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Advances in Diagnosis of Latent TB Infection: What Is the Latest Approach to Diagnose Latent TB Infection to Prevent TB?

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Pulmonary Tuberculosis and Its Prevention

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Abstract

Both types of tests for the diagnosis of latent tuberculosis infection (LTBI), the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs), rely on detecting evidence of cell-mediated immunity to M. tuberculosis antigens. If testing is positive and there are no symptoms, radiographic or microbiologic evidence of TB disease, the patient is typically considered to have LTBI. Advantages of the TST include low cost, ease of administration, no lab requirement, and adjustable interpretation cut-off per individual LTBI risks. Advantages of IGRAs include requiring a single visit, higher specificity compared to the TST, and likely modestly improved sensitivity (particularly with immunocompromised individuals). The TST and IGRA have only poor-to-fair concordance. Both the TST and IGRAs have significant shortcomings. They cannot discriminate asymptomatic infection from past infection, identify individuals at elevated risk of TB disease, or be used to assess response to preventative therapy. A variety of novel technologies are in different phases of investigation, development, or clinical use that may help address these issues.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA

    David J. Horne

  2. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA

    Asa Tapley

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  1. Respiratory Medicine, NHO Ibarakihigashi National Hosp, Ibaraki, Japan

    Takefumi Saito

  2. Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA

    Masahiro Narita

  3. National Jewish Health, Denver, CO, USA

    Charles L. Daley

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Horne, D.J., Tapley, A. (2022). Advances in Diagnosis of Latent TB Infection: What Is the Latest Approach to Diagnose Latent TB Infection to Prevent TB?. In: Saito, T., Narita, M., Daley, C.L. (eds) Pulmonary Tuberculosis and Its Prevention. Respiratory Disease Series: Diagnostic Tools and Disease Managements. Springer, Singapore. https://doi.org/10.1007/978-981-19-3995-2_9

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