Abstract
The optimal treatment for latent tuberculosis infection (LTBI) in subjects exposed to multidrug-resistant (MDR) tuberculosis (TB) remains unclear, and the change in response of the QuantiFERON-TB Gold In-Tube (QTB-IT) test during and after treatment is unknown. Between May 2010 and August 2010, 39 prisoners at the ‘Casa Circondariale’ of Modena, Italy, were exposed to a patient with active pulmonary MDR TB. All contacts were tested with the tuberculin skin test and QTB-IT. Upon exclusion of active TB, subjects positive to both tests were offered 6 months' treatment with pyrazinamide (PZA) and levofloxacin (LVX). QTB-IT testing was repeated at 3 and 6 months after initial testing in all subjects who were offered LTBI treatment. Seventeen (43.5%) of 39 subjects tested positive to both tuberculin skin test and QTB-IT test, and 12 (70.5%) agreed to receive therapy with PZA and LVX at standard doses. Only five (41.6%) of 12 subjects completed 6 months' treatment. Reasons for discontinuation were asymptomatic hepatitis, gastritis and diarrhoea. The QTB-IT values decreased in all subjects who completed the treatment, in two (33%) of six of those who received treatment for less than 3 months and in one (50%) of two patients who discontinued therapy after 3 months. The QTB-IT test results never turned negative. Despite the small number of subjects, the study confirmed that PZA plus LVX is a poorly tolerated option for MDR LTBI treatment. We observed a large degree of variation in the results of the QTB-IT test results among participants. The study confirmed that the interferon gamma release assay is not a reliable tool for monitoring the treatment of MDR LTBI in clinical practice.
Highlights
Multidrug-resistant (MDR) tuberculosis (TB) is defined as Mycobacterium tuberculosis that is resistant at least to isoniazid (INI) and rifampicin (RIF)
Some reports have highlighted the potential hepatotoxicity of combined treatments of PZA plus ETB and PZA plus levofloxacin (LVX) for MDR latent TB infection (LTBI) [5,6], inducing the World Health Organization and the international community to change the approach to the contacts of MDR TB cases, preferring a careful clinical follow-up of 2 years rather than antibiotic treatment [7]
The patients who received LTBI treatment had a mean weight of 70 kg, and all were negative for HIV, hepatitis C virus and hepatitis B virus infection
Summary
Multidrug-resistant (MDR) tuberculosis (TB) is defined as Mycobacterium tuberculosis that is resistant at least to isoniazid (INI) and rifampicin (RIF). In drug-susceptible TB, preventive therapy in individuals with latent TB infection (LTBI) has been shown to be. The treatment recommended for LTBI in contacts exposed to MDR TB was pyrazinamide (PZA) combined with either ethambutol (ETB) or a fluoroquinolone [3]. These recommendations were supported by expert opinion but not by controlled trials [4]. Some reports have highlighted the potential hepatotoxicity of combined treatments of PZA plus ETB and PZA plus levofloxacin (LVX) for MDR LTBI [5,6], inducing the World Health Organization and the international community to change the approach to the contacts of MDR TB cases, preferring a careful clinical follow-up of 2 years rather than antibiotic treatment [7]
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