Latent Tuberculosis Infection
Latent Tuberculosis Infection
复制标题
潜伏性结核感染
DOI：
10.1056/nejmcp2108501
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发表时间：
2021-12-09
影响因子：
158.5
通讯作者：
Dorman, Susan E.
中科院分区：
文献类型：
--
作者：
Shah, Maunank;Dorman, Susan E.
有结核分枝杆菌暴露或进展为结核病危险因素的人应进行结核分枝杆菌感染检测，最好采用干扰素- γ释放试验。在排除结核病后，应治疗进展风险增加的患者，最好采用以利福霉素为基础的方案。预防从潜伏性结核感染（LTBI）发展为结核病是一个重要的个人和公共卫生目标。应筛查成人和儿童接触结核分枝杆菌的危险因素和进展为结核病的危险因素。筛查呈阳性的人应接受结核分枝杆菌感染检测，最好使用干扰素- γ释放试验。对结核分枝杆菌感染检测呈阳性的人应进行结核病评估。LTBI患者进展为结核病的风险增加，一般应接受LTBI治疗并随访至治疗完成。首选LTBI治疗方案包括3个月每周一次的利福喷丁加异烟肼，4个月每天一次的利福平，或3个月每天一次的异烟肼加利福平。异烟肼每天服用一次，持续6或9个月是另一种选择。在选择LTBI治疗方案时，应考虑肝毒性作用和药物-药物相互作用的危险因素。
Latent Tuberculosis Infection Persons with risk factors for Mycobacterium tuberculosis exposure or for progression to tuberculosis disease should be tested for M. tuberculosis infection, preferably with an interferon-gamma release assay. After tuberculosis disease is ruled out, those at increased risk for progression should be treated, preferably with a rifamycin-based regimen.Key Clinical Points Latent Tuberculosis Infection Prevention of progression from latent tuberculosis infection (LTBI) to tuberculosis disease is an important individual and public health goal. Adults and children should be screened for risk factors for Mycobacterium tuberculosis exposure and for risk factors for progression to tuberculosis disease. Persons who screen positive should be tested for M. tuberculosis infection, preferably with the use of an interferon-gamma release assay. Persons who test positive for M. tuberculosis infection should be assessed for tuberculosis disease. Persons with LTBI who are at increased risk for progression to tuberculosis disease generally should be treated for LTBI and followed until treatment is completed. Preferred LTBI treatment regimens include 3 months of once-weekly rifapentine plus isoniazid, 4 months of once-daily rifampin, or 3 months of once-daily isoniazid plus rifampin. Isoniazid administered once daily for 6 or 9 months is an alternative. Risk factors for hepatotoxic effects and drug-drug interactions should be considered when the LTBI treatment regimen is selected.