Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Faculty of Medicine, Leiden University, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Eur J Clin Microbiol Infect Dis. 2020 Jul;39(7):1329-1337. doi: 10.1007/s10096-020-03850-7. Epub 2020 Feb 20.
Screening for latent tuberculosis infection (LTBI) is indicated before immunosuppressive therapies but is complicated by lack of a gold standard and limited by, e.g., immunosuppression. This study aimed to investigate a series of patients diagnosed with LTBI during screening before immunosuppressive therapy, describing how the use of diagnostic tests and treatment evolved over time. This retrospective cohort study included all individuals diagnosed with LTBI during screening before intended immunosuppressive therapy in a tertiary care hospital between January 2000 and December 2017. Evidence for LTBI, including history, tuberculin skin test (TST), QuantiFERON (QFT) result and suggestive lesions on chest radiography (CXR), and CT scan if available, was analyzed. The study included 295 individuals with LTBI, with median follow-up of 3.8 years (IQR 1.7-7.4 years). During screening, TST, QFT, and CXR were positive in 80.8%, 53.4%, and 22.7%, respectively. Chest CT revealed lesions associated with past tuberculosis infection in around 70%, significantly more frequent than CXR. In patients diagnosed with LTBI, we observed that the use of TST declined over time whereas the use of QFT increased, and that isoniazid was replaced with rifampicin as preferential treatment. Preventive treatment was started in 82.3%, of whom 88.6% completed treatment. During follow-up, no individuals developed active tuberculosis. The diagnosis of LTBI was based on history, TST, QFT, and/or CXR in nearly every possible combination, but mostly on TST and QFT. The most striking trends were the decreased use of TST, increased use of QFT, and the replacement of isoniazid with rifampicin for treatment.
在接受免疫抑制治疗前进行潜伏性结核感染（LTBI）筛查，但缺乏金标准且受到免疫抑制等因素的限制。本研究旨在调查在接受免疫抑制治疗前筛查中诊断为 LTBI 的一系列患者，描述诊断检测和治疗随时间的变化。这项回顾性队列研究纳入了 2000 年 1 月至 2017 年 12 月期间在一家三级保健医院接受计划免疫抑制治疗前筛查中诊断为 LTBI 的所有个体。分析了 LTBI 的证据，包括病史、结核菌素皮肤试验（TST）、QuantiFERON（QFT）结果以及胸部 X 线（CXR）上的提示性病变，如果有 CT 扫描也包括在内。该研究纳入了 295 例 LTBI 患者，中位随访时间为 3.8 年（IQR 1.7-7.4 年）。在筛查期间，TST、QFT 和 CXR 的阳性率分别为 80.8%、53.4%和 22.7%。胸部 CT 显示约 70%的患者存在与既往结核感染相关的病变，明显多于 CXR。在诊断为 LTBI 的患者中，我们观察到 TST 的使用随时间推移而减少，而 QFT 的使用增加，异烟肼被利福平取代作为首选治疗。预防性治疗开始于 82.3%的患者，其中 88.6%完成了治疗。在随访期间，没有患者发生活动性结核病。LTBI 的诊断基于病史、TST、QFT 和/或 CXR 的几乎所有可能的组合，但主要基于 TST 和 QFT。最显著的趋势是 TST 的使用减少，QFT 的使用增加，以及用利福平取代异烟肼进行治疗。
