Treating Latent Tuberculosis - Easier Therapy, Study

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Main Category: Tuberculosis
Article Date: 12 Dec 2011 - 7:00 PST

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An investigation led by Timothy Sterling, M.D., professor of Medicine at Vanderbilt University Medical Center, has resulted in a vital alteration in CDC recommendations in the plan of prevention for tuberculosis (TB). The study was published December 8 in New England Journal of Medicine (NEJM).

On December 9 in the Morbidity and Mortality Week Report (MMWR), the Centers for Disease Control and Prevention (CDC) announced that the novel method, which takes one-third the time of current treatment, provides several individuals at a high risk of developing TB an effective treatment option. Latent TB infections result from exposure to TB - the infecting bacteria are alive in the body, but inactive.

Until now, the treatment for latent TB infection involved patients taking daily doses of a medication called isoniazid (INH). Over the course of nine months, a total of 270 daily doses were taken in order to destroy the bacteria, which can remain dormant in the body for several years.

The study, which consisted of 8,000 individuals in 4 countries over a 10 year period, demonstrated that just 12 doses of INH combined with another TB medication called rifapentine, taken once-weekly was safe and effective. In addition the novel therapy improved compliance by at least 10%

Sterling explained:

"This is a game changer. Currently less than half of the people who start the current therapy complete it. The new combination would require a direct observation, but more people would complete treatment."

The CDC explained that although cases of active TB are at an all-time low, around 4% of individuals in the U.S., or 11 million people, have latent TB. Active TB cases, which can be potentially fatal to individuals who have a compromised immune system, still occur in Nashville. In order to prevent a return of active and infections disease, the Metro Nashville Public Health Department's Division of TB Elimination works with an average of 700 novel cases of latent TB every year.

One of the locations for the investigation was The Metro Nashville Public Health. The study received funding by the Centers for Disease Control and Prevention (CDC). Other Vanderbilt investigators included Amy Kerrigan, MSN, R.N., and Alicia Wright, among others.?

Sterling says further research is vital. The novel treatment is not an option for all patients, and may not work well in countries with a higher TB incidence. Children under 2 were excluded from the investigation.

Written by: Grace Rattue

Copyright: Medical News Today
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Discordance Among Commercially-Available Diagnostics For Latent Tuberculosis Infection

Main Category: Tuberculosis
Article Date: 10 Dec 2011 - 1:00 PST

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In populations with a low prevalence of tuberculosis (TB), the majority of positives with the three tests commercially available in the U.S for the diagnosis of TB are false positives, according to a new study.

"We compared commercially available tests for latent tuberculosis infection (LTBI) in a diverse population with a low LTBI prevalence," said James Mancuso, MD, DrPH, of the Walter Reed Army Institute of Research Preventive Medicine Residency Program. "Our results suggest that in low-prevalence populations, most positive results obtained with these tests are false positives."

The findings were published online ahead of print publication in the American Thoracic

Society's American Journal of Respiratory and Critical Care Medicine.

The cross-sectional study involved 2,017 military recruits at Fort Jackson, South Carolina, who completed a risk factor questionnaire and underwent testing with the 3 tests: 1) tuberculin skin test (TST), 2) the interferon gamma release assays (IGRAs) QuantiFERON®-TB Gold In-Tube test (QFT-GIT) and 3) the TSPOT® TB test (T-Spot). The Battey Skin Test (BST) was also administered to assess the impact of non-tuberculosis mycobacteria (NTM) reactivity on test discordance.

The specificities of TST, QFT-GIT, and T-Spot were not significantly different. Of 88 subjects with a positive test, 68 (77%) were positive to one test, 10 (11.4%) were positive to two tests, and only 10 (11.4%) were positive to all three tests. Bacille Calmette Guerin vaccination, tuberculosis prevalence in country of birth,and Battey skin test reaction size were associated with TST positive, IGRA negative test discordance, supporting evidence that NTM sensitization can cause false positive TST results. Greater quantitative test results and higher TB risk strata were associated with increased concordance between tests.

"Our data support a high proportion of false positives with any of these three tests in a low- prevalence population," added Dr. Mancuso, "as 77 percent of our subjects had positive results with only one test. Lower quantitative results were associated with a smaller risk for TB exposure and single positive tests, and lower risk for TB exposure was associated with decreasing test agreement."

There were some limitations to the study, including the lack of a gold standard for determining the presence of M. tuberculosis infection and administrative restrictions that resulted in an increased proportion of inadequate blood draws and TST reading times, which were slightly shorter than optimal.

"Low positive predictive value (PPV) is a well-known issue with the TST, and risk stratification is recommended to guide interpretation of the test," concluded Dr. Mancuso. "Our study suggests that risk stratification may also increase the PPV and reduce the number of false positives with the IGRAs. In accordance with the CDC's recommendation, people at minimal risk of TB infection should not be targeted for LTBI testing, regardless of which test is used."

Article adapted by Medical News Today from original press release. Source: American Thoracic Society
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Diagnosis Of Tuberculosis Is Increased In Postpartum Women

Main Category: Tuberculosis
Also Included In: Women's Health / Gynecology
Article Date: 10 Dec 2011 - 1:00 PST

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The incidence of tuberculosis (TB) diagnosis is significantly increased in mothers postpartum, suggesting a potential new population to target for screening, according to a new UK-wide cohort study.

In the joint study between the Health Protection Agency and the University of East Anglia, researchers analyzed data on all women with pregnancies between 1996 and 2008 from the General Practice Research Database, which contains records from 460 practices across the UK, representing 5.5 percent of the UK population. The findings were published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

"Ours is the first primary care based cohort study to quantify the risk of TB during pregnancy and postpartum," said Dominik Zenner, degree? consultant in public health, Respiratory Diseases Department at the Health Protection Agency. "Although we found a significantly increased risk of TB in the six months following pregnancy, but not during pregnancy, the risk during pregnancy is almost certainly also increased."

The researchers estimated incidence rates for TB in pregnancy, six months postpartum and outside of pregnancy, and modelled adjusted incidence rate ratios (IRRs) in a retrospective cohort study. They also performed a nested self-controlled case series (SCCS) analysis, adjusting for all non-time-dependent confounders, such as country of origin and ethnicity. In the SCSS analysis, pregnant women with TB were selected from the cohort, and incidence rates (IRs) in pregnancy and post-partum were compared with rates outside pregnancy.

A total of 192,801 women with a total of 264,136 pregnancies were included in the cohort study. Of 177 TB events that occurred during the study, 22 occurred during pregnancy and 22 occurred in the 180 days after pregnancy. The crude TB rate for the combined pregnancy and post-partum period was 15.4 per100,000 person years, which was significantly higher than the rate outside of pregnancy (9.1 per 100,000 person years, p=0.02). After adjustment for age, region and socio-economic status, post-partum TB risk was significantly higher than TB risk outside pregnancy (IRR 1.95, CI 1.24-3.07), whereas no significant increase during pregnancy was observed (IRR 1.29, CI 0.82-2.03).

These observations were confirmed in the SCCS analysis. Adjusting for all non-time bound confounders, the time period of observation and patients' age, the IRR of TB during pregnancy (1.03, CI 0.64-1.65) was not significantly increased compared with the risk outside of pregnancy. However, the TB risk was significantly increased in the 6 month period following pregnancy (IRR 1.61, CI 1.01-2.58, p=0.04).

The study had a few limitations, including its observational design. Administrative delay between TB diagnosis and recording of the diagnosis may have occurred. Diagnostic delays may also occur during pregnancy. Immunological changes during pregnancy gradually increase TB susceptibility and then gradually normalize after delivery. The combination of these factors may account for the failure to show a significantly increased TB risk during pregnancy in this study.

"The incidence of TB diagnosis is significantly increased post-partum, probably reflecting an increase in TB incidence during pregnancy," concluded Dr. Zenner. "Given our results, targeted screening of pregnant and post-partum women in high-risk groups may be warranted, given that delays in treatment initiation are associated with poorer outcomes for both mothers and their children."

Article adapted by Medical News Today from original press release. Source: American Thoracic Society
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10 Dec. 2011. APA

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Study Leads To Simpler Therapy For Treating Latent Tuberculosis

Main Category: Tuberculosis
Article Date: 09 Dec 2011 - 2:00 PST

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Research, led by Timothy Sterling, M.D., professor of Medicine at Vanderbilt University Medical Center, has led to an important change in CDC recommendations in the regimen for prevention of the centuries-old scourge, tuberculosis (TB). Sterling's work is published in the Dec. 8 New England Journal of Medicine (NEJM).

On Friday, Dec. 9, The Centers for Disease Control and Prevention (CDC) announced in the Morbidity and Mortality Weekly Report (MMWR) that the new regimen, which takes one-third the time of current therapy, offers an effective treatment option for many patients at high risk for developing TB. Latent TB infections result from exposure to TB, without the contagion and illness caused by the disease itself.

Up to now, the regimen for latent TB infection was daily doses of a drug called isoniazid (INH). A total of 270 daily doses were taken over the course of nine months to eradicate the bacteria, which can lie dormant in the body for years.

The study of 8,000 patients in four countries over 10 years showed that just twelve doses, given once-weekly, of INH combined with another TB drug called rifapentine was as effective. The shorter, weekly combination therapy was safe and effective, but perhaps the most important finding was the new therapy improved compliance by at least 10 percent.

"This is a game changer. Currently less than half of the people who start the current therapy complete it. The new combination would require direct observation, but more people would complete treatment," Sterling said.

The CDC said while cases of active TB are at an all-time low, approximately 4 percent of the U.S. population, or 11 million people, have latent TB. Active TB cases, which can be deadly to patients who have a compromised immune system, still occur in Nashville. To prevent a resurgence of active and infectious disease, the Metro Nashville Public Health Department's Division of TB Elimination works with an average of 700 new cases of latent TB per year.

The Metro Nashville Public Health Department was one of the sites for Sterling's study, which was funded by the Centers for Disease Control and Prevention (CDC). Other Vanderbilt investigators included Amy Kerrigan, MSN, R.N., and Alicia Wright, among others.

Sterling says continued research is important. The new treatment is not an option for all patients, and may not work well in nations where TB incidence is higher. Children under 2 were excluded from the study.

Article adapted by Medical News Today from original press release. Source: Vanderbilt University Medical Center
Visit our tuberculosis section for the latest news on this subject. Vanderbilt University Medical Center Please use one of the following formats to cite this article in your essay, paper or report:

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Vanderbilt University Medical Center. "Study Leads To Simpler Therapy For Treating Latent Tuberculosis." Medical News Today. MediLexicon, Intl., 9 Dec. 2011. Web.
9 Dec. 2011. APA

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All opinions are moderated before being included (to stop spam)

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Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here