Risk of tuberculosis in close contacts of patients with multidrug resistant tuberculosis: a nationwide cohort

Attamna, A; Chemtob, Daniel; Attamna, S; Fraser, Abigail; Rorman, Efrat; Paul, M.; Leibovici, L.

doi:10.1136/thx.2008.100974

Cited by 34 publications

(29 citation statements)

References 2 publications

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“…If tuberculosis develops, prompt initiation of treatment with a regimen designed to treat multidrug-resistant tuberculosis is recommended [229][230][231].…”

Section: Management Of Contacts Of Cases With Multidrug-and Extensivementioning

confidence: 99%

Tuberculosis contact investigation in low prevalence countries: a European consensus

Kamphorst²,

et al. 2010

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Contact investigation to identify individuals with tuberculosis and latent infection with Mycobacterium tuberculosis is an important component of tuberculosis control in low tuberculosis incidence countries. This document provides evidence-based and best-practice policy recommendations for contact tracing among high-and medium-priority contacts in a variety of settings. It provides a basis for national guidelines on contact investigation and tuberculosis outbreak management, and should support countries and tuberculosis control managers in evaluating and revising national policies. A review of existing guidelines, a literature search, several meetings and consultation with experts were used to formulate and grade recommendations for action during contact investigation.Available tests to identify individuals with latent infection with M. tuberculosis are designed to identify immune response against mycobacterial antigens and have variable predictive value for the likelihood to develop active tuberculosis in different populations. Contact investigation should therefore be limited to situations with a clear likelihood of transmission or to those with a higher probability of developing active tuberculosis, for instance, young children and immunocompromised persons. A risk assessment-based approach is recommended, where the need to screen contacts is prioritised on the basis of the infectiousness of the index case, intensity of exposure and susceptibility of contacts.

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“…If tuberculosis develops, prompt initiation of treatment with a regimen designed to treat multidrug-resistant tuberculosis is recommended [229][230][231].…”

Section: Management Of Contacts Of Cases With Multidrug-and Extensivementioning

confidence: 99%

Tuberculosis contact investigation in low prevalence countries: a European consensus

Kamphorst²,

et al. 2010

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“…Two conference abstracts were requested from authors, but not received. We reviewed and abstracted full text for 21 articles: 6 “comparison” studies presented outcomes for persons both treated and untreated for MDR-LTBI [7,19–23], 10 presented only outcomes for persons treated [8,24–32], and 5 only outcomes for untreated persons [33–37]. …”

Section: Resultsmentioning

confidence: 99%

“…Of the 6 comparison studies, all but Bamrah et al [19] (Micronesia) and Schaaf et al [21] (South Africa) were conducted in countries having low TB incidence: Adler-Shohet et al [22] (United States), Attamna et al [7] (Israel), Denholm et al [20] (Australia), and Williams et al [23] (United Kingdom). Among the studies in low-incidence settings, only Denholm et al reported any TB cases (2/49 [4%] study subjects) after 2–6 years following treated and untreated persons.…”

Section: Resultsmentioning

confidence: 99%

“…Person-time TB incidence data were available from few studies and were estimated when unavailable. To analyze TB incidence, we excluded 1 comparison study (Attamna et al [7]) and 1 treatment-only study (Feja et al [8]) that relied solely on registry matches, which are considerably influenced by patient mobility and loss to follow-up, resulting in inability to accurately identify incident TB. Moreover, their inclusion significantly inflates study denominators, creating great meta-analysis heterogeneity.…”

Section: Methodsmentioning

confidence: 99%

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Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Marks

Mase

Morris

2017

Clinical Infectious Diseases

103

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Background Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -TB infection is unknown. Methods We conducted a systematic review of studies published 1 January 1994–31 December 2014 to analyze TB incidence, treatment completion and discontinuation, and cost-effectiveness. We considered contacts with LTBI effectively treated if they were on ≥1 medication to which their MDR-TB strain was likely susceptible. We selected studies that compared treatment vs nontreatment outcomes and performed a meta-analysis to estimate the relative risk of TB incidence and its 95% confidence interval. Results We abstracted data from 21 articles that met inclusion criteria. Six articles presented outcomes for contacts who were treated compared with those not treated for MDR-LTBI; 10 presented outcomes only for treated contacts, and 5 presented outcomes only for untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%–99%) using data from 5 comparison studies. We also found high treatment discontinuation rates due to adverse effects in persons taking pyrazinamide-containing regimens. Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination regimen. Conclusions Few studies met inclusion criteria, therefore results should be cautiously interpreted. We found a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting effectiveness in prevention of progression to MDR-TB, and confirmed cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI regimens often resulted in treatment discontinuation due to adverse effects.

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“…Twelve were given a tailored preventive therapy regimen, 71 were given isoniazid, six were given other treatments and 387 were not given any treatment. No contacts developed TB [69]. In Cape Town, from 1994 to 2000, 105 child contacts of 73 MDR-TB source cases were identified and followed up.…”

Section: Treating Drug-resistant Tuberculosis Infectionmentioning

confidence: 99%

Drug-resistant tuberculosis and advances in the treatment of childhood tuberculosis

Seddon

Schaaf

2016

Pneumonia

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Over the last 10 years, interest in pediatric tuberculosis (TB) has increased dramatically, together with increased funding and research. We have a better understanding of the burden of childhood TB as well as a better idea of how to diagnose it. Our appreciation of pathophysiology is improved and with it investigators are beginning to consider pediatric TB as a heterogeneous entity, with different types and severity of disease being treated in different ways. There have been advances in how to treat both TB infection and TB disease caused by both drug-susceptible as well as drug-resistant organisms. Two completely novel drugs, bedaquiline and delamanid, have been developed, in addition to the use of older drugs that have been re-purposed. New regimens are being evaluated that have the potential to shorten treatment. Many of these drugs and regimens have first been investigated in adults with children an afterthought, but increasingly children are being considered at the outset and, in some instances studies are only conducted in children where pediatric-specific issues exist.

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Risk of tuberculosis in close contacts of patients with multidrug resistant tuberculosis: a nationwide cohort

Cited by 34 publications

References 2 publications

Tuberculosis contact investigation in low prevalence countries: a European consensus

Tuberculosis contact investigation in low prevalence countries: a European consensus

Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Drug-resistant tuberculosis and advances in the treatment of childhood tuberculosis

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