Abstract
In 2014 the World Health Organization adopted a new strategy for tuberculosis control – infectious disease with the highest mortality in the world after AIDS. This new strategy – The End TB Strategy – is aimed to reducing tuberculosis disease by 90% and tuberculosis mortality by 95%, so that by 2035 TB is no longer considered a problem global public health. The World Health Organization report on tuberculosis published in 2014 is estimated that about one third of the world population is infected with M. tuberculosis (approx. 2 billion); 5-10% of them will develop active disease, thus fullfiling the TB pandemia. It is therefore an essential objective to diagnose these cases of latent tuberculosis infection and to establish precise criteria of the latent TB infection treatment. Tuberculin skin test is the most important test for emphasis of TB infection in an organism. The results obtained in recent years in mycobacterial genomics and human cell immunology have led to the development of other tests that detect tuberculosis infection, of which the most commonly used is the test that measures the release of IFN-γ (Interferon gamma-releasing assay IGRA). Any patient with increased risk of infection to disease progression and who has a positive skin test is a candidate for treatment. Immuno-compromised patients (HIV infected, treatment with anti-TNF, organ transplantation, immunosuppressive medication) with LTBI have a higher risk of reactivation. Immuno-compromised patients with LTBI should receive treatment.
Highlights
In 2014 the World Health Organization adopted a new strategy for tuberculosis control – infectious disease with the highest mortality in the world after AIDS
The results obtained in recent years in mycobacterial genomics and human cell immunology have led to the development of other tests that detect tuberculosis infection, of which the most commonly used is the test that measures the release of IFN-γ (Interferon gamma-releasing assay IGRA)
Any patient with increased risk of infection to disease progression and who has a positive skin test is a candidate for treatment
Summary
Există două categorii de persoane cu risc de boală activă: indivizii cu risc crescut de expunere la persoane cu boală activă, eliminatoare de bacili Koch (contacţii strânşi ai persoanelor cu tuberculoză, imigranţi recenţi din ţările cu prevalenţă înaltă, rezidenţi şi angajaţi ai instituţiilor cu risc înalt: închisori, spitale, instituţii de îngrijire a bătrânilor, a pacienţilor cu SIDA sau a celor fără adăpost) şi indivizii cu afecţiuni clinice sau ce prezintă factori asociaţi cu riscul crescut de progresia a ILTB la tuberculoză activă: infectaţii HIV, utilizatorii de droguri injectabile, persoane cu sechele TB evidente radiologic, indice de masă corporală mic (10% sub ideal), pacienţii cu silicoză, diabet zaharat, insuficienţă renală cronică sau hemodializaţi, gastrectomie sau by-pass jejuno-ileal, neoplazii, transplant de organ, tratament prelungit cu corticosteroizi orali, citostatice sau anti-TNF alfa, persoane cu conversia recentă a testului cutanat la tuberculină sau copii sub 5 ani cu rezultat pozitiv al acestui test (10-12). Sunt citaţi ca factori de risc înalt de progresie a infecţiei la boală: infecţia cu HIV (riscul de boală activă este maxim atunci când numărul de CD4 scade sub 200/mm; tuberculoza este adesea prima manifestare a infecţiei HIV, iar frecvenţa acesteia crește când CD4 scad sub 500/ mm3), transplantul de organe (asociat cu terapia imunosupresoare), silicoza, insuficienţa renală asociată cu dializa, carcinomul de cap sau de gât, infecţia recentă cu tuberculoză (în primii doi ani de la infecţie), modificările radiologice pulmonare fibronodulare; risc moderat prezintă pacienţii în tratament cu glucocorticoizi (echivalentul a mai mult de 15 mg/zi de prednison timp de cel puţin o lună) sau inhibitori de TNFα, pacienţii cu diabet, subponderali (IMC sub 20), vârstă foarte tânără de infectare (0-4 ani), fumători (1 pachet/zi) (10,12)
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