Tuberculosis latente: ¿es tiempo de actualiar nuestra práctica? : revisión de la evidencia y propuesta de protocolo para su abordaje y manejo en Costa Rica
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2019
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ANTECEDENTES: Pese a los avances en materia de diagnóstico y medidas terapéuticas para tuberculosis, esta continúa siendo una de las diez principales causas de mortalidad global, y la principal causa de muerte por un proceso infeccioso entre los individuos con VIH. La atención y prevención de este problema de salud pública, requiere estrategias centradas en el diagnóstico y manejo oportuno de los individuos con tuberculosis latente, quienes son el principal reservorio del bacilo y una potencial fuente de contagio para los individuos sanos. En Costa Rica no existe un protocolo específico para el manejo de estos sujetos, y la normativa vigente que regula el manejo de la tuberculosis en general data de 2015, situación que motiva esta revisión de la evidencia. MÉTODOS: Se realizó una revisión de la bibliografía disponible, mediante la búsqueda de información en PubMed, JAMA, EMBASE y Cochrane, utilizando las siguientes palabras clave: latent tuberculosis, quantiferon, interferon gamma release assay, tuberculin skin test, latent tuberculosis diagnosis, prophylactic therapy, latent tuberculosis treatment. Se identificaron inicialmente 892 artículos, tras aplicar los criterios de inclusión y exclusión correspondientes se incluyeron 188 documentos para el análisis respectivo. RESULTADOS Y CONCLUSIONES: La calidad de la evidencia disponible es variable, según los datos encontrados, es pertinente el abordaje sistemático de adultos y niños portadores de VIH, así como individuos seronegativos de todas las edades que sean contactos de un caso confirmado de tuberculosis; debe descartarse tuberculosis latente en los pacientes sometidos a diálisis, aquellos que reciban inmunosupresión crónica con anti-TNF o debido a trasplante de órgano sólido o hematológico, portadores de silicosis, y personal de salud, principalmente. En términos de diagnóstico, el uso de PPD o IGRA se consideran...
Inglés: BACKGROUND: Despite advances in diagnosis and therapeutic measures for tuberculosis, this continues to be one of the leading causes of global mortality and the leading cause of death due to an infectious process among individuals with HIV. The attention and prevention of this public health problem requires strategies focused on the diagnosis and management of individuals with latent tuberculosis, this population is the main reservoir of the bacillus and a potential source of infection for healthy individuals. In Costa Rica there is no specific protocol for the management of these subjects and the current regulations for the management of tuberculosis in the country date from 2015, a situation that motivates this review of the evidence. METHODS: A review of the available literature from PubMed, JAMA, EMBASE and Cochrane was performed using the following keywords: latent tuberculosis, quantiferon, interferon gamma release assay, tuberculin skin test, latent tuberculosis diagnosis, prophylactic therapy, latent tuberculosis treatment. In total, 892 articles were initially identified and after applying the inclusion and exclusion criteria, 188 documents were included for the respective analysis. RESULTS AND CONCLUSIONS: The quality of the available evidence is variable, according to the data found the approach of adults and children with HIV is appropriate, as well as seronegative individuals of all ages who were in contact with a confirmed case of tuberculosis; latent tuberculosis should be ruled out in patients undergoing dialysis, also in those receiving chronic immunosuppression with anti-TNF or due to solid or hematological organ transplantation, patient with silicosis and health personnel. In terms of diagnosis, PPD or IGRA can be used as equivalent tests; in regard of treatment, it is necessary to update the drugs offered to the cases detected in Costa Rica. Practice and norms in the country shoul...
Inglés: BACKGROUND: Despite advances in diagnosis and therapeutic measures for tuberculosis, this continues to be one of the leading causes of global mortality and the leading cause of death due to an infectious process among individuals with HIV. The attention and prevention of this public health problem requires strategies focused on the diagnosis and management of individuals with latent tuberculosis, this population is the main reservoir of the bacillus and a potential source of infection for healthy individuals. In Costa Rica there is no specific protocol for the management of these subjects and the current regulations for the management of tuberculosis in the country date from 2015, a situation that motivates this review of the evidence. METHODS: A review of the available literature from PubMed, JAMA, EMBASE and Cochrane was performed using the following keywords: latent tuberculosis, quantiferon, interferon gamma release assay, tuberculin skin test, latent tuberculosis diagnosis, prophylactic therapy, latent tuberculosis treatment. In total, 892 articles were initially identified and after applying the inclusion and exclusion criteria, 188 documents were included for the respective analysis. RESULTS AND CONCLUSIONS: The quality of the available evidence is variable, according to the data found the approach of adults and children with HIV is appropriate, as well as seronegative individuals of all ages who were in contact with a confirmed case of tuberculosis; latent tuberculosis should be ruled out in patients undergoing dialysis, also in those receiving chronic immunosuppression with anti-TNF or due to solid or hematological organ transplantation, patient with silicosis and health personnel. In terms of diagnosis, PPD or IGRA can be used as equivalent tests; in regard of treatment, it is necessary to update the drugs offered to the cases detected in Costa Rica. Practice and norms in the country shoul...
Descripción
Tesis (médico especialista en neumología)--Universidad de Costa Rica. Programa de Estudios de Posgrado de Neumología, 2019
Palabras clave
PERSONAS VIH POSITIVAS - COSTA RICA, TUBERCULOSIS - DIAGNOSTICO - COSTA RICA, TUBERCULOSIS - TRATAMIENTO - COSTA RICA