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Fulltext Latent tuberculosis infection in a Malaysian prison: implications for a comprehensive integrated control program in prisons

Al-Darraji HA, Kamarulzaman A, Altice FL

BMC Public Health, 2014 Jan 10;14:22.
PMID: 24405607 DOI: 10.1186/1471-2458-14-22

Prisons continue to fuel tuberculosis (TB) epidemics particularly in settings where access to TB screening and prevention services is limited. Malaysia is a middle-income country with a relatively high incarceration rate of 138 per 100,000 population. Despite national TB incidence rate remaining unchanged over the past ten years, data about TB in prisons and its contribution to the overall national rates does not exist. This survey was conducted to address the prevalence of latent TB infection (LTBI) in Malaysia's largest prison.

Matched MeSH terms: Latent Tuberculosis/epidemiology*; Latent Tuberculosis/prevention & control
Fulltext Prevalence and correlates of latent tuberculosis infection among employees of a high security prison in Malaysia

Al-Darraji HA, Tan C, Kamarulzaman A, Altice FL

Occup Environ Med, 2015 Jun;72(6):442-7.
PMID: 25794506 DOI: 10.1136/oemed-2014-102695

OBJECTIVES: Although prison employees share the same tuberculosis (TB) risk environment with prisoners, the magnitude of TB problems among prison employees is unknown in most resource-limited prisons. This survey was conducted to investigate the prevalence and correlates of tuberculin skin test (TST) positivity among employees in Malaysia's largest prison.
METHODS: Consented, full-time prison employees were interviewed using a structured questionnaire that included sociodemographic data, history of working in the correctional system and TB-related risk. TST was placed intradermally and read after 48-72 h. Induration size of ≥10 mm was considered positive. Logistic regression analyses were conducted to explore associations with TST positivity.
RESULTS: Of the 445 recruited prison employees, 420 (94.4%) had complete data. Most were young (median=30.0 years) men (88.8%) who had only worked at this prison (76.4%) for a median total employment period of 60 months (IQR 34.5-132.0). The majority were correctional officers, while civilian employees represented only 7.6% of the sample. Only 26 (6.2%) reported having ever been screened for TB since employment. Prevalence of TST positivity was 81% and was independently associated with longer (≥12 months) prison employment (AOR 4.9; 95% CI 1.5 to 15.9) and current tobacco smoking (AOR=1.9, 95% CI 1.2 to 3.2).
CONCLUSIONS: Latent TB prevalence was high in this sample, approximating that of prisoners in this setting, perhaps suggesting within prison TB transmission in this facility. Formal TB control programmes for personnel and prisoners alike are urgently needed within the Malaysian correctional system.

Matched MeSH terms: Latent Tuberculosis/etiology; Latent Tuberculosis/epidemiology*
Tuberculosis screening in a novel substance abuse treatment center in Malaysia: implications for a comprehensive approach for integrated care

Al-Darraji HA, Wong KC, Yeow DG, Fu JJ, Loeliger K, Paiji C, et al.

J Subst Abuse Treat, 2014 Feb;46(2):144-9.
PMID: 24074846 DOI: 10.1016/j.jsat.2013.08.023

People who use drugs (PWUD) represent a key high risk group for tuberculosis (TB). The prevalence of both latent TB infection (LTBI) and active disease in drug treatment centers in Malaysia is unknown. A cross-sectional convenience survey was conducted to assess the prevalence and correlates of LTBI among attendees at a recently created voluntary drug treatment center using a standardized questionnaire and tuberculin skin testing (TST). Participants (N=196) were mostly men (95%), under 40 (median age=36 years) and reported heroin use immediately before treatment entry (75%). Positive TST prevalence was 86.7%. Nine (4.6%) participants were HIV-infected. Previous arrest/incarcerations (AOR=1.1 for every entry, p<0.05) and not being HIV-infected (AOR=6.04, p=0.03) were significantly associated with TST positivity. There is an urgent need to establish TB screening and treatment programs in substance abuse treatment centers and to tailor service delivery to the complex treatment needs of patients with multiple medical and psychiatric co-morbidities.

Matched MeSH terms: Latent Tuberculosis/diagnosis*; Latent Tuberculosis/epidemiology
Genomic plasticity between human and mycobacterial DNA: A review

Danjuma L, Ling MP, Hamat RA, Higuchi A, Alarfaj AA, Marlina, et al.

Tuberculosis (Edinb), 2017 12;107:38-47.
PMID: 29050770 DOI: 10.1016/j.tube.2017.03.006

Mycobacterium tuberculosis has a remarkable ability of long-term persistence despite vigorous host immunity and prolonged therapy. The bacteria persist in secure niches such as the mesenchymal stem cells in the bone marrow and reactivate the disease, leading to therapeutic failure. Many bacterial cells can remain latent within a diseased tissue so that their genetic material can be incorporated into the genetic material of the host tissue. This incorporated genetic material reproduces in a manner similar to that of cellular DNA. After the cell division, the incorporated gene is reproduced normally and distributed proportionately between the two progeny. This inherent adoption of long-term persistence and incorporating the bacterial genetic material into that of the host tissue remains and is considered imperative for microbial advancement and chemotherapeutic resistance; moreover, new evidence indicates that the bacteria might pass on genetic material to the host DNA sequence. Several studies focused on the survival mechanism of M. tuberculosis in the host immune system with the aim of helping the efforts to discover new drugs and vaccines against tuberculosis. This review explored the mechanisms through which this bacterium affects the expression of human genes. The first part of the review summarizes the current knowledge about the interactions between microbes and host microenvironment, with special reference to the M. tuberculosis neglected persistence in immune cells and stem cells. Then, we focused on how bacteria can affect human genes and their expression. Furthermore, we analyzed the literature base on the process of cell death during tuberculosis infection, giving particular emphasis to gene methylation as an inherited process in the neutralization of possibly injurious gene components in the genome. The final section discusses recent advances related to the M. tuberculosis interaction with host epigenetic circuitry.

Matched MeSH terms: Latent Tuberculosis/drug therapy; Latent Tuberculosis/genetics*; Latent Tuberculosis/immunology; Latent Tuberculosis/microbiology*
Generation of a T cell receptor (TCR)-like single domain antibody (sDAb) against a Mycobacterium Tuberculosis (Mtb) heat shock protein (HSP) 16kDa antigen presented by Human Leukocyte Antigen (HLA)-A*02

Dass SA, Norazmi MN, Dominguez AA, Miguel MESGS, Tye GJ

Mol Immunol, 2018 09;101:189-196.
PMID: 30007228 DOI: 10.1016/j.molimm.2018.07.001

The discovery of heat shock protein 16 kDa antigen protein has deepen the understanding of latent tuberculosis since it was found to be primarily expressed by Mycobacterium tuberculosis during latent phase leading to the rapid optimization and development in terms of diagnosis and therapeutics. Recently, T cell receptor-like antibody has been explored extensively targeting various diseases due to its dual functionality (T cell receptor and antibody). In this study, a TCR-like domain antibody (A2/Ab) with the binding capacity to Mtb heat shock protein (HSP) 16 kDa antigen presented by major histocompatible complex (MHC) HLA-A*02 was successfully generated via biopanning against human domain antibody library. The generated antibody (A2/Ab) exhibited strong functionality and binding capacity against the target assuring the findings of this study to be beneficial for the development of latent tuberculosis diagnosis and immunotherapeutics in future.

Matched MeSH terms: Latent Tuberculosis
Fulltext An evaluation of treatment outcome in tuberculosis directly observed treatment short course facilities in Jigawa State, Nigeria (2010–2014)

Faisal, M., Moniruddin, C., Alauddin, A.B.M.C.

JUMMEC, 2017;20(2):1-7.
MyJurnal

Tuberculosis (TB) is a major public health problem worldwide. It is estimated that 2 billion people, a third of
the world population, have TB infection, but are not down with the disease. Globally, incident cases of TB
showed a rising trend, with a 6.6 million reported in 1990, 8.3 million in 2000, 9.24 million in 2004, and an
estimated 9.27 million incident cases in 2007. The aim of this study was to evaluate the treatment outcome of
TB patients in Nigeria in the state of Jigawa. A cross sectional retrospective study was conducted to evaluate the
treatment outcome in directly observed treatment with a short course for tuberculosis (TB DOTS) in facilities
in the state between the years 2010 to 2014. The study population were all the patients with TB, who had
access to DOTS therapy. Data were collected from the various local governmental areas for tuberculosis control
(LGA TB) register. The LGA TB control registers contained basic information of the patients, and a statistical
software SPSS-V22.0 was used to analyse the data. A total of 963 TB patients were studied. More than half
(57.4%) of the patients were male, and nearly three- fourths (71.2%) of the patients accessed care from urban
local government areas in the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis
(PTB). Among the patients, more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them
were HIV positive. This study revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria
was higher than the overall TSR of Nigeria, and the defaulter rate in this state was lower than the Nigerian
average. The aim of this study was to evaluate the treatment outcome of TB patients in Nigeria in the state
of Jigawa. A cross sectional retrospective study was conducted to evaluate the treatment outcome in directly
observed treatment with a short course for tuberculosis (TB DOTS) in facilities in the state between the years
2010 to 2014. The study population were all the patients with TB, who had access to DOTS therapy. Data were
collected from the various local governmental areas for tuberculosis control (LGA TB) register. The LGA TB
control registers contained basic information of the patients, and a statistical software SPSS-V22.0 was used
to analyse the data. A total of 963 TB patients were studied. More than half (57.4%) of the patients were
male, and nearly three- fourths (71.2%) of the patients accessed care from urban local government areas in
the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis (PTB). Among the patients,
more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them were HIV positive. This study
revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria was higher than the overall TSR
of Nigeria, and the defaulter rate in this state was lower than the Nigerian average.

Matched MeSH terms: Latent Tuberculosis
Fulltext Factors associated with tuberculosis among children and adolescents in kelantan: a cross-sectional study

Hafizuddin Awang

Malaysian Journal of Paediatrics and Child Health, 2018;24(1):1-14.
MyJurnal

Objectives: This study aimed to estimate the proportion of tuberculosis patients among children and adolescents, to describe the socio-demography and clinical factors for tuberculosis infection among children and adolescents in Kelantan from 2012 until 2015. Methods: This study was a retrospective cross-sectional study between tuberculosis and non-tuberculosis cases among children and adolescents using Tuberculosis Information System as a source population. All notified cases that fulfilled the inclusion and exclusion criteria were included in the study. Descriptive statistics, simple and multiple logistic regressions were used for data analysis. Results: Out of 5412 tuberculosis cases, 8.4% were children and adolescents group with mean age of 15. Among 322 children and adolescents with tuberculosis, majority of them were Malay (91.2%), 7.5% illiterate and 79.6% resided in non-urban area. By clinical factors, 2.8% were Human Immunodeficiency Virus (HIV) positive and 14.6% were cigarettes smokers. Older age, cigarettes smoking, female gender, Malay ethnicity, good education level and non-urban residence were the significant associated factors for tuberculosis infection among children and adolescents with AOR 1.41 (95%CI: 1.29,1.54; p

Matched MeSH terms: Latent Tuberculosis
Fulltext Knowledge and practice among nurses on management of tuberculosis in a teaching hospital

Hng, S.H., Siti Nabihah, S., Siti Nabilah, S.

Medicine & Health, 2018;13(1):153-164.
MyJurnal

Tuberculosis (TB) has become a worldwide public concern with 10.4 million new cases reported in 2015 and 1.4 million deaths. More importantly, an increase in trend in TB incidence among healthcare workers has become a major concern. Therefore, the present study was conducted to explore the knowledge and practice towards TB and the factors associated with it among nurses in a teaching hospital. The present study used cross-sectional design and stratified sampling method. A total of 275 nurses in a teaching hospital participated in this study. The knowledge and practice on management of TB was measured using a structured questionnaire. Majority of the respondents had good knowledge and practice on management of TB represented by 70.2% and 63.3%, respectively. However, knowledge gap (1.8%) and practice gap (0.4%) were identified in method of sputum collection. Work place setting was the only demographic factor found significantly associated with level of knowledge and practice (p=0.028). Level of knowledge and practice on management of TB identified among nurses was not associated with many socio-demographic factors. Nurses as frontline healthcare workers are at high risk of being exposed due to frequent contact with various patients especially those who are undiagnosed and TB suspect patients. Hence, implementation of TB Infection Control (TBIC) measures is important to minimize the risk of infection and cross-infection within hospital.

Matched MeSH terms: Latent Tuberculosis
Fulltext Prevalence and Factors Associated with Tuberculosis Treatment Success among TB/HIV Co-Infection in North-East Malaysia

Jalal TMT, Abdullah S, Wahab FA, Dir S, Naing NN

Malays J Med Sci, 2017 Dec;24(6):75-82.
PMID: 29379389 DOI: 10.21315/mjms2017.24.6.9

Background: One of the six strategies developed by WHO, in order to stop Tuberculosis (TB) is addressing TB/HIV high-risk groups. This study aimed to determine the prevalence of successful TB treatment and factors associated with TB treatment success among TB/HIV co-infection patients in North-East Malaysia.
Methods: A cross-sectional study was carried out in the a-year period from 2003 to 2012 by reviewing TB/HIV records in all hospitals and health clinics. The outcome of interest was treatment success as defined by Ministry of Health (MOH) when the patients was cured or completed TB treatment.
Results: Out of 1510 total TB/HIV co-infection cases, 27.9% (95% CI: 25.2, 30.6) of the patients were having treatment success. A majority of TB/HIV co-infection cases were male (91.1%). Fifty-eight percent the patients were drug addicts and 6% were having positive tuberculin tests. The multiple logistic regression revealed that male (OR: 0.39, 95% CI: 0.22, 0.71) and positive tuberculin test result (OR: 2.61, 95% CI: 1.63, 4.19) were significantly associated with the treatment success of TB/HIV co-infection patients. Other factors such as age, comorbid, sputum smear and x-ray findings were not significantly factors in this study.
Conclusion: Female patients and those with negative tuberculin test should be emphasised for successful tuberculosis treatment.

Matched MeSH terms: Latent Tuberculosis
Fulltext Tuberculosis and biologics - a glimpse of Sabah rheumatology patients

Le Low, Darman Shah N. S., Mohd Noh M., Y. Y. Chong

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):66-66.
MyJurnal

Introduction: Biologic patients are at increased risk of tuberculosis (TB) infection, especially in TB prevalent areas like Sabah. We present three cases of rheumatology patients who developed tuberculosis infection while on bi-ologics. Case description: Case1: 47 year old lady with active rheumatoid arthritis despite being on four disease modifying antirheumatic drugs (DMARDS) was given subcutaneous Etanercept after prescreening with mantoux test and interferon gamma release assay (IGRA). Due to poor response, she was switched to Tofacitinib with a repeat pre-screening done except IGRA. Three months after biologics, she developed pulmonary tuberculosis and Tofacitinib was stopped. Case2: 50 year old male with seropositive rheumatoid arthritis and seroconverted hepatitis B. He was worked up for biologic treatment after failing multiple DMARDS; mantoux was 10mm, IGRA not done. He was start-ed on subcutaneous Etanercept for disabling arthritis while being treated for latent TB but developed TB Lymphadeni-tis on his third month of biologic therapy which was withheld thereafter. Case3:48 year old teacher with seropositive rheumatoid arthritis and old pulmonary TB, had intolerance to methotrexate, was initiated on three DMARDS but symptoms remained uncontrolled. Prescreening with IGRA was negative and Adalimumab commenced. Following two years of biologic, she developed reactivation of TB. Rituximab was commenced a year after for persistent active arthritis but withheld due to dermatitis. Conclusion: All patients had mantoux test done routinely but not IGRA due to its cost and limited availability. A follow up study to analyze the effectiveness of IGRA versus Mantoux in detecting latent TB in such patients would be beneficial.

Matched MeSH terms: Latent Tuberculosis
Fulltext Role of Mantoux test in the diagnosis of tuberculosis

Loh KY

Malays Fam Physician, 2011;6(2):85-86.
PMID: 25606232 MyJurnal

Mantoux test is a sensitive but non-specific in the diagnosis of active tuberculosis. The positive cut-off of 10 mm in a person without BCG and 15 mm with previous BCG is appropriate. The interpretation of Mantoux needs to be correlated to the patient’s clinical context. Mantoux test may have a role in assisting extrapulmonary tuberculosis and latent tuberculosis in children.

Matched MeSH terms: Latent Tuberculosis
Fulltext Prevalence of tuberculosis symptoms and latent tuberculous infection among prisoners in northeastern Malaysia

Margolis B, Al-Darraji HA, Wickersham JA, Kamarulzaman A, Altice FL

Int J Tuberc Lung Dis, 2013 Dec;17(12):1538-44.
PMID: 24200265 DOI: 10.5588/ijtld.13.0193

There are currently no routine screening procedures for active tuberculosis (TB) or latent tuberculous infection (LTBI) in Malaysian prisons.

Matched MeSH terms: Latent Tuberculosis/diagnosis; Latent Tuberculosis/epidemiology*
Fulltext Latent tuberculosis infection screening in foreign-born populations: a successful mobile clinic outreach model

Morano JP, Zelenev A, Walton MR, Bruce RD, Altice FL

Am J Public Health, 2014 Aug;104(8):1508-15.
PMID: 24922157 DOI: 10.2105/AJPH.2014.301897

OBJECTIVES: We evaluated the efficacy of a mobile medical clinic (MMC) screening program for detecting latent tuberculosis infection (LTBI) and active tuberculosis.
METHODS: A LTBI screening program in a MMC in New Haven, Connecticut, used medical surveys to examine risk factors and tuberculin skin test (TST) screening eligibility. We assessed clinically relevant correlates of total (prevalent; n = 4650) and newly diagnosed (incident; n = 4159) LTBI from 2003 to 2011.
RESULTS: Among 8322 individuals, 4159 (55.6%) met TST screening eligibility criteria, of which 1325 (31.9%) had TST assessed. Similar to LTBI prevalence (16.8%; 779 of 4650), newly diagnosed LTBI (25.6%; 339 of 1325) was independently correlated with being foreign-born (adjusted odds ratio [AOR] = 8.49; 95% confidence interval [CI] = 5.54, 13.02), Hispanic (AOR = 3.12; 95% CI = 1.88, 5.20), Black (AOR = 2.16; 95% CI = 1.31, 3.55), employed (AOR = 1.61; 95% CI = 1.14, 2.28), and of increased age (AOR = 1.04; 95% CI = 1.02, 1.05). Unstable housing (AOR = 4.95; 95% CI = 3.43, 7.14) and marijuana use (AOR = 1.57; 95% CI = 1.05, 2.37) were significantly correlated with incident LTBI, and being male, heroin use, interpersonal violence, employment, not having health insurance, and not completing high school were significantly correlated with prevalent LTBI.
CONCLUSIONS: Screening for TST in MMCs successfully identifies high-risk foreign-born, Hispanic, working, and uninsured populations and innovatively identifies LTBI in urban settings.
Study site: Mobile clinic, New Haven, Connecticut, United States

Matched MeSH terms: Latent Tuberculosis/diagnosis*; Latent Tuberculosis/epidemiology
Fulltext Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

Nathavitharana RR, Bond P, Dramowski A, Kotze K, Lederer P, Oxley I, et al.

Presse Med, 2017 Mar;46(2 Pt 2):e53-e62.
PMID: 28256382 DOI: 10.1016/j.lpm.2017.01.014

Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

Matched MeSH terms: Latent Tuberculosis/epidemiology
Fulltext A rare case of Tuberculous Prostatitis

Nurul Yaqeen Esa, Mohammad Hanafiah, Marymol Koshy, Hilmi Abdullah, Ahmad Izuanuddin Ismail, Mohamed Fauzi Abdul Rani

Journal of Clinical and Health Sciences, 2016;1:33-36.

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

Matched MeSH terms: Latent Tuberculosis
Fulltext A rare case of Tuberculous Prostatitis

Nurul Yaqeen Esa, Mohammad Hanafiah, Marymol Koshy, Hilmi Abdullah, Ahmad Izuanuddin Ismail, Mohamed Fauzi Abdul Rani

Journal of Clinical and Health Sciences, 2016;1(2):33-36.
MyJurnal

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

Matched MeSH terms: Latent Tuberculosis
Fulltext Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia

Ooi CJ, Hilmi I, Banerjee R, Chuah SW, Ng SC, Wei SC, et al.

Intest Res, 2019 Jul;17(3):285-310.
PMID: 31146509 DOI: 10.5217/ir.2019.00026

The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.

Matched MeSH terms: Latent Tuberculosis
Fulltext Close contact investigation of TB in high-burden, low- and middle-income countries

Pang YK

Malays Fam Physician, 2014;9(2):11-17.
PMID: 25893066 MyJurnal

Tuberculosis (TB) remains a very common disease in most of the low- and middle-income countries. As a result of high disease burden, TB control measures in these countries are usually concentrated on intensifying active disease case-finding and early treatment of infectious TB. On the contrary, in countries with low disease burden, the focus is on contact investigation to identify latently infected individuals and prophylactically treating them to prevent disease reactivation and transmission. These two strategies are deemed important for the effective TB control. Nonetheless, WHO cautions that targeted contact investigation and latent TB infection (LTBI) treatment should only be undertaken by countries that have the operational capacity/ resources and have achieved ≥ 85% treatment success rate of active TB. The screening of LTBI is further challenged by the lack of a “gold standard” test to identify and validate individuals with this condition. Tuberculin skin test (TST) is still the preferred investigation as it is cheap, widely available and validated in many trials. The sensitivity and specificity of the newer test—interferon gamma release assay (IGRA) for LTBI screening has been encouraging in low prevalence countries. However, the evidence supporting such usage remains uncertain in high burden settings. Diagnosis of LTBI should adhere to the strict criteria outlined in the guidelines to avoid misdiagnosing active TB as LTBI. The treatment of the latter involved only one or two anti-TB drugs. It has been demonstrated that in the properly conducted contact screening and LTBI treatment, chances of the emergence of multi-drug-resistant TB is very low.

Matched MeSH terms: Latent Tuberculosis
Fulltext Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: management

Park DI, Hisamatsu T, Chen M, Ng SC, Ooi CJ, Wei SC, et al.

Intest Res, 2018 Jan;16(1):17-25.
PMID: 29422794 DOI: 10.5217/ir.2018.16.1.17

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Matched MeSH terms: Latent Tuberculosis
Fulltext Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: risk assessment

Park DI, Hisamatsu T, Chen M, Ng SC, Ooi CJ, Wei SC, et al.

Intest Res, 2018 Jan;16(1):4-16.
PMID: 29422793 DOI: 10.5217/ir.2018.16.1.4

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Matched MeSH terms: Latent Tuberculosis

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