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Dick Menzies - One of the best experts on this subject based on the ideXlab platform.
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New short regimens for Latent Tuberculosis treatment: safety first!
The European respiratory journal, 2018Co-Authors: Dick Menzies, Anete TrajmanAbstract:Safety must be the first consideration in evaluating any new regimen for Latent Tuberculosis treatment. Caution is needed when using isoniazid plus rifapentine, once or twice weekly, in individuals aged over 50 years, even for a short period.http://ow.ly/T0fT30mOs7m
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Using a quality improvement approach to improve care for Latent Tuberculosis infection.
Expert review of anti-infective therapy, 2018Co-Authors: Leila Barss, Dick MenziesAbstract:ABSTRACTIntroduction: Latent Tuberculosis infection (LTBI) management is recognized as a key component of the World Health Organization End Tuberculosis Strategy. The term ‘cascade of care in LTBI’...
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The cascade of care in diagnosis and treatment of Latent Tuberculosis infection: a systematic review and meta-analysis
The Lancet. Infectious diseases, 2016Co-Authors: Hannah Alsdurf, Haileyesus Getahun, Philip C. Hill, Alberto Matteelli, Dick MenziesAbstract:Summary Background WHO estimates that a third of the world's population has Latent Tuberculosis infection and that less than 5% of those infected are diagnosed and treated to prevent Tuberculosis. We aimed to systematically review studies that report the steps from initial Tuberculosis screening through to treatment for Latent Tuberculosis infection, which we call the Latent Tuberculosis cascade of care. We specifically aimed to assess the number of people lost at each stage of the cascade. Methods We did a systematic review and meta-analysis of study-level observational data. We searched MEDLINE (via OVID), Embase, and Health Star for observational studies, published between 1946 and April 12, 2015, that reported primary data for diagnosis and treatment of Latent Tuberculosis infection. We did meta-analyses using random and fixed effects analyses to identify percentages of patients with Latent Tuberculosis infection completing each step in the cascade. We also estimated pooled proportions in subgroups stratified by different characteristics of interest to assess risk factors for losses. Results We identified 58 studies, describing 70 distinct cohorts and 748 572 people. Steps in the cascade associated with greater losses included completion of testing (71·9% [95% CI 71·8–72·0] of people intended for screening), completion of medical evaluation (43·7% [42·5–44·9]), recommendation for treatment (35·0% [33·8–36·4]), and completion of treatment if started (18·8% [16·3–19·7]). Steps with fewer losses included receiving test results, referral for evaluation if test positive, and accepting to start therapy if recommended. Factors associated with fewer losses were immune-compromising medical indications, being part of contact investigations, and use of rifamycin-based regimens. Interpretation We identify major losses at several steps in the cascade of care for Latent Tuberculosis infection. Improvements in management of Latent Tuberculosis will need programmatic approaches to address the losses at each step in the cascade. Funders Canadian Institutes of Health Research.
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Adverse events associated with treatment of Latent Tuberculosis in the general population
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2011Co-Authors: Benjamin M Smith, Kevin Schwartzman, Gillian Bartlett, Dick MenziesAbstract:Background Guidelines recommend treatment of Latent Tuberculosis in patients at increased risk for active Tuberculosis. Studies investigating the association of therapy with serious adverse events have not included the entire treated population nor accounted for comorbidities or occurrence of similar events in the untreated general population. Our objective was to estimate the risk of adverse events requiring hospital admission that were associated with therapy for Latent Tuberculosis infection in the general population. Methods Using administrative health data from the province of Quebec, we created a historical cohort of all residents dispensed therapy for Latent Tuberculosis between 1998 and 2003. Each patient was matched on age, sex and postal region with two untreated residents. The observation period was 18 months (from 6 months before to 12 months after initiation of therapy). The primary outcome was hospital admission for therapy-associated adverse events. Results During the period of observation, therapy for Latent Tuberculosis was dispensed to 9145 residents, of whom 95% started isoniazid and 5% started rifampin. Pretreatment comorbid illness was significantly more common among patients receiving such therapy compared with the matched untreated cohort. Of all patients dispensed therapy, 45 (0.5%) were admitted to hospital for a hepatic event compared with 15 (0.1%) of the untreated patients. For people over age 65 years, the odds of hospital admission for a hepatic event among patients treated for Latent Tuberculosis infection was significantly greater than among matched untreated people after adjustment for comorbidities (odds ratio [OR] 6.4, 95% CI 2.2–18.3). Excluding patients with comorbid illness, there were two excess admissions to hospital for hepatic events per 100 patients initiating therapy compared with the rate among untreated people over 65 years (95% CI 0.1–3.87). Interpretation The risk of adverse events requiring hospital admission increased significantly among patients over 65 years receiving treatment for Latent Tuberculosis infection. The decision to treat Latent Tuberculosis infection in elderly patients should be made after careful consideration of risks and benefits.
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Saudi guidelines for testing and treatment of Latent Tuberculosis infection.
Annals of Saudi medicine, 2010Co-Authors: Hamdan Al Jahdali, Salim Baharoon, Abdullah A. Abba, Ziad A. Memish, Abdulrahman A. Alrajhi, Ali Albarrak, Qais A. Haddad, Mohammad Al Hajjaj, Madhukar Pai, Dick MenziesAbstract:Pulmonary Tuberculosis is a common disease in Saudi Arabia. As most cases of Tuberculosis are due to reactivation of Latent infection, identification of individuals with Latent Tuberculosis infecti...
Haileyesus Getahun - One of the best experts on this subject based on the ideXlab platform.
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national policies on the management of Latent Tuberculosis infection review of 98 countries
Bulletin of The World Health Organization, 2018Co-Authors: Ann Jagger, Yohhei Hamada, Silke Reiterkaram, Haileyesus GetahunAbstract:Objective To review policies on management of Latent Tuberculosis infection in countries with low and high burdens of Tuberculosis. Methods We divided countries reporting data to the World Health Organization (WHO) Global Tuberculosis Programme into low and high Tuberculosis burden, based on WHO criteria. We identified national policy documents on management of Latent Tuberculosis through online searches, government websites, WHO country offices and personal communication with programme managers. We made a descriptive analysis with a focus on policy gaps and deviations from WHO policy recommendations. Findings We obtained documents from 68 of 113 low-burden countries and 30 of 35 countries with the highest burdens of Tuberculosis or human immunodeficiency virus (HIV)-associated Tuberculosis. Screening and treatment of Latent Tuberculosis infection in people living with HIV was recommended in guidelines of 29 (96.7%) high-burden and 54 (79.7%) low-burden countries. Screening for children aged < 5 years with household Tuberculosis contact was the policy of 25 (83.3%) high- and 28 (41.2%) low-burden countries. In most high-burden countries the recommendation was symptom screening alone before treatment, whereas in all low-burden countries it was testing before treatment. Some low-burden countries' policies did not comply with WHO recommendations: nine (13.2%) recommended Tuberculosis preventive treatment for travellers to high-burden countries and 10 (14.7%) for patients undergoing abdominal surgery. Conclusion Lack of solid evidence on certain aspects of management of Latent Tuberculosis infection results in national policies which vary considerably. This highlights a need to advance research and develop clear, implementable and evidence-based WHO policies.
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National policies on the management of Latent Tuberculosis infection: review of 98 countries.
Bulletin of the World Health Organization, 2018Co-Authors: Ann Jagger, Silke Reiter-karam, Yohhei Hamada, Haileyesus GetahunAbstract:Objective To review policies on management of Latent Tuberculosis infection in countries with low and high burdens of Tuberculosis. Methods We divided countries reporting data to the World Health Organization (WHO) Global Tuberculosis Programme into low and high Tuberculosis burden, based on WHO criteria. We identified national policy documents on management of Latent Tuberculosis through online searches, government websites, WHO country offices and personal communication with programme managers. We made a descriptive analysis with a focus on policy gaps and deviations from WHO policy recommendations. Findings We obtained documents from 68 of 113 low-burden countries and 30 of 35 countries with the highest burdens of Tuberculosis or human immunodeficiency virus (HIV)-associated Tuberculosis. Screening and treatment of Latent Tuberculosis infection in people living with HIV was recommended in guidelines of 29 (96.7%) high-burden and 54 (79.7%) low-burden countries. Screening for children aged
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The cascade of care in diagnosis and treatment of Latent Tuberculosis infection: a systematic review and meta-analysis
The Lancet. Infectious diseases, 2016Co-Authors: Hannah Alsdurf, Haileyesus Getahun, Philip C. Hill, Alberto Matteelli, Dick MenziesAbstract:Summary Background WHO estimates that a third of the world's population has Latent Tuberculosis infection and that less than 5% of those infected are diagnosed and treated to prevent Tuberculosis. We aimed to systematically review studies that report the steps from initial Tuberculosis screening through to treatment for Latent Tuberculosis infection, which we call the Latent Tuberculosis cascade of care. We specifically aimed to assess the number of people lost at each stage of the cascade. Methods We did a systematic review and meta-analysis of study-level observational data. We searched MEDLINE (via OVID), Embase, and Health Star for observational studies, published between 1946 and April 12, 2015, that reported primary data for diagnosis and treatment of Latent Tuberculosis infection. We did meta-analyses using random and fixed effects analyses to identify percentages of patients with Latent Tuberculosis infection completing each step in the cascade. We also estimated pooled proportions in subgroups stratified by different characteristics of interest to assess risk factors for losses. Results We identified 58 studies, describing 70 distinct cohorts and 748 572 people. Steps in the cascade associated with greater losses included completion of testing (71·9% [95% CI 71·8–72·0] of people intended for screening), completion of medical evaluation (43·7% [42·5–44·9]), recommendation for treatment (35·0% [33·8–36·4]), and completion of treatment if started (18·8% [16·3–19·7]). Steps with fewer losses included receiving test results, referral for evaluation if test positive, and accepting to start therapy if recommended. Factors associated with fewer losses were immune-compromising medical indications, being part of contact investigations, and use of rifamycin-based regimens. Interpretation We identify major losses at several steps in the cascade of care for Latent Tuberculosis infection. Improvements in management of Latent Tuberculosis will need programmatic approaches to address the losses at each step in the cascade. Funders Canadian Institutes of Health Research.
Carol Dukes Hamilton - One of the best experts on this subject based on the ideXlab platform.
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Safety of 2 months of rifampin and pyrazinamide for treatment of Latent Tuberculosis.
American journal of respiratory and critical care medicine, 2002Co-Authors: Jason E. Stout, John J. Engemann, Allen C. Cheng, Ellen R. Fortenberry, Carol Dukes HamiltonAbstract:An alternative regimen for the treatment of Latent Tuberculosis infection is 2 months of rifampin and pyrazinamide, but some patients have died of hepatitis associated with this therapy. One hundred fourteen patients received rifampin/pyrazinamide in Wake County, North Carolina, between December 1999 and May 2002; 60.5% of these patients were homeless, and at least 17% drank alcohol to excess. Seventy-seven patients (67.5%) completed a full 2-month course. Nine patients had a history of viral hepatitis or chronic liver disease. Four of 114 (3.5%; 95% confidence interval, 1.0-8.7%) patients developed hepatitis on therapy, and another two had symptoms consistent with hepatitis but did not report for laboratory testing (total confirmed plus suspected hepatitis rate 5.3%; 95% confidence interval, 2.0-11.1%). No patient who developed hepatitis had a history of viral hepatitis or liver disease, and none had been previously treated with isoniazid. No patients died or were hospitalized due to drug side effects. Rifampin/pyrazinamide was associated with a significantly higher rate of hepatitis than previously described with isoniazid therapy for Latent Tuberculosis but resulted in a high completion rate. The rifampin/pyrazinamide regimen for Latent Tuberculosis infection may be useful for high-risk, traditionally nonadherent patient groups, but careful monitoring for toxicity is required.
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Antepartum or postpartum isoniazid treatment of Latent Tuberculosis infection.
Obstetrics & Gynecology, 2000Co-Authors: Kim A. Boggess, Evan R. Myers, Carol Dukes HamiltonAbstract:Abstract Objective: To compare health outcomes and costs of different strategies for treatment of Latent Tuberculosis infection in pregnancy. Methods: Using a Markov decision-analysis model, the following three strategies were evaluated for treatment of Latent Tuberculosis infection in pregnancy, defined as positive tuberculin skin reaction of 10 mm or greater and negative chest radiograph: no treatment, antepartum isoniazid administration, in which women were given 300 mg of isoniazid with pyridoxine beginning at 20 weeks’ gestation for 6 months; and postpartum isoniazid, in which women were given isoniazid and pyridoxine for 6 months after delivery. Sensitivity analyses were performed for a wide range of probability and cost estimates, and considered discount rates. Results: Under base-case assumptions, the fewest cases of Tuberculosis within the cohort occurred with antepartum treatment (1400 per 100,000) compared with no treatment (3300 per 100,000) or postpartum treatment (1800 per 100,000). Antepartum treatment resulted in a marginal increase in life expectancy due to the prevented cases of Tuberculosis, despite more cases of isoniazid-related hepatitis and deaths, compared with no treatment or postpartum treatment. Antepartum treatment was the least expensive. Only if the case-fatality rate for Tuberculosis was tenfold lower than the base-case and the risk of fatal hepatitis tenfold higher did antepartum treatment become the least advantageous strategy. Conclusion: Rather than delaying treatment until postpartum, consideration for antepartum treatment of Latent Tuberculosis during pregnancy should be given. If isoniazid is not administered antepartum, then efforts to improve postpartum compliance should be instituted, as either antepartum or postpartum treatment is better than no treatment.
Tm O'connor - One of the best experts on this subject based on the ideXlab platform.
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Impact of Quantiferon TB Gold intensity response in active over Latent Tuberculosis
European Respiratory Journal, 2012Co-Authors: Faheem Khan, Orla Cotter, Jim Clair, David R Curran, Tm O'connorAbstract:We sought to determine whether the intensity of response in patients with a positive Quantiferon-TB Gold assay (QTF) was predictive of active over Latent Tuberculosis, and whether other factors determined the intensity of response. We analyzed positive Quantiferon assays (Cellestis, Carnegie, Australia) performed between July 2009 and April 2011 in the Mercy University Hospital, Cork. The group consisted of 94 patients with Latent Tuberculosis and 35 patients with active Tuberculosis. There was no difference in the intensity of response between patients with Latent and active Tuberculosis (p=0.1589). In patients with Latent Tuberculosis, there were no correlations between age (p=0.353), sex (p=0.476), smoking status (p=0.323), contact history (p=0.612), Mantoux response (p=0.055), Irish nationality (p=0.768), previous BCG vaccination (p=0.504), WCC (p=0.187), peripheral lymphocyte count (p=0.786), neutrophil count (p=0.157) and the intensity of QTF response. Similarly in active TB group there is no correlation found between mentioned variables and QTF response. The intensity of QTF response does not help to differentiate active from Latent Tuberculosis. In adults with Tuberculosis, the intensity of QTF response is not influenced by age, sex, smoking, remoteness of contact history, Mantoux response, nationality, CXR abnormalities, BCG vaccination and peripheral lymphocyte count.
Eric J. Rubin - One of the best experts on this subject based on the ideXlab platform.
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Latent Tuberculosis Infection in the United States
The New England journal of medicine, 2011Co-Authors: C. Robert Horsburgh, Eric J. RubinAbstract:This article reviews recommended strategies for screening and treatment of Latent Tuberculosis in the United States, with attention to the role of interferon-γ–release assays in screening and of shorter treatment regimens (as compared with a 9-month course of isoniazid).
