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/HPSCopacification which does not improve after a course of antibiotics should be investigated for TB. More thanhalf of children with radiological pulmonary disease are asymptomatic (identified through contact tracing).The chest X-ray is typically “sicker” than the child. 77-25-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSC3. Management of Latent TB InfectionAn estimated one-third of the world’s population is infected with M. tuberculosis. Some of these infectionsare latent TB infections (LTBI) i.e. when the bacteria remain inactive in the body, although they can bereactivated later. People with LTBI have no symptoms and are not infectious but they usually have apositive TST or IGRA and may develop active TB disease if not treated. Approximately 10-15% of thosepresumed infected may eventually develop the active disease at some point in their lives. Approximately50% of those persons who develop clinical disease do so within five years of the initial infection, with theremaining 50% reactivating over ensuing years. 26If co-morbidity develops impairing the immune system e.g. HIV infection, this risk further increases. In caseswhere there is a long period documented between the exposure and the development of disease, dormantbacilli are thought to remain in either the lung or other sites, which can be ‘reactivated’ if favourablecircumstances for the organism occur. However not everyone with LTBI will develop active TB disease. Themajority of exposed persons will kill off the TB bacteria and will be left only with a positive skin test as amarker of exposure.LTBI should be treated to prevent the development of active TB disease with its associated risk of thespread of TB and the development of outbreaks. Treatment of people with LTBI, including those with HIVco-infection, effectively reduces the risk of progression to active TB disease. However, there is no accuratetool to predict which individuals with LTBI are at greatest risk of developing active disease.A person with LTBI usually has a positive TST or IGRA but no physical findings of TB disease and the chestX-ray is normal or only reveals evidence of healed infection i.e. granulomas or calcification in the lung, hilarlymph nodes or both. Persons with LTBI can develop TB disease later in life.The following table outlines the difference between LTBI and active TB disease (table 3.1).Table 3.1: Differences between LTBI and active TB diseaseA person with latent TB infectionNo symptomsUsually have a positive skin test or blood testSputum is TB smear and culture negativeNormal chest X-ray or evidence of healedinfectionNot infectiousA person with active TB diseaseHas symptoms which may include• Unexplained productive cough lasting 3weeks or more• Chest pain• Productive cough/haemoptysis• Weakness or fatigue• Weight loss• Anorexia• Chills• Fever• Night sweatsUsually have a positive skin test of blood testMay have a positive sputum smear/cultureMay have an abnormal chest X-rayMay be infectious3.1 Epidemiology of LTBIIn the USA, it is estimated that approximately 10 to 15 million persons have LTBI. Particularly high rates ofinfection are found among the urban poor such as intravenous drug users and homeless persons. 78;79 Theelderly also have high rates of positive TST tests attributable to the much higher risk of TB infection during-26-
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25-27 Middle Gardiner Street Dublin
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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