Diagnosing and Treating Latent TB Infection (LTBI)

Diagnosing and Treating Latent TB Infection (LTBI)
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Module Version Module 14 – March 2010 Diagnosing and Treating Latent TB Infection (LTBI) Instructor’s Notes Module 14: Diagnosing and Treating Latent Tuberculosis Infection (LTBI) Module Time: Approximately 60 minutes This module has been divided into the following sections: Diagnosing Latent TB Infection (slides 3-20) – 30 min. Treatment options, monitoring and special situations (slides 21-37) - 28 min. Summary (slide 38) - 2 min. Resource documents: Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV (CTBG) Appendices A and B Interactive options: Ideas for interactive discussions are offered on many of the slides in this module. Participant discussion can enhance active learning, but will add more time to the lecture and must be planned for. Additional Material: Slides containing related material may be found in the following modules: 2, 9A, 9B, 10A, and 10B.

Funded by the Health Resources and Services Administration (HRSA)
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Project Partners Module Version Funded by the Health Resources and Services Administration (HRSA)

Module Overview Current methods for diagnosing TB infection
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Module Overview Module Version Diagnosing Latent TB Infection (slides 3-20) – 30 min. Overview: [Review the slide content] [Image credit: Public Health Image Library, CDC/ Dr. Ray Butler; Janice Carr, 2006.] Current methods for diagnosing TB infection Treatment options Monitoring

Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV
Learning Objectives Module Version Upon completion of this session, participants will be able to: State the two methods for diagnosing TB infection Determine the groups that would most benefit from treatment for latent TB infection (LTBI) Determine LTBI treatment options and related monitoring Learning objectives: [Review the slide content]

Current Terms and Definitions
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Current Terms and Definitions Module Version Latent TB infection (LTBI) = presence of M. tb organisms without symptoms or radiographic evidence of TB disease Treatment of LTBI replaces “preventive therapy” and “chemoprophylaxis” Tuberculin Skin Test (TST) replaces PPD when referring to the Mantoux tuberculin skin test procedure or result [Review the relevant terms and definitions]

Mantoux TB Skin Test (TST)
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Diagnosing LTBI Module Version Mantoux TB Skin Test (TST) Blood Assays for M. tb: QuantiFERON® - Gold and In-Tube T-SPOT.TB ® TST - Skin test that produces delayed-type hypersensitivity reaction in persons with M. tb infection Blood Assays for M.tb - Blood tests that measures and compares amount of interferon-gamma (IFN-g) released by blood cells in response to antigens. There are several types currently in use in some parts of the world: [Review slide content] Multiple puncture test such as the Tine test should no longer be used because they are harder to standardize and the results are less reliable Can refer participants to the Caribbean TB guidelines Appendix A on pages [Image source: Centers for Disease Control and Prevention, Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection slideset, 2005]

Tuberculin Skin Test (TST)
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Tuberculin Skin Test (TST) Module Version The tuberculin skin test has been around as a diagnostic test for Mycobacterium tuberculosis infection for a very long time. The earliest tuberculin was produced by Dr. Robert Koch in 1890 as a hopeful vaccine and potential cure for tuberculosis While Dr. Koch’s discovery did not protect against or cure TB, his observations that a local reaction occurred at the site where tuberculin was injected in patients with TB but not in a non-tuberculous patient, laid the groundwork for future research on the diagnostic use of tuberculin for detecting TB infection [Image source: (Left) Canada’s Digital Collection program, Industry Canada. Valley Echo 1957:38(5):5 at: (Right) Francis J. Curry National Tuberculosis Center/Ann Raftery] THEN NOW

Standard Tuberculin Preparations
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Standard Tuberculin Preparations Module Version Current preparations of tuberculin contain a purified protein derivative (PPD) of Koch’s Old Tuberculin The two standard preparations are: USA: PPD-S – dose of 0.1 ml contains 5 tuberculin units (TU) of PPD UK: PPD-RT-23 – dose of 0.1 ml contains TU (equivalent to 5TU of PPD-S) Current tuberculin preparations are derived from the Old Tuberculin preparation developed by Dr. Koch and contain a purified protein derivative (PPD) of the Old Tuberculin Since tuberculin gets denatured by strong light, heat and storage time, it must be stored in a refrigerated condition, in covered containers, and used within the recommended time schedule (within 30 days for PPD-S once vial is opened)

Administering the TST Locate and clean site, stretch skin with thumb
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Administering the TST Module Version Locate and clean site, stretch skin with thumb Inject 0.1 ml of 5 TU PPD-S intradermally at a 10°-15° angle, on volar surface of lower arm using a 27-gauge needle, bevel up Produce a wheal mm in diameter Do not massage injection site The procedure for placing the Mantoux tuberculin skin test is detailed in Appendix A, on pages of the Caribbean TB guidelines 0.1 ml of PPD tuberculin containing 5TU is injected intradermally on the volar surface of the forearm Gloves are not necessary for proper intradermal injections, however, individual institutions or agency policies may require the use of gloves When properly placed, a wheal measuring 6-8 mm is produced. This wheal will disappear within a short period of time after injection [Image source: (left) Centers for Disease Control and Prevention, poster; (right) Centers for Disease Control and Prevention, Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection slideset, 2005]

Reading the TST Module Version Record site, date and time of injection as well as PPD lot number Measure reaction in 48 to 72 hours Measure induration (palpable swelling), not erythema Forearm: Transversely to the long axis of the forearm. Record in mm! Ensure trained health care professional measures and interprets the TST The reaction is a delayed (cellular) hypersensitivity reaction [Review slide content] [Image source: Centers for Disease Control and Prevention, Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings slide set. 2006]

TST Interpretation ≥ 5 mm ≥ 15 mm ≥ 10 mm HIV-infection
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV TST Interpretation Module Version ≥ 5 mm HIV-infection Other immunosuppressed Recent contact Fibrotic CXR changes Organ transplant recipients ≥ 15 mm Consider significant “positive” for all ≥ 10 mm Recent immigrants Injection drug users Lab personnel Residents/employees of congregate settings Persons with clinical risk factors Children < 5-years-old or child/adolescent exposed to high-risk adult Whether a reaction to the Mantoux tuberculin skin test (TST) is classified or interpreted as “positive” depends on the size of the induration and the person’s risk factors for TB [Review slide content] “Other immunosuppressed” include patients with organ transplants or patients receiving equivalent of ≥15mg/DAY prednisone for 1 month or more, and blocking agents against tumor necrosis factor alpha (e.g., Etanercept [Enbrel®], Infliximab [Remicade®] and Adalimumab [HumiraTM]). Generally, these drugs are used to treat autoimmune illnesses In the U.S., “recent immigrants” refers to persons born in areas of the world where TB is common who have arrived within the last 5 years. 10mm induration or greater is considered positive in these individuals given their chance for exposure to TB is greater. For this reason, it is very important to assess the country of origin as well as countries where the individual traveled to or worked to help you correctly interpret the TST result “Clinical risk factors” would include persons with another medical condition that would increase their risk for progression of LTBI to active TB disease This is discussed in greater detail in training Module 2. These conditions would include: silicosis, diabetes mellitus, chronic renal failure or on hemodialysis, solid organ transplantation, certain types of cancer (e.g., leukemia), gastrectomy or jejunoileal bypass, underweight or malnourished persons, substance abuse and tobacco users, extremes in age (particularly children < 5 years-old): [Refer to pages 7-8 in the Caribbean TB Guidelines]

What factors might produce a false-positive TST result?
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Module Version What factors might produce a false-positive TST result? Some persons may react to the TST even though they are not infected with M. tuberculosis [Ask:] What are some causes of false-positive TST reactions? [Pose question to the participants. Take a few minutes to note their responses on flip chart paper or white board, then proceed to the next slide to summarize]

False-Positive TST (2) Factors that may cause false-positive TST are:
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV False-Positive TST (2) Module Version Factors that may cause false-positive TST are: Non-tuberculous mycobacteria (NTM) BCG vaccination Consider a positive TST result to indicate TB infection if risk factors are present [Review slide content] These are the two most common causes of false-positive results Others might include: Incorrect method of TST administration Incorrect interpretation of reaction Incorrect bottle of antigen used

BCG and TST Interpretation
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV BCG and TST Interpretation Module Version BCG is the most widely used vaccine in the world Wang, et al – meta-analysis Effect of BCG vaccination on TST results was less after 15 years Positive TST with indurations of >15 mm more likely to be result of TB infection than of BCG vaccination The effect of prior BCG vaccination on TST has been the subject of many reviews. A recent meta-analysis by Wang et al suggested that an induration of greater than 15 mm was more likely due to TB infection rather than prior BCG The effect BCG has on the body’s ability to mount a response to the TST wanes over time (consider no effect after 15 years post-BCG if BCG given before age 1) The larger the response, the more likely it represents TB infection vs. BCG L Wang, et al. Thorax 2002;57:

What factors might produce a false-negative TST result?
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Module Version What factors might produce a false-negative TST result? Some persons may not react to the TST even though they are infected with M. tuberculosis [Pose question to the participants. Take a few minutes to note their responses on flip chart paper or white board, then proceed to the next slide to summarize]

False-Negative TST (2) Module Version Factors that may affect the ability to respond to the TST include: Anergy (the inability to react to a TST because of a weakened immune system) Recent TB infection (up to 8-10 weeks following exposure) or infection many years ago Recent live-virus vaccination/infection (e.g., measles) Overwhelming TB disease Very young age (newborns < 6 months old) Poor administration technique (e.g., TST placed too shallow or too deep) Host factors: Anergy – HIV, immunosuppressive diseases (eg. lymphoma, renal failure), malnutrition, or medications, Recent infection – if tested during the “window period” – this can be anywhere from 2 weeks up to 8-10 weeks following TB exposure and infection Very old TB infection – immune system’s “recall” may be sluggish if exposure was many years ago Live virus vaccination (MMR, oral polio, varicella) - place TST on the same day or wait 6 weeks Current viral infection (measles, mumps, varicella) can interfere with body’s ability to mount a delayed-type hypersensitivity response to the TST Acute overwhelming TB disease - (25% will be negative on TST, especially severe TB, TB pleurisy) Newborns <6 months (immune system not fully developed) Factors related to testing procedure: Improper storage of PPD Delayed injection after filing syringe Subcutaneous injection Lack of experience administering and reading TST and/or bias in interpretation

Blood Assays for M. tuberculosis
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Blood Assays for M. tuberculosis Module Version QuantiFERON®-TB Gold In-Tube (Cellestis Ltd, Victoria, Australia) Measures Interferon-gamma (IFN-y) T-SPOT.TB (Oxford Immunotec Ltd, Oxford, UK) Measures peripheral blood mononuclear cells that produce IFN-γ As mentioned earlier in this presentation, we now have a blood test that can also determine whether someone has been infected with tuberculosis. These are referred to as blood assays for Mycobacterium tuberculosis (BAMT) or more commonly known as T-cell interferon-gamma release assays (IGRAs). The two commercially available products are: [review slide content] QuantiFERON-TB Gold In Tube: This test uses whole blood and measures interferon-gamma (IFN-γ) secreted from stimulated T-cells that have previously been exposed to M. tuberculosis. The QuantiFERON-TB Gold In-Tube assay is a laboratory test that involves 4 steps: Collection of blood into QuantiFERON-TB Gold In-Tube Blood Collection Tubes Overnight incubation at 37oC. TB infected patients' blood cells will produce IFN-γ. Detection of released IFN-γ in harvested plasma using an ELISA Analysis of data using the QuantiFERON-TB Gold In-Tube Analysis Software T-SPOT.TB: This is also a laboratory test. Steps involved: A peripheral blood sample is collected The white blood cells are separated out, washed and counted, then added to wells of a standard 96-well microtitre plate This plate is then incubated in the presence of antigen from the disease of interest (in this case, TB). If those antigens are present, the T cells will recognize the antigen and secrete cytokine (e.g. IFN-γ) as part of the normal immune response This cytokine is captured by particular cytokine-specific antibodies lining the well floor. The cytokine-bound antibodies are subsequently visually illuminated using a ‘sandwich capture’ technique. This produces spots on the well floor, where each spot represents the footprint of one T cell that responded to the antigens These spots are then counted and the frequency of T cells can then be quantified

Blood Assays for M. tuberculosis (2)
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Blood Assays for M. tuberculosis (2) Module Version There is limited data on how these tests perform in certain populations: Children (≤ 5yrs) Recent contacts Cost and access to these tests may be two of the greatest barriers to use in the Caribbean As these are relatively new diagnostic tests, there is still much for us to learn on how to interpret results in different population groups The data on the use of blood assays for M. tuberculosis in certain populations is still growing. How these tests perform in children and among persons recently exposed to M. tuberculosis should be considered Errors in collecting or transporting blood specimens or in running and interpreting the assay can decrease the accuracy [Source: Lalvani A, Millington KA Curr Opin Infect Dis Jun;20(3):264-71;

Clinical Pearl-Testing
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Clinical Pearl-Testing Module Version Negative TST or Blood Assay for M. tuberculosis does not exclude TB disease! [Review slide content] The TST and blood assays for M. tuberculosis (BAMTs) are diagnostic tests for TB infection, not for active TB disease. A percentage of patients with overwhelming active TB will have a negative TST and BAMT [Image source:

Rule Out Active TB Module Version Before initiating single-drug treatment (monotherapy) for LTBI, active TB disease must be ruled out with: Chest X-ray Clinical evaluation [Review slide content] [Before moving to next slide, check in with participants on whether they have any questions on diagnosis of TB infection] [Image source: Francis J. Curry National Tuberculosis Center/Ann Raftery]

Treating Latent TB Infection
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Module Version Treating Latent TB Infection Treatment Options, Monitoring and Special Situations (slides 21-37) - 28 min. This next section will cover the treatment regimen options for latent TB infection, required monitoring and instructions for special situations [Image source: Francis J. Curry National Tuberculosis Center/Kelly Smith]

LTBI Treatment: Isoniazid (1)
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV LTBI Treatment: Isoniazid (1) Module Version INH remains the mainstay of LTBI treatment Duration of treatment? HIV-infected or radiographic evidence of prior TB: All others months 9 months preferred 6 months acceptable [Review slide content] The recommended duration of treatment considered adequate to treat TB infection has changed over time The 9 mo. timeframe is based on modeling by the late George Comstock who showed you get the greatest protection for effort expended at the 9 month mark (efficacy of up to 92% if compliant vs. approximately 68% protection from 6 months INH) and very little added by taking 12 months The mounting evidence of the protective effect Isoniazid preventive therapy (IPT) provides to those with HIV warrants the use of the longer, 9 month duration in patients with HIV and known or suspect LTBI. If 9 months is not feasible due to adverse effects, non-adherence, or limited resources, a minimum of 6 months is considered acceptable

Completion of Treatment
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Completion of Treatment Module Version Completion of therapy is based on total number of doses administered, not on duration alone! Count doses, not months 9 mo INH daily — 270 doses within 12 mo 6 mo INH daily — 180 doses within 9 mo 4 mo RIF daily — 120 doses within 6 mo Interruption of more than 2 mo — medical evaluation to rule out active TB before restart [Review slide content]

Isoniazid: Hepatitis Module Version Incidence of hepatitis in persons taking INH is lower than previously thought (0.1 to 0.15%) Hepatitis risk increases with age Uncommon in persons <20 years old Nearly 2% in persons 50 to 64-years-old Risk increased with underlying liver disease or heavy alcohol consumption [Review slide content]

Monitoring During Treatment
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Monitoring During Treatment Module Version Baseline laboratory testing should be obtained for patients starting INH when: HIV infected Pregnant or immediate postpartum (within 3 months) History of chronic liver disease or heavy alcohol use Initial evaluation suggests a liver disorder Evaluate monthly for: Adherence Symptoms (particularly for hepatitis) Obtain baseline AST (SGOT) or ALT (SGPT) and bilirubin for patient’s at increased risk for hepatitis: HIV Pregnant woman, postpartum within 3 months of delivery Daily alcohol, chronic liver disease (e.g., Hep B, C, alcoholic hepatitis, cirrhosis) Routine laboratory monitoring during treatment of LTBI is indicated for: Those whose baseline liver function tests are abnormal Other persons with a risk of hepatic disease Persons experiencing symptoms compatible with hepatitis INH has a number of other potential side-effects Can refer participants to Caribbean TB guidelines Appendix B, page 154 for guidance on clinical and laboratory monitoring during treatment for LTBI

Supplemental Pyridoxine (B6)
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Supplemental Pyridoxine (B6) Module Version Peripheral neuropathy occurs in < 0.2 % using conventional Isoniazid (INH) doses Add vitamin B6 (pyridoxine) supplement (25-50mg daily) for patients with: Diabetes, HIV, renal failure, alcoholism, malnutrition, advanced age Pregnant or breastfeeding mothers (and infant) Patients with a seizure disorder [Review slide content]

Patient Education Module Version  Patients should be instructed to stop medication and seek immediate medical consultation if they experience loss of appetite, abdominal pain, nausea, vomiting, jaundice or other symptoms of hepatitis. Monthly face-to-face interview Rationale for treatment Adherence Symptoms of adverse drug effects Plans to continue treatment The monthly face-to-face interview with patients receiving treatment for LTBI should cover these issues: [review slide content] [Image credit: Lung Health Image Library/Gary Hampton]

Withholding Isoniazid
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Withholding Isoniazid Module Version INH should be withheld when: Transaminase levels exceed 3 times the upper limit of normal if associated with symptoms; or 5 times the upper limit of normal if the patient is asymptomatic [Review slide content] Other common reasons to interrupt INH include: Moderate to severe rash or other evidence of hypersensitivity (e.g., lupus-like syndrome) Refractory paraesthesia (unresponsive to B6) Severe or intolerable CNS effects (e.g., intractable headaches, refractory asthenia, seizures, psychosis, extrapyramidal effects)

Special Situations Treating Latent TB Infection
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Module Version Treating Latent TB Infection Special Situations [Before moving on to this next section, check in with participants to see if they have any questions] [Interactive option: Could consider inserting a role-play here to demonstrate counseling a patient with LTBI prior to starting IPT. Ask for a volunteer to play the role of the patient. Alternatively, you could identify prior to the training, individuals who would be willing to play role of patient and healthcare provider]

LTBI Treatment: INH Resistant
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV LTBI Treatment: INH Resistant Module Version Contacts of INH-resistant TB: 4-6 months of rifampicin (longer for children and immunocompromised) daily Consider use of rifabutin in HIV-infected patients on rifampicin-incompatible protease inhibitors For persons intolerant of INH, use 4 months of rifampicin daily 6 months RIF for children and persons with HIV infection For children or persons who are immunocompromised, RIF x 6 months Some PI combinations (e.g., RTV-boosted lopinavir) are compatible with rifampicin Use of rifabutin with PIs usually requires intermittent, low-dosing (e.g., 150mg po q MWF). In the setting of non-adherence with ART, such a regimen would lead to chronic exposure to subtherapeutic rifabutin levels and could theoretically cultivate rifamycin resistance—exercise caution and take special measures to promote ART adherence

LTBI Treatment: Pregnancy
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV LTBI Treatment: Pregnancy Module Version Treatment for LTBI during pregnancy is controversial Wait until after delivery? Possible increase hepatotoxicity during pregnancy and early post-partum Treatment for LTBI with close clinical and laboratory monitoring should be encouraged if the woman is also: HIV-infected or a close contact to an infectious TB patient [Review slide content] For pregnant, HIV-negative women with LTBI, isoniazid given daily or twice weekly for 9 or 6 months is recommended. [Can refer participants to page 152 of the 2010 Caribbean TB guidelines under “Special considerations for treatment of LTBI…”] For women at risk for progression of LTBI to disease, especially those who are HIV-infected or who have likely been infected recently, initiation of isoniazid preventive therapy should not be delayed on the basis of pregnancy alone, even during the first trimester For women whose risk for active TB is lower, some experts recommend waiting until after delivery to start treatment It’s important to remember that baseline hepatic measurements (AST, ALT and bilirubin) should be obtained prior to initiating treatment in pregnant women or in women immediately postpartem (i.e. within 3 months of delivery)

LTBI Treatment: Breastfeeding
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV LTBI Treatment: Breastfeeding Module Version Breastfeeding is not a contraindication Infant will get a small amount of INH (sub-therapeutic) No toxic effects reported Give both mother and infant vitamin B6 (pyridoxine) [Review slide content]

LTBI Treatment: MDR-TB
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV LTBI Treatment: MDR-TB Module Version No drug regimens with proven efficacy for LTBI resulting from exposure to MDR-TB Treatment may be indicated in some high- risk situations (seek consultation with an MDR-TB expert) Clinical follow-up recommended for 2 years post-contact [Review slide content] As there are no proven drug regimens effective for treating MDR-LTBI, consultation with an expert in the treatment and management of MDR-TB should be obtained before initiating treatment to contacts

Window Period Prophylaxis
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Window Period Prophylaxis Module Version Window period – refers to the interval between infection and detectable reactivity to the TST Treatment during the window period: should be considered for children < 5 and persons with significant immunosuppression can be discontinued if, after 8 weeks, a repeat TST is negative and child remains asymptomatic Contacts with HIV or severe immunosuppression should complete the full course of treatment regardless of repeat TST [Review slide content]

Re-treatment of LTBI Module Version Real issue is the probability of acquiring new infection Recommended for those who have HIV infection and children who have been in contact with a sputum smear-positive case Evidence that re-infection can occur has resulted in the question of should you retreat [Review slide content]

Counseling A Patient With LTBI
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Counseling A Patient With LTBI Module Version NEVER say: You’ve been “exposed” so you need to be treated. INSTEAD say: You have been exposed and infected with the TB germ. But don’t worry… Good news: You do not have the disease and you are not contagious to anyone Bad news: It is sleeping in your body, can wake up later, make you very ill and contagious to others [Review slide content]

Counseling A Patient With LTBI (2)
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Counseling A Patient With LTBI (2) Module Version Why get treated? Treatment will prevent future disease and protect you and those close to you. Warning: Taking medication for 6-9 months is a long time but it takes that long to kill all or most of the TB germs “TOUGH bugs”… so take your medicine correctly and completely! [Review slide content]

Treatment of LTBI: Summary
Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis and TB/HIV Treatment of LTBI: Summary Module Version Assess for TB risk factors If risk is present, perform test for TB infection (TST or blood assay for M.tb) If test for TB infection is positive, rule out TB disease If TB disease is ruled out, initiate treatment for LTBI If treatment is initiated, monitor patient regularly and ensure completion! Summary (slide 38) - 2 min. And in summary: [Review slide content]

Diagnosing and Treating Latent TB Infection (LTBI)

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Diagnosing and Treating Latent TB Infection (LTBI)

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