/114/4/S2/1175).
[2.]
T.R. Sterling, J. Bethel, S. Goldberg, et al.
The scope and impact of treatment of latent tuberculosis infection in the United States and Canada.
Am J Respir Crit Care Med, 173 (2006), pp. 927-931
[3.]
S.H. Ferebee.
Controlled chemoprophylaxis trials in tuberculosis: a general review.
Bibl Tuberc, 26 (1970), pp. 28-106
[4.]
K.H. Hsu.
Isoniazid in prevention and treatment of tuberculosis: a 20-year study of the effectiveness in children.
JAMA, 229 (1974), pp. 528-533
[5.]
International Union Against Tuberculosis.
Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. Committee on Prophylaxis.
Bull World Health Organ, 60 (1982), pp. 555-564
[6.]
U. Mack, G.B. Migliori, M. Sester, H.L. Rieder, S. Ehlers, D. Goletti, A. Bossink, K. Magdorf, C. Holscher, B. Kampmann, S.M. Arend, A. Detjen, G. Bothamley, J.P. Zellweger, H. Milburn, R. Diel, P. Ravn, F. Cobelens, P.J. Cardona, B. Kan, I. Solovic, R. Duarte, D.M. Cirillo, C. Lange.
TBNET.LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement.
Eur Respir J, 33 (2009), pp. 956-973
[7.]
J.R. Starke.
Current chemotherapy for tuberculosis in children.
Infect Dis Clin North Am, 6 (1992), pp. 215-235
[8.]
World Health Organizaiton.
Treatment of tuberculosis: guidelines for national programmes.
3rd ed., World Health Organization, (1997),
[9.]
S.H. Ferebee.
Controlled chemoprophylaxis trials in tuberculosis. A general review.
Adv Tuberc Res, 17 (1969), pp. 28-106
[10.]
Targeted tuberculin testing and treatment of latent tuberculosis infection.
Am J Respir Crit Care Med, 161 (2000), pp. S221-S247
[11.]
E.B. Gutierrez, V. Gomes, C.M. Picone, H. Suga, A.N. Atomiya.
Active tuberculosis and Mycobacterium tuberculosis latent infection in patients with HIV/AIDS.
HIV Med, 10 (2009), pp. 564-572
[12.]
S.S. Lee, K.J. Chou, I.J. Su, Y.S. Chen, H.C. Fang, T.S. Huang, H.C. Tsai, S.R. Wann, H.H. Lin, Y.C. Liu.
High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis: Comparison of QuantiFERON-TB GOLD, ELISPOT, and tuberculin skin test.
Infection, 37 (2009), pp. 96-102
[13.]
C.Y. Jeon, M.B. Murray.
Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies.
PLoS Med, 5 (2008), pp. e152
[14.]
D. Menzies, R. Joshi, M. Pai.
Risk of tuberculosis infection and disease associated with work in health care settings.
Int J Tuberc Lung Dis, 11 (2007), pp. 593-605
[15.]
J.T. Costa, R. Silva, R. Sa, M.J. Cardoso, J. Ferreira, C. Ribeiro, M. Miranda, J.L. Placido.
Tuberculosis – Risk of continued transmission in healthcare workers.
Rev Port Pneumol, 16 (2010), pp. 5-21
[16.]
Hong Kong Chest Service/Tuberculosis Research Centre, Madras Medical Research Council, British Medical Research Council.
A double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong.
Am Rev Respir Dis, 145 (1992), pp. 36-41
[17.]
G.W. Comstock, C. Baum, D.E. Snider Jr..
Isoniazid prophylaxis among Alaskan Eskimos: a final report of the Bethel Isoniazid Studies.
Am Rev Respir Dis, 119 (1979), pp. 827-830
[18.]
J. Katz, S. Kunofsky, V. Damijonaitis, A. Lafleur, T. Caron.
Effect of isoniazid upon the reactivation of inactive tuberculosis. Final report.
Am Rev Respir Dis, 91 (1965), pp. 345-350
[19.]
G.W. Comstock, S.H. Ferebee, L.M. Hammes.
A controlled trial of community-wide isoniazid prophylaxis in Alaska.
Am Rev Respir Dis, 95 (1967), pp. 935-943
[20.]
N.P. Spyridis, P.G. Spyridis, A. Gelesme, V. Sypsa, M. Valianatou, F. Metsou, D. Gourgiotis, M.N. Tsolia.
The effectiveness of a 9-month regimen of isoniazid alone versus 3 – and 4-month regimens of isoniazid plus rifampin for treatment of latent tuberculosis infection in children: results of an 11-year randomized study.
Clin Infect Dis, 45 (2007), pp. 715-722
[21.]
D. Menzies, R. Long, A. Trajman, M.J. Dion, J. Yang, H. Al Jahdali, Z. Memish, K. Khan, M. Gardam, V. Hoeppner, A. Benedetti, K. Schwartzman.
Adverse events with 4 months of rifampin therapy or 9 months of isoniazid therapy for latent tuberculosis infection: a randomized trial.
Ann Intern Med, 149 (2008), pp. 689-697
[22.]
K. Ijaz, J.A. Jereb, L.A. Lambert, W.A. Bower, P.R. Spradling, P.D. McElroy, M.F. Iademarco, T.R. Navin, K.G. Castro.
Severe or fatal liver injury in 50 patients in the United States taking rifampin and pyrazinamide for latent tuberculosis infection.
Clin Infect Dis, 42 (2006), pp. 346-355
[23.]
Centers for Disease Control and Prevention.
Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection in the United States, 2003.
MMWR Morb Mortal Wkly Rep, 52 (2003), pp. 735-739
[24.]
P.D. McElroy, K. Ijaz, L.A. Lambert, et al.
National survey to measure rates of liver injury, hospitalization, and death associated with rifampin and pyrazinamide for latent tuberculosis infection.
Clin Infect Dis, 41 (2005), pp. 1125-1133
[25.]
S.A. Gilroy, M.A. Rogers, D.C. Blair.
Treatment of latent tuberculosis infection in patients aged > or =35 years.
Clin Infect Dis, 31 (2000), pp. 826-829
[26.]
F.F. Fountain, E.A. Tolley, A.R. Jacobs, T.H. Self.
Rifampin hepatotoxicity associated with treatment of latent tuberculosis infection.
Am J Med Sci, 337 (2009), pp. 317-320
[27.]
D.E. Kopanoff, D.E. Snider Jr., G.J. Caras.
Isoniazid-related hepatitis: a U.S. Public Health Service cooperative surveillance study.
Am Rev Respir Dis, 117 (1978), pp. 991-1001
[28.]
D.E. Snider Jr..
Pyridoxine supplementation during isoniazid therapy.
Tubercle, 61 (1980), pp. 191-196
[29.]
W.W. Yew, C.C. Leung.
Antituberculosis drugs and hepatotoxicity.
Respirology, 11 (2006), pp. 699-707
[30.]
A. Tostmann, M.J. Boeree, R.E. Aarnoutse, W.C. de Lange, A.J. van der Ven, R. Dekhuijzen.
Antituberculosis drug-induced hepatotoxicity: concise up-to-date review.
J Gastroenterol Hepatol, 23 (2008), pp. 192-202
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