ABSTRACT
No disponble
Subject(s)
Humans , Child, Preschool , Child , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/therapy , Isoniazid/therapeutic use , Rifampin/therapeutic use , Risk Factors , Prospective Studies , Communicable Period , Radiography, ThoracicSubject(s)
Antitubercular Agents/therapeutic use , Isoniazid/therapeutic use , Rifampin/therapeutic use , Tuberculosis, Multidrug-Resistant/drug therapy , Antitubercular Agents/pharmacology , Child , Child, Preschool , Contact Tracing , Drug Resistance, Multiple, Bacterial , Drug Therapy, Combination , Ethambutol/therapeutic use , Humans , Isoniazid/pharmacology , Microbial Sensitivity Tests , Mycobacterium tuberculosis/drug effects , Prospective Studies , Pyrazinamide/therapeutic use , Rifampin/pharmacology , Spain/epidemiology , Tuberculosis, Multidrug-Resistant/epidemiologyABSTRACT
Background: Screening strategies based on interferon-γ release assays in tuberculosis contact tracing may reduce the need for preventive therapy without increasing subsequent active disease. Methods: We conducted an open-label, randomized trial to test the noninferiority of a 2-step strategy with the tuberculin skin test (TST) followed by QuantiFERON-TB Gold In-Tube (QFT-GIT) as a confirmatory test (the TST/QFT arm) to the standard TST-alone strategy (TST arm) for targeting preventive therapy in household contacts of patients with tuberculosis. Participants were followed for 24 months after randomization. The primary endpoint was the development of tuberculosis, with a noninferiority margin of 1.5 percentage points. Results: A total of 871 contacts were randomized. Four contacts in the TST arm and 2 in the TST/QFT arm developed tuberculosis. In the modified intention-to-treat analysis, this accounted for 0.99% in the TST arm and 0.51% in the TST/QFT arm (-0.48% difference; 97.5% confidence interval [CI], -1.86% to 0.90%); in the per-protocol analysis, the corresponding rates were 1.67% and 0.82% in the TST and TST/QFT arms, respectively (-0.85% difference; 97.5% CI, -3.14% to 1.43%). Of the 792 contacts analyzed, 65.3% in the TST arm and 42.2% in the TST/QFT arm were diagnosed with tuberculosis infection (23.1% difference; 95% CI, 16.4% to 30.0%). Conclusions: In low-incidence settings, screening household contacts with the TST and using QFT-GIT as a confirmatory test is not inferior to TST-alone for preventing active tuberculosis, allowing a safe reduction of preventive treatments. Clinical Trials Registration: NCT01223534.
Subject(s)
Contact Tracing , Interferon-gamma Release Tests/standards , Latent Tuberculosis/diagnosis , Reagent Kits, Diagnostic/standards , Tuberculin Test/standards , Adult , Cost-Benefit Analysis , Family Characteristics , Female , Humans , Incidence , Male , Mass Screening/methods , Middle Aged , Preventive Health Services/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Tuberculosis/epidemiology , Contact Tracing , Tuberculin Test/statistics & numerical data , Isoniazid/therapeutic use , Drug Resistance, Bacterial , Disease OutbreaksSubject(s)
Antitubercular Agents/therapeutic use , Disease Outbreaks , Isoniazid/therapeutic use , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis/drug therapy , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Spain/epidemiology , Tuberculosis/epidemiologyABSTRACT
El uso de las pruebas de liberación de interferón-gamma para el diagnóstico de la infección tuberculosa está muy generalizado en España. Sin embargo, no se ha alcanzado un consenso respecto a su aplicación en situaciones clínicas específicas. Con el fin de redactar una guía de empleo en la práctica clínica, un grupo de expertos que incluyó a especialistas en enfermedades infecciosas, enfermedades respiratorias, microbiología, pediatría y medicina preventiva, junto con un experto en metodología, efectuaron una búsqueda sistemática en la literatura, sintetizaron los resultados, calificaron la calidad de las evidencias y formularon recomendaciones de acuerdo con la metodología Grading of Recommendations of Assessment Development and Evaluations. Este documento es una guía basada en la evidencia para el empleo de las pruebas de liberación de interferón-gamma en el diagnóstico de la infección tuberculosa en pacientes en riesgo de padecer tuberculosis o en los que se sospeche enfermedad activa. La guía será aplicable tanto en atención primaria y especializada como en salud pública
Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in Spain. However, there is no consensus on their application in specific clinical scenarios. To develop a guide-line for their use, a panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, conducted a systematic literature search, summarized the findings, rated the quality of the evidence, and formulated recommendations following the Grading of Recommendations of Assessment Development and Evaluations methodology. This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at risk of tuberculosis or suspected of having active disease. The guidelines will be applicable to specialist and primary care, and public health
Subject(s)
Humans , Male , Female , Interferon-gamma/analysis , Interferon-gamma Release Tests/instrumentation , Interferon-gamma Release Tests/methods , Interferon-gamma Release Tests , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/drug therapy , Latent Tuberculosis/diagnosis , Bacterial Infections/complications , Bacterial Infections/diagnosis , Latent Tuberculosis/prevention & control , Preventive Medicine/methods , Respiratory Tract Diseases/prevention & control , Primary Health Care/methods , Primary Health Care/trends , Primary Health Care , Public Health/methodsABSTRACT
Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in Spain. However, there is no consensus on their application in specific clinical scenarios. To develop a guide-line for their use, a panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, conducted a systematic literature search, summarized the findings, rated the quality of the evidence, and formulated recommendations following the Grading of Recommendations of Assessment Development and Evaluations methodology. This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at risk of tuberculosis or suspected of having active disease. The guidelines will be applicable to specialist and primary care, and public health.
Subject(s)
Interferon-gamma Release Tests/standards , Tuberculosis/diagnosis , Adolescent , Adult , Age Factors , Child , Child, Preschool , Contact Tracing , Enzyme-Linked Immunosorbent Assay , Evidence-Based Medicine , HIV Infections/complications , Humans , Infant , Mass Screening , Organ Transplantation , Preoperative Care , Spain , Tuberculosis/complicationsABSTRACT
Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in Spain. However, there is no consensus on their application in specific clinical scenarios. To develop a guideline for their use, a panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, conducted a systematic literature search, summarized the findings, rated the quality of the evidence, and formulated recommendations following the GRADE (Grading of Recommendations of Assessment Development and Evaluations) methodology. This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at the risk of tuberculosis or suspected of having active disease. The guidelines will be applicable to specialist and primary care, and public health
Las técnicas de detección in vitro de interferón-gamma (IGRA, del inglés interferon-gamma release assays), están ampliamente implantadas para el diagnóstico de infección tuberculosa en España. Sin embargo, no hay consenso sobre su aplicación en diferentes escenarios clínicos. Para desarrollar una guía de práctica clínica sobre su uso, un grupo de trabajo compuesto por especialistas en enfermedades infecciosas, neumología, microbiología, pediatría y medicina preventiva, junto con un metodólogo, llevaron a cabo una búsqueda sistemática de la literatura, sintetizaron la evidencia y gradaron su calidad, y formularon las recomendaciones siguiendo el método GRADE (Grading of Recommendations of Assessment Development and Evaluations). Este documento proporciona una guía basada en la evidencia para el uso de los IGRA para el diagnóstico de infección tuberculosa en pacientes en riesgo de tuberculosis o con sospecha de enfermedad activa. Esta guía es aplicable en la atención especializada y primaria, y salud pública
Subject(s)
Humans , Tuberculosis/diagnosis , Latent Tuberculosis/diagnosis , Mycobacterium tuberculosis/isolation & purification , Interferon-gamma/analysis , Contact Tracing/methods , Risk FactorsABSTRACT
Interferon-gamma release assays are widely used for the diagnosis of tuberculosis infection in Spain. However, there is no consensus on their application in specific clinical scenarios. To develop a guideline for their use, a panel of experts comprising specialists in infectious diseases, respiratory diseases, microbiology, pediatrics and preventive medicine, together with a methodologist, conducted a systematic literature search, summarized the findings, rated the quality of the evidence, and formulated recommendations following the GRADE (Grading of Recommendations of Assessment Development and Evaluations) methodology. This document provides evidence-based guidance on the use of interferon-gamma release assays for the diagnosis of tuberculosis infection in patients at the risk of tuberculosis or suspected of having active disease. The guidelines will be applicable to specialist and primary care, and public health.
Subject(s)
Interferon-gamma Release Tests/standards , Practice Guidelines as Topic , Tuberculosis/diagnosis , Humans , Interferon-gamma , SpainABSTRACT
No disponible
