Multi-drug-resistant tuberculosis secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Secondary prevention for tuberculosis includes methods for screening and early diagnosis, such as tuberculin skin test (TST) and IGRAs; and to guarantee the correct treatment regimen at the right time to prevent disease progression.

Secondary Prevention

Screening

Further information: [[:Tuberculosis screening]]

Tuberculin Skin Test

• Children with close contact with a TB confirmed case should be evaluated for tuberculosis infection.
• TST is the test of choice for screening for tuberculosis infection.

Interferon-Gamma Release Assays (IGRAs)

• IGRA can be used in place of (but not in addition to) TST in screening for M. tuberculosis infection in the following conditions:

• A patient have received BCG vaccination
• Groups that historically have poor rates of return for TST reading.

• TST preferred compared to IGRA for TB screening due to its low cost and high accessibility.

Early Diagnosis

• Early detection of tuberculosis disease is important to give treatment at the appropriate time and prevent complications.
• All patients should be routinely asked about:

• History of TB exposure, infection, or disease
• Symptoms or signs of TB disease
• Medical conditions that increase their risk for TB disease

• Patients with the following characteristics should be tested for tuberculosis:

• Cough for ≥3 weeks
• Loss of appetite
• Unexplained weight loss
• Night sweats
• Hemoptysis
• Hoarseness
• Fever
• Fatigue
• Chest pain
• Patient from an endemic area of TB

Prompt Treatment

• Empiric therapy should be started as soon as a patient has tuberculosis disease confirmed.
• Sputum specimens should be sent for culture and DST before starting treatment.

DOTS-Plus Strategy

WHO has devised a new strategy to manage MDR-TB using the second line of drugs wihin the DOTS strategy in middle and low income countries. They must be implemented in well functioning national TB programs . The best way to avoid future MDR- TB epidemics is through prevention of development of future drug resistance.