Mycobacterial Diseases

Atypical Mycobacterium

Griffith DE, Aksamit T, Brown-Elliott BA, et al. The official ATS/IDSA statement :Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases.  Am J Respir Crit Care Med 2007; 175:367-416.  More comprehensive than its 1997 predecessor, this statement provides a general overview of NTM pathogenesis, presentation, and diagnosis as well as easily retrieved treatment recommendations on specific organisms. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17277290&query_hl=36&itool=pubmed_docsum

Latent tuberculosis

ATS Statement: Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247. Emphasizes restricting testing to patients you intend to treat if positive and defines positive for patients with different risk factors. Recommended duration of INH increased to 9 months. Significant risk of hepatotoxicity with combination INH and rifampin reported since this statement published. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10764341

Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 2007; 146:340-54. The role of IFN-gamma release assays in the diagnosis of active and latent TB remains unclear and is current hot-bed of clinical research. This review found these tests lacked sensitivity when active TB was used as a surrogate for latent TB but offered good specificity, especially among individuals with prior BCG vaccination compared to skin testing. However, the various tests were often discordant and common reverted from positive to negative with serial testing. http://www.ncbi.nlm.nih.gov/pubmed/17339619?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

International Union against Tuberculosis Committee on Prophylaxis.Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. Bull WHO 1982;60:555-64. Noteworthy for being the only study of the efficacy and safety of different durations of INH prophylaxis. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6754120

Stead WW. Management of health care workers after inadvertent exposure to TB: a guide for the use of preventive therapy. Ann Intern Med 1995;122:906-12. Based on early TB outbreaks and more recent studies of health care and nursing home exposures, the author makes recommendations for the management of health care workers with heavy exposure to active disease. Specifically, workers with prior positive PPD do not need treatment unless they become symptomatic per the author. Skin test negative workers should receive INH prophylaxis until they are tested for conversion 8 weeks after exposure. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7755225

Active tuberculosis

Blumberg HM, Burman WJ, Chaisson RE, et al. ATS/CDC/IDSA: Treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-662. Comprehensive consensus guide to treatment. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12588714

CDC.  Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs--worldwide, 2000-2004. Morb Mortal Wkly Rep. 2006; 55:301-5. This report summarizes the results of a survey distributed to a multinational network of Tb laboratories between 2000-2004. Of 17,690 TB isolates, 20% were MDR and 2% were XDR. XDR TB has emerged worldwide as a threat to public health and TB control, raising concerns of a future epidemic of virtually untreatable TB. http://www.ncbi.nlm.nih.gov/pubmed/16557213?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Bock NN, McGowan JE, Ahn J, et al. Clinical predictors of tuberculosis as a guide for respiratory isolation policy. Am J Respir Crit Care Med 1996;154:1468-72. Study found upper lobe infiltrate, presence of cavity, self-report of prior positive PPD, and history of TB exposure were predictive of active disease while history of INH prophylaxis was negatively predictive. Basing isolation solely on these criteria, however, would have resulted in failure to isolate 19% of active cases. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8912766

Conde MB, Loivos AC, Rezende VM, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis.  Am J Respir Crit Care Med 2003;167:723-5.  Prospective study of 84 patients with pleural tuberculosis found induced sputum culture was helpful in patients with no infiltrate on CXR; 55% of patients with effusion and otherwise clear CXR were culture positive, although only 12% had a rapid diagnosis via positive smears. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12598215