The Francis Crick Institute
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Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries

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journal contribution
posted on 2021-08-19, 10:26 authored by Haileyesus Getahun, Alberto Matteelli, Ibrahim Abubakar, Mohamed Abdel Aziz, Annabel Baddeley, Draurio Barreira, Saskia Den Boon, Susana Marta Borroto Gutierrez, Judith Bruchfeld, Erlina Burhan, Solange Cavalcante, Rolando Cedillos, Richard Chaisson, Cynthia Bin-Eng Chee, Lucy Chesire, Elizabeth Corbett, Masoud Dara, Justin Denholm, Gerard de Vries, Dennis Falzon, Nathan Ford, Margaret Gale-Rowe, Chris Gilpin, Enrico Girardi, Un-Yeong Go, Darshini Govindasamy, Alison D Grant, Malgorzata Grzemska, Ross Harris, C Robert Horsburgh, Asker Ismayilov, Ernesto Jaramillo, Sandra Kik, Katharina Kranzer, Christian Lienhardt, Philip LoBue, Knut Lönnroth, Guy Marks, Dick Menzies, Giovanni Battista Migliori, Davide Mosca, Ya Diul Mukadi, Alwyn Mwinga, Lisa Nelson, Nobuyuki Nishikiori, Anouk Oordt-Speets, Molebogeng Xheedha Rangaka, Andreas Reis, Lisa Rotz, Andreas Sandgren, Monica Sañé Schepisi, Holger J Schünemann, Surender Kumar Sharma, Giovanni Sotgiu, Helen R Stagg, Timothy R Sterling, Tamara Tayeb, Mukund Uplekar, Marieke J van der Werf, Wim Vandevelde, Femke van Kessel, Anna Van't Hoog, Jay K Varma, Natalia Vezhnina, Constantia Voniatis, Marije Vonk Noordegraaf-Schouten, Diana Weil, Karin Weyer, Robert John Wilkinson, Takashi Yoshiyama, Jean Pierre Zellweger, Mario Raviglione
Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3-4 month isoniazid plus rifampicin; or 3-4 month rifampicin alone.