The physician orders a chest x-ray (CXR) examination and informs B.A. that the image is clear, showing no signs of active TB infection
He tells her that she has class 2 TB, or a latent TB infection (LTBI), and that he will report her condition to the local public health department.
What is a LTBI?
What parameters determine whether treatment is initiated for LTBI?
Is B.A. a candidate for LTBI treatment? State your rationale.
Persons with LTBI are infected with M. tuberculosis but do not have active TB disease; they do not
feel sick or have any symptoms. The only sign of a TB infection is a positive reaction to the tuberculin
skin test or to TB blood tests. Persons with LTBI are not infectious and cannot spread TB infection
to others. Overall, about 5% to 10% of patients with latent disease will develop active TB disease
at some time in their lives. About half of those people who develop active TB will do so within the
first 2 years of infection. For persons whose immune systems are weak, especially those with HIV
infection, the risk of developing active TB disease is considerably higher.
Persons in the following high-risk groups should be treated for LTBI if their reaction to the Mantoux
tuberculin skin test is greater than or equal to 5 mm:
• HIV-infected persons
• Recent contacts of a TB patient
• Persons with fibrotic changes on chest radiograph consistent with old TB
• Patients with organ transplants or who are immunosuppressed
In addition, persons in the following high-risk groups should be considered for treatment of LTBI if
their reaction to the Mantoux tuberculin skin test is greater than or equal to 10 mm:
• Recent arrivals (less than 5 years) from high-prevalence countries
• Injection drug users
• Residents and employees of high-risk congregate settings (e.g., correctional facilities, nursing
homes, homeless shelters, hospitals, and other health care facilities)
• Mycobacteriology laboratory personnel
• Persons with medical conditions that increase the risk of progression to active TB infection
• Children under 4 years of age, or children and adolescents exposed to adults in high-risk
categories
Yes. Because B.A. had a response greater than 15 mm and has a history of type II diabetes, she is at
greater risk for progressing to active TB infection and should receive treatment.
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