WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment: Module 1: prevention [Internet]. Geneva: World Health Organization; 2020. PMID: 32186832.
Migliori GB, Sotgiu G, Rosales-Klintz S, et al. ERS/ECDC Statement: European Union standards for tuberculosis care, 2017 update. Eur Respir J. 2018 May 17;51(5). pii: 1702678. doi: 10.1183/13993003.02678-2017. Print 2018 May. PubMed PMID: 29678945.
Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017 Nov;72(Suppl 2):ii1-ii64. doi: 10.1136/thoraxjnl-2017-210927. Review. PubMed PMID: 29054853.
Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2017 Jan 15;64(2):111-115. doi: 10.1093/cid/ciw778. PubMed PMID: 28052967; PubMed Central PMCID: PMC5504475.
Sotgiu G, Nahid P, Loddenkemper R, Abubakar I, Miravitlles M, Migliori GB. The ERS-endorsed official ATS/CDC/IDSA clinical practice guidelines on treatment of drug-susceptible tuberculosis. Eur Respir J. 2016 Oct;48(4):963-971. doi: 10.1183/13993003.01356-2016. Epub 2016 Sep 1. PubMed PMID: 27587550.
Public Health Agency of Canada, Canadian Thoracic Society, The Lung Association. Canadian Tuberculosis Standards, 7th Edition. 2013. http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tb-canada-7/assets/pdf/tb-standards-tb-normes-pref-eng.pdf. Published 2014. Accessed January 13, 2017.
World Health Organization. Treatment of tuberculosis: guidelines. http://www.who.int/tb/publications/tb_treatmentguidelines/en/. Published 2010. Accessed January 13, 2017.
Griffith DE, Aksamit T, Brown-Elliott BA, et al; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416. Review. Erratum in: Am J Respir Crit Care Med. 2007 Apr 1;175(7):744-5. Dosage error in article text. PubMed PMID: 17277290.
This chapter is divided into subchapters to provide information on 3 related but discreet topics in tuberculosis (TB):
1) Active TB disease refers to an active disease state that has resulted from infection with Mycobacterium tuberculosis. An individual with active disease may present with systemic and/or respiratory symptoms. The disease can be pulmonary or extrapulmonary. If pulmonary disease is present, infection can be spread to others via airborne droplet nuclei. Since the disease is often present for several weeks or months before the onset of telltale signs or symptoms, transmission to susceptible individuals may occur before the illness is apparent. The gold standard for diagnosis of active TB disease is microbiologic culture testing of sputum and other specimens yielded from affected sites. Treatment with combination drug therapy is usually highly successful in achieving cure.
2) Latent TB infection refers to a state of inactive infection due to M tuberculosis without the presence of the disease. An individual with latent TB infection is asymptomatic and cannot transmit infection to others. Individuals who become infected are at risk of progressing to active disease. About 5% of newly infected hosts (often those with immune dysfunction) are unable to contain the infection and therefore proceed to early disease progression within the first 18 to 24 months (primary TB). The rest of the infected hosts are classified as being in a state of latent TB infection. The majority of persons with latent TB infection will remain disease-free for life, but ~5% of all infected hosts will develop late disease progression with the development of active TB disease (postprimary or reactivation TB) sometime after 18 to 24 months of acquiring infection. Detection of latent TB infection occurs through targeted screening of high-risk groups using the TB skin test and/or the interferon gamma release assay blood test. Treatment with preventative drug therapy is successful in reducing the risk of reactivation. The decision to treat latent TB infection is individualized and must balance the risk of reactivation with the risk of potential drug toxicities.
3) Nontuberculous mycobacteria (NTM) diseases refer to conditions related to mycobacterium other than the M tuberculosis complex, which are of unknown or lesser pathogenicity. NTM can exist as a contaminant or colonizer, or can cause disease. There are some shared features between the clinical presentation of active M tuberculosis disease and NTM disease. Unlike active TB, NTM organisms cannot be transmitted from human to human. The most common organ of involvement is the lung, although extrapulmonary sites can also be affected, especially in immune-deficient states. Detection is through microbiologic culture, but clinical and radiographic assessments are necessary to differentiate between the states of colonization and disease. Combination drug therapy is used on selective individuals who manifest symptomatic disease of an advanced or progressive nature. The clinical response to therapy is often suboptimal.