Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India.
Chest. 2012 Sep;142(3):761-773. doi: 10.1378/chest.12-0142.
About one-third of the world population has latent TB infection (LTBI), the majority of which is distributed in 22 high-burden countries. Early diagnosis and treatment of active TB remains the top priority in resource-poor countries with high TB prevalence. Notwithstanding, because LTBI contributes significantly to the pool of active TB cases later on, its diagnosis and treatment is essential, especially in high-risk groups. The lack of a gold standard and several limitations of currently available tools, namely the tuberculin skin test and interferon-γ release assays, are major constraints for LTBI diagnosis. In areas with high TB prevalence, interferon-γ release assays have not shown superiority over the conventional tuberculin skin test and are yet to be systematically studied. Decisions regarding LTBI treatment with isoniazid preventive therapy should be made, keeping in mind the high prevalence of isoniazid resistance in these settings. Although efforts to shorten the LTBI treatment duration are encouraging, most trials have focused on adherence and toxicity. Future trials on short-duration regimens in high-burden settings should address drug efficacy issues as well. LTBI management, therefore, should comprise a targeted screening approach and individualization of LTBI treatment protocols. In addition, efforts should focus on airborne infection control measures in high-burden countries. A high prevalence of drug-resistant TB, the HIV epidemic, and delays in the diagnosis of active TB cases are other major concerns in areas of high TB prevalence. There is ample space for further research in these countries, whose outcomes may strengthen future national guidelines.
世界上约有三分之一的人口患有潜伏性结核感染（LTBI），其中大部分分布在 22 个高负担国家。在结核患病率高的资源匮乏国家，早期诊断和治疗活动性结核仍然是重中之重。然而，由于 LTBI 后来大大增加了活动性结核病例的数量，因此对其进行诊断和治疗至关重要，尤其是在高危人群中。缺乏金标准和目前可用工具（即结核菌素皮肤试验和干扰素-γ释放试验）的几个限制，是 LTBI 诊断的主要障碍。在结核患病率高的地区，干扰素-γ释放试验并未显示优于传统的结核菌素皮肤试验，并且尚未进行系统研究。在这些情况下，决定是否使用异烟肼预防性治疗 LTBI 时，应考虑到这些环境中异烟肼耐药率高的问题。尽管缩短 LTBI 治疗时间的努力令人鼓舞，但大多数试验都集中在依从性和毒性方面。未来在高负担地区进行的关于短疗程方案的试验也应解决药物疗效问题。因此，LTBI 管理应包括有针对性的筛查方法和 LTBI 治疗方案的个体化。此外，应重点关注高负担国家的空气传播感染控制措施。高耐药结核的流行、艾滋病毒的流行以及活动性结核病例的诊断延迟，是结核高负担地区的其他主要问题。这些国家有很大的研究空间，其结果可能会加强未来的国家指南。
