Guidelines on the Prevention and Control of Tuberculosis in Ireland

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<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCChemotherapy: The multidrug antibiotic treatment regimens used to treat active TBCompliance: see adherenceContact: A person identified as having come in contact with an active case of TB disease. The degree ofcontact is usually further defined as close and casual. The level and duration of contact usually suggests therisk of becoming infected.Contact tracing: The identification of contacts to find associated cases of TB disease, to detect peoplewith LTBI and to identify those not infected but for whom BCG vaccination might be appropriate.Conversion: A change in the result of a test for Mycobacterium tuberculosis infection that is interpreted toindicate a change from being uninfected to infected.Culture: The process of growing TB bacteria from sputum or other samples for identification and diagnosisCulture positive disease: The isolation of Mycobacterium tuberculosis complex (excluding BCG strain)from sputum, body secretions or tissueCure and completion rate: The proportion of people receiving treatment for active TB who either havenegative culture results during the continuation phase of treatment or who complete treatment withoutdocumented culture statusDirectly observed therapy (DOT): A way of helping patients to take their medicine for TB. A personreceiving DOT will meet with a healthcare worker everyday or several times a week at an agreed placee.g. the patient’s home, the TB clinic or other convenient location. The healthcare worker will observe thepatient taking their medication at this place helping to ensure that higher treatment completion rates areachieved. Sometimes someone in their family or a close friend will be able to help in a similar way to thehealthcare worker.Directly observed prophylaxis (DOP): The process whereby a health care worker or other responsibleadult e.g. family member or close friend watches the patient swallow each dose of medication for latenttuberculosis infection, helping to ensure higher treatment completion rates. DOP is also known as directlyobserved preventive therapy (DOPT). This definition is used in the Canadian Tuberculosis Standards, 6 thedition (2007).Directly observed therapy short-course (DOTS): The internationally recommended approach to TBcontrol, which forms the core of the World Health Organization (WHO) Stop TB Strategy ( 2006). The fivecomponents of DOTS are: political commitment with increased and sustained financing; case detectionthrough quality-assured bacteriology; standardised treatment with supervision and patient support;an effective drug supply and management system and a monitoring and evaluation system and impactmeasurementEarly morning specimen/sputum: Sputum from the first productive cough of the day (after waking)Elimination: The elimination of tuberculosis as a global public health problem, defined by the WHO StopTB Partnership (see www.stoptb.org/globalplan/) as an incidence of tuberculosis disease of less than 1 caseper million populationExtensively drug-resistant TB (XDR-TB): is resistance to at least isoniazid and rifampicin (i.e. MDR-TB),plus resistance to any fluoroquinolone, and any one of the following second line anti-TB injectable drugs(capreomycin, amikacin or kanamycin)Gamma–interferon test (interferon–gamma or IGRA): A blood test to diagnose LTBI (which may be usedas an alternative or an addition to tuberculin skin tests) based on detecting the response of white bloodcells to TB antigens-189-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCGastric washings: Some patients (particularly children) with suspected TB are unable to cough up anysputum. As an alternative, in a gastric lavage, saline solution is introduced into the stomach through atube, the contents are pumped out and are examined for M. tuberculosis complex bacteria.High incidence country: Any country with an incidence of TB ≥ 40 cases per 100,000 population per yearHistology: Microscopic examination of cells and clinical samplesIndex case: The initial person found to have TB whose contacts are traced. Consequently the source oftheir infection may be found, but the initial presenting patient is regarded as the index case.Induration: The soft tissue swelling that is measured when determining the TST response to purifiedprotein derivative (PPD) tuberculin. It is to be distinguished from erythema, which is not measured, i.e.does not constitute a measurable reaction to the antigen.Infectious: The condition whereby the patient can transmit infection to others by virtue of the productionof infectious aerosols. Those with smear-positive cavitary and laryngeal disease are usually the mostinfectious.Inform and advise information: Information provided to patients so that they are able to recognise thesymptoms of TB and be aware of the action they should take if these symptoms arise.Latent TB Infection: A person with LTBI usually has a positive TST or interferon gamma test but no physicalfindings of TB disease and the chest X-ray is normal or only reveals evidence of healed infection i.e.granulomas or calcification in the lung, hilar lymph nodes or both. Persons with LTBI are asymptomatic andare not infectious.Mantoux test: A type of TST in which tuberculin is injected intradermally. The injection site is examined forsigns of an immune response after 2-3 days. A negative Mantoux test is ≤ 5mm. The reaction to a TST isclassified according to the individual’s risk factors (table 2.1, chapter 2).Meta-analysis: A statistical technique for combining (pooling) the results of a number of studies thataddress the same question and report on the same outcomes to produce a summary result. The aim isto derive more precise and clear information from a large data pool. It is generally more reliably likely toconfirm or refute a hypothesis than individual trialsMycobacterium tuberculosis complex: The related mycobacterial species (M. tuberculosis, M. bovis, M.africanum, M. microti, M. canetii, M. caprae or M. pinnipedii) which cause tuberculosis in humansMultidrug-resistant TB (MDR-TB): TB bacilli resistant to at least isoniazid and rifampicin with or withoutresistance to ethambutol and streptomycinNon-tuberculous mycobacteria (NTM): All mycobacterial species except those that cause tuberculosis(Mycobacterium tuberculosis [including subspecies M. canetti], M. bovis, M. africanum, M.caprae, M.microti and M. pinnipedii) and those that cause leprosy (M. leprae). These mycobacteria are ubiquitous,often found in soil and water and are usually more clinically significant in the immunocompromised patient.They are also described as atypical mycobacteria.Nucleic acid amplification test: A test to detect fragments of nucleic acid allowing rapid and specificdiagnosis of M. tuberculosis directly from a range of clinical samplesNew entrant: Anyone coming to work or settle in Ireland. This will include immigrants, refugees, asylumseekers, students and people on work permits. This group may also include Irish born persons or Irishcitizens re-entering the country after a prolonged stay in a high incidence country.Polymerase chain reaction (PCR): The process whereby genetic material is amplified and subsequentlyevaluated for the presence of DNA material to identify various mycobacterial species-190-
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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