Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries.
Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries.
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DOI：
10.1183/13993003.01245-2015
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Raviglione M
中科院分区：
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作者：
Getahun H;Matteelli A;Abubakar I;Aziz MA;Baddeley A;Barreira D;Den Boon S;Borroto Gutierrez SM;Bruchfeld J;Burhan E;Cavalcante S;Cedillos R;Chaisson R;Chee CB;Chesire L;Corbett E;Dara M;Denholm J;de Vries G;Falzon D;Ford N;Gale-Rowe M;Gilpin C;Girardi E;Go UY;Govindasamy D;D Grant A;Grzemska M;Harris R;Horsburgh CR Jr;Ismayilov A;Jaramillo E;Kik S;Kranzer K;Lienhardt C;LoBue P;Lönnroth K;Marks G;Menzies D;Migliori GB;Mosca D;Mukadi YD;Mwinga A;Nelson L;Nishikiori N;Oordt-Speets A;Rangaka MX;Reis A;Rotz L;Sandgren A;Sañé Schepisi M;Schünemann HJ;Sharma SK;Sotgiu G;Stagg HR;Sterling TR;Tayeb T;Uplekar M;van der Werf MJ;Vandevelde W;van Kessel F;van't Hoog A;Varma JK;Vezhnina N;Voniatis C;Vonk Noordegraaf-Schouten M;Weil D;Weyer K;Wilkinson RJ;Yoshiyama T;Zellweger JP;Raviglione M
潜伏性结核感染（LTBI）的特征是对先前获得的结核分枝杆菌感染存在免疫应答，而没有活动性结核（TB）的临床证据。在这里，我们报告了世界卫生组织的循证指南，用于在高收入或中高收入国家和结核病发病率<100/100 000/年的高风险人群中管理LTBI的公共卫生方法。该指南强烈建议对艾滋病毒感染者、肺结核病例的成人和儿童接触者、开始抗肿瘤坏死因子治疗的患者、接受透析的患者、准备器官或血液移植的患者以及矽肺患者进行LTBI的系统检测和治疗。根据结核病流行病学和资源可用性，有条件地建议对囚犯、医务工作者、来自结核病高负担国家的移民、无家可归者和非法药物使用者进行系统的LTBI检测和治疗。无论是商业干扰素γ释放测定或结核菌素皮肤试验可用于测试LTBI。在LTBI治疗前应进行胸部X线检查，以排除活动性结核病。推荐的LTBI治疗方案包括：6或9个月的异烟肼; 12周的利福喷丁加异烟肼; 3-4个月的异烟肼加利福平;或3-4个月的利福平单药。
Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3–4 month isoniazid plus rifampicin; or 3–4 month rifampicin alone.