TB Nurse Case Management San Antonio, Texas March 7 9, Clinical Diagnosis and

Size: px
Start display at page:

Download "TB Nurse Case Management San Antonio, Texas March 7 9, Clinical Diagnosis and"

Transcription

1 TB Nurse Case Management San Antonio, Texas March 7 9, 2012 Clinical Diagnosis and Management of LTBI Lynn Horvath, MD March 7, 2012 Lynn Horvath, MD has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1

2 CLINICAL DIAGNOSIS AND MANAGEMENT OF LATENT TB INFECTION (LTBI) Lynn L. Horvath, MD, FACP, FIDSA Infectious Disease Physician, Texas Center for Infectious Disease Medical Consultant, Heartland National TB Center Associate Professor of Medicine University of Texas Health Center Tyler 1/3 of World Infected with TB 2

3 Global Tuberculosis Impact In 2010: Active TB cases 9 million cases 1.4 million deaths Latent TB cases 2+ billion have Latent TB infection Division of Tuberculosis Elimination Active TB Disease Active infectious process involving the lungs ± other organs Symptoms Fever Chills Night Sweats Weight Loss Cough Productive Cough Hemoptysis When disease involves the lungs, the person is contagious 3

4 Latent TB Infection (LTBI) LTBI is NOT just exposure to TB!!!!! LTBI means you are infected with TB!!!! But it is not active, yet. Latent TB Infection Quiescent infection with M. tuberculosis Bacteria is dormant or Bacteria is slowly metabolically active and is controlled by your immune system Not contagious! 4

5 Latent TB Infection How can we tell you have LTBI? Positive TST or IGRA Tuberculin skin test (TST) Interferon Gamma Release Assay (IGRA) No Symptoms suggestive of Active TB A normal or stable CXR Negative TB sputum smears and cultures NOT INFECTIOUS NOW, but Dormant TB bacilli is inside that patient! At risk for development of Active TB disease in the future! LTBI Progression to Active TB Disease LTBI 10% lifetime risk of Active TB Disease 90% lifetime risk of no active TB ~0.1% per year thereafter 2-3% Second Year 5% First Year Active TB Disease (10%) No TB Disease (90%) 5

6 Active TB Infection in USA USA has aggressive program for TB treatment TB is a reportable disease Ensure all patients take their medications DOT Directly Observed Therapy Ensure all patients complete their TB treatment Contact Investigations Identify contacts with Active TB Identify contacts with LTBI Latent TB Infection Why do we care if someone has LTBI if they are not contagious? 6

7 Latent TB Infection If we identify an LTBI case, We can treat it & prevent an active TB case We can prevent all the secondary cases that one active TB case would have caused Ultimately, should be a cost effective approach Is this combination approach working? Reported TB Cases United States, * No. of Cases *Updated as of July 21, 2011 Year 7

8 Active TB Cases United States, Year No. Rate* , , , , , , : 84,304 TB Cases/52.6 cases per 100,000 US Population *Cases per 100,000. Updated as of July 21, 2011 TB Case Rates,* United States, 2010 D.C. *Cases per 100,000. < 3.6 (2010 national average) >3.6 8

9 Why is US TB declining? Active TB Treatment Programs Aggressive Tracking of Active TB cases DOT Programs Completion of TB treatment LTBI Treatment Programs Division of Tuberculosis Elimination LTBI Diagnosis 9

10 Latent TB Infection Diagnosis Who should be tested? Why Is TB Testing Recommended Only For Select Groups? Declining TB resources Identify LTBI in those most likely to progress to active TB disease (most likely to benefit) Treat those with Risk of disease > than risk of toxicity from LTBI Meds 10

11 Who Should be Tested for LTBI? Contacts of persons with active TB HIV positive individuals Recent immigrants (<5 yrs) from high prevalence countries Injection Drug Users Residents and Employees of high risk congregate settings: Correctional facilities and Homeless Shelters Hospitals, Clinics, Nursing Homes, Substance Abuse Facilities Newest Category: Patients considering treatment with TNF-α Antagonists Contacts of Active TB Case Among close contacts to a TB Case: 30% have LTBI 1-3% have active TB disease Without LTBI treatment: 10% with LTBI with develop Active TB Approximately 5% of contacts with newly acquired LTBI progress to TB disease within 2 years The other 5% activate > 2 years after acquisition Examination of contacts is one of the most effective strategies for LTBI diagnosis and TB control! 11

12 Number of TB Cases in U.S.-born vs. Foreign-born Persons United States, * s No. of Cases *Updated as of July 21, : 11,182 Active TB cases/3.6 cases per 100,000 US Population 1953: 84,304 TB Cases/52.6 cases per 100,000 US Population TNF alpha Antagonists Block TNF alpha activity which is required for granuloma formation and control of TB infection Used for rheumatoid arthritis, Crohn s disease, psoriasis and a variety of other immune mediated diseases Remicaid Enbrel Humira Cimzia (inflixamab) (entanercept) (adalimubab) (certolizumab) 12

13 Warning: Risk Of Active TB Infections with Infliximab Tuberculosis (frequently disseminated or extrapulmonary at clinical presentation), and other opportunistic infections have been observed in patients receiving Remicade some of these infections have been fatal. Patients should be evaluated for LTBI with a TST. Treatment of LTBI should be initiated prior to therapy with Remicade. SEE WARNINGS PDR 2004 Tests for LTBI Diagnosis 13

14 LTBI Diagnostics TB Skin Test (TST) Interferon Gamma Release Assays (IGRA) TB Skin Test (TST) Purified Protein Derivative (PPD): Concentrated Filtrate of heat killed TB PPD is given via intradermal injection Read induration, not erythema, at hrs 14

15 TB Skin Test (TST) Pros: Inexpensive Simple to perform More Sensitive than IGRA Cons: Must return in hrs Difficult to interpret False Negatives: Elderly Immunosuppressed False Positives: Low risk populations NonTuberculous Mycobacteria Reading the TB Skin Test Measure induration, not erythema!!! 15

16 Induration of 5mm Considered a Positive TST HIV positive persons Recent contacts of TB cases Fibrotic Changes on CXR c/w prior TB Patients with organ transplants or other immunosuppression Prednisone therapy 15 mg/day > 1 month CDC. June 2000 Induration of 10mm Considered a Positive TST Recent arrivals (<5 yrs) )high hprevalence countries ti IVDU Residents/employees - high-risk congregate facilities (health care, prisons, shelters, etc.) TB lab personnel Children <4 yrs or exposed to adults at risk Persons with high-risk medical conditions CDC. June

17 Induration of 10mm Considered a Positive TST Persons with high-risk medical conditions Silicosisi Diabetes Chronic Renal Failure Hematologic Disorders/Leukemia/Lymphoma Cancers, particularly Head/neck and Lung Low Body weight less than 10% below Ideal body weight Gastrectomy Jejunal Bypass CDC. June 2000 Induration of 15mm Considered a Positive TST Persons with no risk factors Why did you even place the PPD???? CDC. June

18 Interferon Gamma Release Assays Blood tests for detecting M. tuberculosis infection Sensitized white blood cells will release IFN-gamma in response to contact with TB antigens Two Tests currently available: T-SPOT TB (Oxford Immunotec) Quantiferon TB-Gold In-Tube (Cellestis) Interferon Gamma Release Assays Pros Patient does not have to return for second visit - No Cross reactivity with BCG Vaccination - Less Cross reactivity with other NTMs - More Specific than TST Cons Expensive Does not differentiate LTBI from active disease 18

19 No Cross-reactivity to BCG and Most NTMs Tuberculosis Complex Antigens Environmental Strains Antigens ESAT-6 CFP 10 ESAT-6 CFP 10 M. tuberculosis + + M. abcessus - - M. africanum + + M. avium - - M. bovis + + M. branderi - - BCG substrain M. celatum - - gothenburg - - M. chelonae - - moreau - - M. fortuitum - - tice - - M. gordonae + + tokyo - - M. intracellulare - - danish - - M. kansasii + + glaxo - - M. malmoense - - montreal - - M. marinum + + pasteur - - M. oenavense - - M. scrofulaceum - - M. smegmatis - - M. szulgai + + M. terrae - - M. vaccae - - M. xenopii - - Update on IGRAs: review of 38 studies on performance of IGRAs CI = confidence interval 19

20 Within-Subject Variability and Boosting of T-Cell Interferon-γ Responses after Tuberculin Skin Testing 26 South African participants with varying TB exposure risk, HIV negative, BCG + QFT-Gold, QFT-Gold IT, T-Spot repeated 4 times over 21 days pre- TST and then on days 3,7, 28 and 84 post-tst All 5 low risk patients were IGRA negative and remained IGRA negative 7/21 medium to high risk subjects had conversion or reversion, 1º with T-spot The results of this study confirm that short-term variability commonly occurs with both IGRA s. AJRCCM 2009, 180; 49 Within-Subject Variability and Boosting of T-Cell Interferon-γ Responses after Tuberculin Skin Testing Boosting: A significant increase in mean QFT-Gold IFN-γ responses was noted by day 7 post-tst that persisted for up to 3 months after the TST Author proposals for QFT-Gold interpretation: Borderline or uncertainty zone: IU/ml Conversion threshold: Increase from <0.35 to >0.7 IU/ml AJRCCM 2009, 180; 49 20

21 QFT-Gold Testing for Health Care Workers: Summary Significant ifi intra-individual i id variability in test t results with serial short term testing Results can be boosted by TST (between 3 days and 3 months). QFT-Gold testing should not be done more than 3 days after TST Multiple factors (some known, some unknown) likely can influence QFT-Gold results For low risk HCW s, low-level positive results must be viewed with caution and generally should be repeated (clinical judgment required for medium to high risk) QFT-Gold Testing for Health Care Workers: Summary Know the NUMBERS! Do not accept positive or negative as the only written result! You can only interpret indeterminate result if you know the numbers and you know the patient! 21

22 Should I use TST or IGRA? Neither test is perfect Pick one and use it only! Do not use both to confirm!!! Active TB or LTBI? The Clinical Evaluation 22

23 Standard Components of TB/LTBI Evaluation If TST or IGRA Positive Patient History Physical examination Radiologic evaluation?laboratory? Patient History Symptoms Fever Chills Night Sweats Weight Loss Cough Productive Cough Hemoptysis PMH: Diabetes HIV Other Immunosuppression Silicosis Drug/alcohol/tobacco TB exposures or Risk? 23

24 Physical Exam Lungs Palpate liver Look for anything that will complicate therapy! Radiologic Exam CXR must be done Must be normal Or IF abnormal: Not consistent with Active TB Stable abnormality confirmed over a 3 month period 24

25 Clinical Evaluation: CXR Findings associated with higher risk of TB (require further evaluation and possible treatment for TB) Noncalcified nodular lesions Fibrotic scars Findings consistent with TB disease (require further evaluation and possible treatment for TB) Enlarged hilar, mediastinal or subcarinal lymph nodes Atelectasis Alveolar consolidation Interstitial infiltrates, cavitary and non-cavitary Pleural effusion Focal mass Hyperinflation in children If CXR is abnormal, do not just treat for LTBI! You must rule out Active TB! TST+/IGRA+ with Abnormal CXR CLASS 4 - TB Not Clinically Active Must Exclude active disease! Abnormal CXR - Any Abnormality!!!! NODULES/ FIBROTIC LESIONS OF OLD TB PLEURAL THICKENING CALCIFIED GRANULOMA BRONCHIECTASIS Is CXR Stable (compared to an old film) or is this a CXR with no comparison? 25

26 Management of TST+/IGRA + With Abnormal CXR If patient has any signs or symptoms of TB disease: The patient is a TB Suspect Start 4 drugs! Never start a single drug in a patient with possible active TB Management of TST+/IGRA + With Abnormal CXR If Patient has no symptoms of Active TB: Collect 3 sputum for smears and culture Evaluate for symptoms If no symptoms - Wait Repeat CXR If CXR stable at 2 3 months and cultures negative, treat LTBI 26

27 Laboratory Exam Not Required But, if you have the funding CBC Chem 7 LFTs Hepatitis B/C testing Laboratory Exam Sputum AFB smear and culture Only get if you suspect active disease If you order, and AFB smear is negative, don t start LTBI rx until cultures are negative 6 weeks!!!!! 27

28 Before Treatment of LTBI: Exclude Active Tuberculosis! Absence of symptoms Negative CXR Negative medical evaluation Od Order and wait itfor sputum culture if any question LTBI Treatment 28

29 Rationale for Treatment of LTBI Prevent progression of infection to disease Interrupt transmission of disease Evidence that this works? 1953: 52.6 cases/100,000 US Population 2010: 3.6 cases/100,000 US Population Who should be treated for LTBI? A decision to test is a decision to treat! Tests should only be placed on persons who would benefit from treatment Occasional tests placed for administrative reasons and these individuals should be evaluated on a case by case basis regarding initiation of treatment 29

30 Who has Highest Priority for LTBI Treatment? Positive IGRA or 5 mm PPD HIV Infected Recent contact of active TB case Persons with fibrotic changes on CXR Organ Transplant recipients Immunosuppressed patients 15mg Prednisone/Day for 1 month TNF- α antagonists CDC. November Who has Highest Priority for LTBI Treatment? Positive IGRA or 10 mm PPD Recent immigrants (< 5 years) from high prevalence countries Injection Drug Users Residents and employees of high risk congregate settings (Prison, Homeless shelters, Hospitals, Nursing Homes or other health care facilities) Mycobacteriology Lab personnel Children < 4yo, or children/adolescents exposed to high risk adults CDC. November

31 What should you do with Negative IGRA/TST in Immunosuppressed Persons? Empiric treatment for LTBI is warranted even when TST or IGRA is negative on initial or repeat testing 8-10 weeks after exposure Close contacts to Active TB case with AIDS Children < 5 years Contacts with significant immunosuppression Prednisone 15mg/day for 1 month Persons receiving treatment with TNF alpha antagonists LTBI Treatment Options CDC Recommended Treatment regimens: INH x 9 months Daily Twice Weekly DOT INH x 6 months Daily Twice Weekly DOT Rifampin 600mg daily x 4 months INH/Rifapentine x 3 months Once weekly DOT x 12 weeks CDC. November

32 So which regimen should you choose? Efficacy Duration Cost Efficacy Short term efficacy is equivalent Long term INH (most data) Rifampin INH/Rifapentine (least data) 32

33 Duration of Therapy INH 9 INH 6 Rifampin INH +RPT 9 months (270 doses) 6 months (180 doses) 4 months (120 doses) 12 weeks (12 doses) The longer the duration/more doses, the less likely your patient is to complete Rx! Fewer than 60% complete 9 months of INH! Cost INH (6 Months) INH (9 Months) Rifampin INH +RPT $20 $30 $110 $250* Medication costs *DOT cost not included! 33

34 INH LTBI Therapy INH LTBI Therapy The standard treatment regimen for LTBI is nine months of daily INH. The regimen is very effective and is the preferred regimen for HIV infected people taking antiretroviral therapy, and children aged 2-11 years. CDC. November

35 How Much Isoniazid Is Needed for the Prevention of Tuberculosis? Longer durations of therapy corresponded to lower TB rates No extra increase in protection among those who took >9 months Community based study, Bethel Alaska Comstock GW, Int J Tuberc. Lung Dis 3: LTBI Treatment Acceptance and Completion in the U.S. and Canada Employees at health care clinics more likely to decline therapy Risk factors for failing to complete treatment: 9 month INH regimen Residence in a congregate setting Injection drug use Age 15 years Employment at health care facility Overall, fewer than half of the people starting LTBI therapy completed treatment Chest 2010, 137;

36 INH Side Effects Hepatotoxicity Migraine Headaches Gastrointestinal Nausea, Diarrhea, Constipation Rash Peripheral Neuropathy Pyridoxine 50mg daily can prevent this INH Hepatotoxicity Asymptomatic elevation of aminotransferases: 20% of patients Clinical hepatitis: 0.6% of patients Fulminant hepatitis (hepatic failure) Approximately 4/100,000 persons s completing therapy (continued INH with symptoms of hepatitis, prior INH hepatotoxicity, malnutrition). 36

37 Severe INH Liver Injuries Among Persons Being Treated for LTBI, U.S., MMWR 3/5/10/ 59(08); CDC project to monitor SAEs with treatment of LTBI patients with SAEs, all hepatotoxicity 2 children < 15 yrs of age Adults median age 39 Diagnosed between 2 nd and 9 th month One patient HIV seropositive for Hep C, HIV 5/17 liver transplant (one child), 5/17 died (one transplant) Severe INH Liver Injuries Among Persons Being Treated for LTBI, U.S., MMWR 3/5/10/ 59(08); patients with CDC on-site investigation Symptoms 1-7 months after INH started Fatigue, nausea, abdominal pain in 7 patients who waited for jaundice to seek medical attention 3/10 with possible predispositions 7/10 patients t diagnosed d by provider other than the prescriber of INH 2 patients INH discontinued within 3 days of symptoms, 8 stopped at least one week after symptom onset, all after medical instruction 37

38 Severe INH Liver Injuries Among Persons Being Treated for LTBI, U.S., MMWR 3/5/10/ 59(08); Death and liver transplantation approximately 1/150,000-1/220,000 patients receiving LTBI treatment All patients monitored according to current guidelines SAEs idiosyncratic reaction, independent of dosing, possible anytime during treatment, t t can occur in children Severe INH Liver Injuries Among Persons Being Treated for LTBI, U.S., MMWR 3/5/10/ 59(08); Medical providers should emphasize to patients that INH treatment should be stopped immediately upon the earliest onset of symptoms (e.g. excess fatigue, nausea, vomiting, abdominal pain, or jaundice), even before a clinical evaluation has been conducted, and that initial symptoms might be subtle and might not include jaundice. 38

39 INH Toxicity Monitoring The critical element for INH toxicity monitoring is CLINICAL MONITORING. My recommendation: Only prescribe 30 day supply at a time/no refills Communicate with patient every 30 days Ask about Nausea, vomiting, Abdominal pain, Jaundice Document a note about this communication Only refill INH if the patient is OK Stop INH and/or check LFTs if not OK Rifampin LTBI Therapy 39

40 4 Mos Rifampin vs 9 Mos INH for Treatment of LTBI Menzies et al AJRCCM 2004, 170; 445 Completion of therapy significantly better with rifampin with fewer side effects than INH Lardizabal et al Chest 2006, 130; 1712 Patients receiving rifampin were significantly more likely to complete therapy than those receiving INH Menzies et al Ann Int Med 2008, 149; 689 Significantly higher rate of treatment completion with fewer serious adverse events Rifampin Treatment of LTBI Pros: Higher Completion Rates Less Side Effects Less Hepatotoxicty Cons: Drug Interactions Hormone Contraceptives Warfarin Prednisone HIV Antiretrovirals And many more must look up all drugs for interactions!!!!! Orange Body Fluids Other Side Effects: Rash Thrombocytopenia Anemia Leukopenia Allergic Interstitial Nephritis 40

41 INH/Rifapentine LTBI Treatment INH/Rifapentine LTBI Therapy The 12 dose regimen of INH and RPT does not replace other recommended LTBI treatment regimens. It is another effective regimen option for otherwise healthy patients aged 12 years who have a predictive factor for greater likelihood of TB developing including Recent TB contacts TST/IGRA Converters Radiographic findings of healed pulmonary TB CDC. November

42 INH + RPT is NOT recommended for: Children under 2 yo HIV infected on Antiretroviral Therapy Presumed INH or Rifampin Resistance Pregnancy If you choose to prescribe INH + RPT CDC. November

43 If you choose to prescribe INH + RPT The regimen must be administered via DOT Be vigilant about Rifamycin drug interactions: Coumadin Hormonal contraception HIV Antiretrovirals If you choose to prescribe INH + RPT Use caution! INH + RPT has been well tolerated and effective in 3 clinical trials However, with both INH and Rif-PZA, fatal liver injuries came to attention only after the regimens were widely adopted. Report any adverse events to the FDA at 43

44 The Unknowns of INH + RPT Long term efficacy? Will it increase MDRTB? Will it be safe? Who should prescribe INH + RPT? Health Departments with established DOT programs Ideal candidates for the regimen are LTBI patient discovered in contact investigation of active TB cases. 44

45 Summary Targeted Testing for LTBI TST or IGRA, Not Both! Rule out active Disease before starting LTBI Rx Treatment Options INH 9 mo preferred over 6 mo Rifampin 4 mo INH/Rifapentine 3 mo DOT & Caution advised Case 1 April 22,

46 Case 2 December 2, 2010 Case 2 December 13,

47 Case 3 April 22, 2010 Case 3 April 22,

48 Case 3 July 21, 2010 Case 3 June 8,

49 Questions? Guidelines on Diagnosis and Treatment of Latent TB Infection (LTBI) CDC. Targeted TB Testing and Treatment of LTBI. June ATS/CDC/IDSA. Controlling Tuberculosis in the U.S. November NTCA/CDC. Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis. December CDC. Guidelines for Using the QuantiFERON-TB Gold Test for Detecting Mycobacterium tuberculosis Infection, United States. December 2005 CDC. TB Elimination, Treatment Options for Latent Tuberculosis Infection. November

Contracts Carla Chee, MHS May 8, 2012

Contracts Carla Chee, MHS May 8, 2012 Moving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012 Contracts Carla Chee, MHS May 8, 2012 Carla Chee, MHS has the following disclosures to make: No conflict of interests No relevant

More information

Advanced Management of Patients with Tuberculosis Little Rock, Arkansas August 13 14, 2014

Advanced Management of Patients with Tuberculosis Little Rock, Arkansas August 13 14, 2014 Advanced Management of Patients with Tuberculosis Little Rock, Arkansas August 13 14, 2014 Tuberculosis Pathogenesis and Treatment of Latent TB Infection Lisa Armitige, MD, PhD August 13, 2014 Lisa Armitige,

More information

TB Intensive Houston, Texas October 15-17, 2013

TB Intensive Houston, Texas October 15-17, 2013 TB Intensive Houston, Texas October 15-17, 2013 Tuberculosis Pathogenesis and Treatment f Latent TB Infection Lynn Horvath, MD October 15, 2013 Lynn Horvath, MD has the following disclosures to make: No

More information

TB Intensive San Antonio, Texas November 11 14, 2014

TB Intensive San Antonio, Texas November 11 14, 2014 TB Intensive San Antonio, Texas November 11 14, 2014 Tuberculosis Pathogenesis and Treatment of Latent TB Infection Lynn Horvath, MD November 11, 2014 Lynn Horvath, MD has the following disclosures to

More information

Treatment of TB Infection Lisa Y. Armitige, MD, PhD April 7, 2015

Treatment of TB Infection Lisa Y. Armitige, MD, PhD April 7, 2015 Treatment of TB Infection Lisa Y. Armitige, MD, PhD April 7, 2015 Tuberculosis Infection Diagnosis and Treatment April 7, 2015 El Paso, TX EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has

More information

Diagnosis and Medical Management of TB Infection Lisa Y. Armitige, MD, PhD September 12, TB Nurse Case Management September 12 14, 2017

Diagnosis and Medical Management of TB Infection Lisa Y. Armitige, MD, PhD September 12, TB Nurse Case Management September 12 14, 2017 Diagnosis and Medical Management of TB Infection Lisa Y. Armitige, MD, PhD September 12, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has

More information

Diagnosis and Medical Management of LTBI

Diagnosis and Medical Management of LTBI TB Nurse Case Management San Antonio, Texas December 8-10, 2009 Diagnosis and Medical Management of LTBI Barbara Seaworth, MD December 8, 2009 CLINICAL DIAGNOSIS AND MANAGEMENT OF LATENT TB INFECTION Barbara

More information

Tuberculosis Update. Topics to be Addressed

Tuberculosis Update. Topics to be Addressed Tuberculosis Update Robert M. Jasmer, M.D. University of California, San Francisco TB Control Section, San Francisco Department of Public Health Topics to be Addressed TB in the USA Screening recommendations

More information

Moving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012

Moving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012 Moving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012 LTBI and TB Disease Treatment Cara Christ, MD, MS May 8, 2012 Cara Christ, MD, MS has the following disclosures to make: No conflict

More information

Diagnosis and Medical Case Management of Latent TB. Bryan Rock, MD April 27, 2010

Diagnosis and Medical Case Management of Latent TB. Bryan Rock, MD April 27, 2010 TB Nurse Case Management Lisle, Illinois April 27-28, 28 2010 Diagnosis and Medical Case Management of Latent TB Infection Bryan Rock, MD April 27, 2010 DIAGNOSIS AND MANAGEMENT OF LATENT TUBERCULOSIS

More information

Making the Diagnosis of Tuberculosis

Making the Diagnosis of Tuberculosis Making the Diagnosis of Tuberculosis Alfred Lardizabal, MD NJMS Global Tuberculosis Institute Testing for TB Infection Targeted Testing: Key Points Test only if plan for ensuring treatment De-emphasizes

More information

Mycobacterial Infections: What the Primary Provider Should Know about Tuberculosis

Mycobacterial Infections: What the Primary Provider Should Know about Tuberculosis Mycobacterial Infections: What the Primary Provider Should Know about Tuberculosis Henry F. Chambers, M.D Professor of Medicine, UCSF Topics for Discussion Epidemiology Diagnosis of active TB Screening

More information

TB in Corrections Phoenix, Arizona

TB in Corrections Phoenix, Arizona TB in Corrections Phoenix, Arizona March 24, 2011 Treatment of Latent TB Infection Renuka Khurana MD, MPH March 24, 2011 Renuka Khurana, MD, MPH has the following disclosures to make: No conflict of interests

More information

has the following disclosures to make:

has the following disclosures to make: CLINICAL DIAGNOSIS AND MANAGEMENT OF TB DISEASE Annie Kizilbash MD, MPH September 22, 2015 TB Nurse Case Management September 22 24, 2015 San Antonio. TX EXCELLENCE EXPERTISE INNOVATION Annie Kizilbash

More information

Barbara J Seaworth MD Medical Director, Heartland National TB Center Professor, Internal Medicine and Infectious Disease UT Health Northeast

Barbara J Seaworth MD Medical Director, Heartland National TB Center Professor, Internal Medicine and Infectious Disease UT Health Northeast Practical Aspects for Using the Interferon Gamma Release Assay (IGRA) Test Live Webinar July 14, 2017 Barbara J Seaworth MD Medical Director, Heartland National TB Center Professor, Internal Medicine and

More information

DIAGNOSIS AND MEDICAL MANAGEMENT OF TB DISEASE

DIAGNOSIS AND MEDICAL MANAGEMENT OF TB DISEASE DIAGNOSIS AND MEDICAL MANAGEMENT OF TB DISEASE Annie Kizilbash MD, MPH Assistant Professor University of Texas Health Science Center Staff Physician, Texas Center for Infectious Diseases TB Nurse Case

More information

Diagnosis and Medical Management of Latent TB Infection

Diagnosis and Medical Management of Latent TB Infection Diagnosis and Medical Management of Latent TB Infection Marsha Majors, RN September 7, 2017 TB Contact Investigation 101 September 6 7, 2017 Little Rock, AR EXCELLENCE EXPERTISE INNOVATION Marsha Majors,

More information

Tuberculosis Education for the Medical Professional

Tuberculosis Education for the Medical Professional Tuberculosis Education for the Medical Professional North Dakota Diagnosis and Medical Management of Latent TB Infection Dawn Farrell, RN, BSN, PHN Maria Robles, BSN July 10, 2007 Tuberculosis Education

More information

Tuberculosis Tools: A Clinical Update

Tuberculosis Tools: A Clinical Update Tuberculosis Tools: A Clinical Update CAPA Conference 2014 JoAnn Deasy, PA-C. MPH, DFAAPA jadeasy@sbcglobal.net Adjunct Faculty Touro PA Program Learning Objectives Outline the pathogenesis of active pulmonary

More information

Screening for Tuberculosis Infection. Harlingen, TX. Linda Dooley, MD has the following disclosures to make:

Screening for Tuberculosis Infection. Harlingen, TX. Linda Dooley, MD has the following disclosures to make: TB Infection Diagnosis Recommendations Talk Developed by Lisa Y. Armitige, MD, PhD Medical Consultant, Heartland National TB Center Associate Professor Internal Medicine/Pediatrics/Infectious Disease UT

More information

Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection (LTBI) Lloyd Friedman, M.D. Milford Hospital Yale University

Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection (LTBI) Lloyd Friedman, M.D. Milford Hospital Yale University Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection (LTBI) Lloyd Friedman, M.D. Milford Hospital Yale University Tuberculosis Estimates USA World Infection 15,000,000 2,000,000,000

More information

Latent TB Infection (LTBI)

Latent TB Infection (LTBI) Latent TB Infection (LTBI) Diagnosis & Treatment of Latent TB Infection (LTBI) Amee Patrawalla MD MPH Assistant Professor UMDNJ-New Jersey Medical School Infection with Mycobacterium tuberculosis without

More information

What the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Life Cycle of M. tuberculosis

What the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Life Cycle of M. tuberculosis What the Primary Physician Should Know about Tuberculosis Henry F. Chambers, M.D Professor of Medicine, UCSF Topics for Discussion Microbiology Epidemiology Common disease presentations Diagnosis of active

More information

Diagnosis and Management of Latent TB Infection Douglas Hornick, MD September 27, 2011

Diagnosis and Management of Latent TB Infection Douglas Hornick, MD September 27, 2011 TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Diagnosis and Management of Latent TB Infection Douglas Hornick, MD September 27, 2011 Douglas Hornick, MD has the following disclosures to

More information

Diagnosis and Medical Management of TB Disease. Quratulian Annie Kizilbash, MD, MPH March 17, 2015

Diagnosis and Medical Management of TB Disease. Quratulian Annie Kizilbash, MD, MPH March 17, 2015 Diagnosis and Medical Management of TB Disease Quratulian Annie Kizilbash, MD, MPH March 17, 2015 TB Nurse Case Management March 17 19, 2015 San Antonio, Texas EXCELLENCE EXPERTISE INNOVATION Quratulian

More information

LATENT TUBERCULOSIS. Robert F. Tyree, MD

LATENT TUBERCULOSIS. Robert F. Tyree, MD LATENT TUBERCULOSIS Robert F. Tyree, MD 1 YK TB OFFICERS Ron Bowerman Elizabeth Roll Mien Chyi (Pediatrics) Cindi Mondesir (Pediatrics) The new guys: Philip Johnson Robert Tyree 2009 CDC TB CASE DEFINITION

More information

Understanding and Managing Latent TB Infection Arnold, Missouri October 5, 2010

Understanding and Managing Latent TB Infection Arnold, Missouri October 5, 2010 Understanding and Managing Latent TB Infection Arnold, Missouri October 5, 2010 What is Latent TB Infection (LTBI)? Traci Hadley, RN October 5, 2010 LTBI or TB Disease? Presented by : Traci Hadley, RN

More information

Fundamentals of Tuberculosis (TB)

Fundamentals of Tuberculosis (TB) TB in the United States Fundamentals of Tuberculosis (TB) From 1953 to 1984, reported cases decreased by approximately 5.6% each year From 1985 to 1992, reported cases increased by 20% 25,313 cases reported

More information

What the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Global Impact of TB

What the Primary Physician Should Know about Tuberculosis. Topics for Discussion. Global Impact of TB What the Primary Physician Should Know about Tuberculosis Henry F. Chambers, M.D Professor of Medicine, UCSF Topics for Discussion Epidemiology Common disease presentations Diagnosis of active TB Screening

More information

Latent TB Infection Treatment

Latent TB Infection Treatment Latent TB Infection Treatment Douglas B. Hornick, MD Pulmonologist w/ Infectious Attitude Division of Pulmonary/Critical Care/Occ Med UI Carver College of Medicine 2014 MFMER slide-1 Disclosures: None

More information

Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA)

Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA) Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA) April 2019 Bob Belknap M.D. Director, Denver Metro TB Program Disclosures No relevant financial relationships Objectives Be able to

More information

TB Prevention Who and How to Screen

TB Prevention Who and How to Screen TB Prevention Who and How to Screen 4.8.07. IUATLD 1st Asia Pacific Region Conference 2007 Dr Cynthia Chee Dept of Respiratory Medicine / TB Control Unit Tan Tock Seng Hospital, Singapore Cycle of Infection

More information

ATS/CDC Guidelines for Treating Latent TB Infection

ATS/CDC Guidelines for Treating Latent TB Infection TB Intensive Tyler, Texas June 2-4, 2010 ATS/CDC Guidelines for Treating Latent TB Infection Timothy R. Aksamit, MD June 2, 2010 ATS/CDC Guidelines for Treating LTBI Tuberculosis Intensive University of

More information

Chapter 5 Treatment for Latent Tuberculosis Infection

Chapter 5 Treatment for Latent Tuberculosis Infection Chapter 5 Treatment for Latent Tuberculosis Infection Table of Contents Chapter Objectives.... 109 Introduction.... 111 Candidates for the Treatment of LTBI... 112 LTBI Treatment Regimens.... 118 LTBI

More information

TB: Management in an era of multiple drug resistance. Bob Belknap M.D. Denver Public Health November 2012

TB: Management in an era of multiple drug resistance. Bob Belknap M.D. Denver Public Health November 2012 TB: Management in an era of multiple drug resistance Bob Belknap M.D. Denver Public Health November 2012 Objectives: 1. Explain the steps for diagnosing latent and active TB role of interferon-gamma release

More information

Latent TB, TB and the Role of the Health Department

Latent TB, TB and the Role of the Health Department Latent TB, TB and the Role of the Health Department Elaine Darnall, RN, BSN, CIC TB Nurse Consultant Illinois Dept of Public Health March 21, 2018 Elaine Darnall has disclosed that there is no actual or

More information

TB Intensive Tyler, Texas December 2-4, 2008

TB Intensive Tyler, Texas December 2-4, 2008 TB Intensive Tyler, Texas December 2-4, 2008 Interferon Gamma Releasing Assays: Diagnosing TB in the 21 st Century Peter Barnes, MD December 2, 2008 TOPICS Use of interferon-gamma release assays (IGRAs)

More information

Approaches to LTBI Diagnosis

Approaches to LTBI Diagnosis Approaches to LTBI Diagnosis Focus on LTBI October 8 th, 2018 Michelle Haas, M.D. Associate Director Denver Metro Tuberculosis Program Denver Public Health DISCLOSURES I have no disclosures or conflicts

More information

TB Update: March 2012

TB Update: March 2012 TB Update: March 2012 David Schlossberg, MD, FACP Medical Director, TB Control Program Philadelphia Department of Public Health 1 TB Update: March 2012 IGRAs vs TST LTBI A New Regimen NAATs What is Their

More information

Diagnosis & Medical Case Management of TB Disease. Lisa Armitige, MD, PhD October 22, 2015

Diagnosis & Medical Case Management of TB Disease. Lisa Armitige, MD, PhD October 22, 2015 Diagnosis & Medical Case Management of TB Disease Lisa Armitige, MD, PhD October 22, 2015 Comprehensive Care of Patients with Tuberculosis and Their Contacts October 19 22, 2015 Wichita, KS EXCELLENCE

More information

Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA)

Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA) Tuberculin Skin Test (TST) and Interferon-gamma Release Assays (IGRA) April 2018 Bob Belknap M.D. Director, Denver Metro TB Program No Disclosures Objectives be able to describe: 1. Who should get tested

More information

TB Skin Test Practicum Houston, Texas Region 6/5 South September 23, 2014

TB Skin Test Practicum Houston, Texas Region 6/5 South September 23, 2014 TB Skin Test Practicum Houston, Texas Region 6/5 South September 23, 2014 Catalina Navarro, BSN, RN has the following disclosures to make: No conflict of interests No relevant financial relationships with

More information

Latent Tuberculosis Best Practices

Latent Tuberculosis Best Practices Latent Tuberculosis Best Practices Last Updated September 7, 2016 LTBI Demographics in the US o 13million people in the US with LTBI (estimate) o In 2014, approximately 66% of TB cases in the United States

More information

CLINICAL DIAGNOSIS AND MANAGEMENT OF TB Disease

CLINICAL DIAGNOSIS AND MANAGEMENT OF TB Disease CLINICAL DIAGNOSIS AND MANAGEMENT OF TB Disease Barbara J Seaworth MD Medical Director Heartland National TB Center Professor of Medicine University of Texas Health Center Tyler Barbara J Seaworth MD has

More information

Contact Investigation and Prevention in the USA

Contact Investigation and Prevention in the USA Contact Investigation and Prevention in the USA George D. McSherry, MD Division of Infectious Disease Penn State Children s Hospital Pediatric Section TB Center of Excellence Rutgers Global Tuberculosis

More information

CHILDHOOD TUBERCULOSIS: NEW WRINKLES IN AN OLD DISEASE [FOR THE NON-TB EXPERT]

CHILDHOOD TUBERCULOSIS: NEW WRINKLES IN AN OLD DISEASE [FOR THE NON-TB EXPERT] CHILDHOOD TUBERCULOSIS: NEW WRINKLES IN AN OLD DISEASE [FOR THE NON-TB EXPERT] QUESTION: : Which children in the United States should get a tuberculin skin test? Do questionnaires really work? Jeffrey

More information

Latent Tuberculosis Infections Controversies in Diagnosis and Management Update 2016

Latent Tuberculosis Infections Controversies in Diagnosis and Management Update 2016 Latent Tuberculosis Infections Controversies in Diagnosis and Management Update 2016 Randy Culpepper, MD, MPH Deputy Heath Officer/Medical Director Frederick County Health Department March 16, 2016 2 No

More information

TB Intensive. San San Antonio, Texas. December 1-3, 2010

TB Intensive. San San Antonio, Texas. December 1-3, 2010 TB Intensive San Antonio, Texas December 1-3, 2010 ATS/CDC Guidelines for Treating Latent TB Infection Timothy Aksamit, MD; Mayo Clinic December 1, 2010 ATS/CDC Guidelines for Treating LTBI Tuberculosis

More information

Advanced Concepts in Pediatric Tuberculosis

Advanced Concepts in Pediatric Tuberculosis Advanced Concepts in Pediatric Tuberculosis: Nizar F. Maraqa, MD, FPIDS Division of Pediatric Infectious Diseases & Immunology University of Florida College of Medicine - Jacksonville Advanced Concepts

More information

Tuberculosis Populations at Risk

Tuberculosis Populations at Risk Tuberculosis Populations at Risk One-third of the world is infected with TB, an average of one new infection per second Two million people died from tuberculosis in 2010, 1 every 20 seconds TB is the leading

More information

Evaluation and Management of the Patient with Latent Tuberculosis Infection (LTBI)

Evaluation and Management of the Patient with Latent Tuberculosis Infection (LTBI) Evaluation and Management of the Patient with Latent Tuberculosis Infection (LTBI) CURTIS FOWLER MPT,PA C ASSISTANT CLINICAL PROFESSOR UNIVERSITY OF THE PACIFIC Learning objectives Recognize the appropriate

More information

TB Intensive San Antonio, Texas

TB Intensive San Antonio, Texas TB Intensive San Antonio, Texas August 2, 2011 ATS/CDC Guidelines for Treating LTBI Timothy Aksamit, MD April 6, 2011 Timothy Aksamit, MD has the following disclosures to make: No conflict of interests

More information

Michael J. Huey, MD. NYSCHA Annual Meeting WE-2, October 19, 2016

Michael J. Huey, MD. NYSCHA Annual Meeting WE-2, October 19, 2016 Michael J. Huey, MD Assistant Vice President and Executive Director Emory University Student Health Services Associate Professor, Family and Preventive Medicine Emory University School of Medicine President-elect

More information

Therapy for Latent Tuberculosis Infection

Therapy for Latent Tuberculosis Infection Screening and Treatment of LTBI in TB Control in the US Margarita Elsa Villarino MD MPH Division of TB Elimination, CDC April 14, 2004 TB Prevention and Control in the United States The fundamental strategies

More information

Peggy Leslie-Smith, RN

Peggy Leslie-Smith, RN Peggy Leslie-Smith, RN EMPLOYEE HEALTH DIRECTOR - AVERA TRAINING CONTENT 1. South Dakota Regulations 2. Iowa Regulations 3. Minnesota Regulations 4. Interferon Gamma Release Assay (IGRA)Testing 1 SOUTH

More information

Disclosures. Updates in TB for the PCP: Opportunities for Prevention. Objectives PART 1: WHY TEST? 4/14/2016. None

Disclosures. Updates in TB for the PCP: Opportunities for Prevention. Objectives PART 1: WHY TEST? 4/14/2016. None Disclosures Updates in TB for the PCP: Opportunities for Prevention None Pennan Barry, MD, MPH Chief, Surveillance and Epidemiology, California TB Control Branch Assistant Clinical Professor, Division

More information

Pediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017

Pediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017 Pediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has the following disclosures

More information

TUBERCULOSIS. Pathogenesis and Transmission

TUBERCULOSIS. Pathogenesis and Transmission TUBERCULOSIS Pathogenesis and Transmission TUBERCULOSIS Pathogenesis and Transmission Infection to Disease Diagnostic & Isolation Updates Treatment Updates Pathogenesis Droplet nuclei of 5µm or less are

More information

Diagnosis of Tuberculosis Infection and Disease

Diagnosis of Tuberculosis Infection and Disease Diagnosis of Tuberculosis Infection and Disease David E. Griffith, M.D. Assistant Medical Director Heartland National TB Center The Medical Evaluation for Diagnosing Tuberculosis Traditional Approach Patient

More information

LTBI: Who to Test & When to Treat

LTBI: Who to Test & When to Treat LTBI: Who to Test & When to Treat TB Intensive May 10 th, 2016 David Horne, MD, MPH Harborview Medical Center University of Washington DISCLOSURES I have no disclosures or conflicts of interest to report

More information

Diagnosis Latent Tuberculosis. Disclosures. Case

Diagnosis Latent Tuberculosis. Disclosures. Case Diagnosis Latent Tuberculosis Neha Shah MD MPH Field Medical Officer Tuberculosis Control Branch California Department of Public Health Centers for Disease Control and Prevention September 2016 1 Disclosures

More information

TB In Detroit 2011* Early TB: Smudge Sign. Who is at risk for exposure to or infection with TB? Who is at risk for TB after exposure or infection?

TB In Detroit 2011* Early TB: Smudge Sign. Who is at risk for exposure to or infection with TB? Who is at risk for TB after exposure or infection? Those oral antibiotics are just not working! Inpatient Standards of Care & Discharge Planning S/He s in the Hospital: Now What Do I Do? Dana G. Kissner, MD TB Intensive Workshop, Lansing, MI 2012 Objectives:

More information

10/3/2017. Updates in Tuberculosis. Global Tuberculosis, WHO 2015 report. Objectives. Disclosures. I have nothing to disclose

10/3/2017. Updates in Tuberculosis. Global Tuberculosis, WHO 2015 report. Objectives. Disclosures. I have nothing to disclose Disclosures Updates in Tuberculosis I have nothing to disclose Chris Keh, MD Assistant Clinical Professor, Division of Infectious Diseases, UCSF TB Controller, TB Prevention and Control Program, Population

More information

ESCMID Online Lecture Library. by author

ESCMID Online Lecture Library. by author Tuberculosis prevention in immunodepressed patients M. Carmen Fariñas Álvarez Infectious Diseases.H.U.Marqués de Valdecilla University of Cantabria, Spain DISCLOSURES I have no potential conflicts with

More information

Targeted Testing and the Diagnosis of. Latent Tuberculosis. Infection and Tuberculosis Disease

Targeted Testing and the Diagnosis of. Latent Tuberculosis. Infection and Tuberculosis Disease Self-Study Study Modules on Tuberculosis Targeted Testing and the Diagnosis of Latent Tuberculosis Infection and Tuberculosis Disease 1 Module 3: Objectives At completion of this module, learners will

More information

What you need to know about diagnosing and treating TB: a preventable, fatal disease. Bob Belknap M.D. Denver Public Health November 2014

What you need to know about diagnosing and treating TB: a preventable, fatal disease. Bob Belknap M.D. Denver Public Health November 2014 What you need to know about diagnosing and treating TB: a preventable, fatal disease Bob Belknap M.D. Denver Public Health November 2014 The Critical First Step Consider TB in the Differential 1. Risks

More information

TB Screening and Diagnosis

TB Screening and Diagnosis TB Screening and Diagnosis Douglas B. Hornick, MD Pulmonologist w/ Infectious Attitude Division of Pulm/Crit Care/Occ Med UI Carver College of Medicine Disclosures: None Objectives Rural (US) TB epidemiology

More information

Diagnosis and Management of TB Disease Lisa Armitige, MD, PhD September 27, 2011

Diagnosis and Management of TB Disease Lisa Armitige, MD, PhD September 27, 2011 TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Diagnosis and Management of TB Disease Lisa Armitige, MD, PhD September 27, 2011 Lisa Armitige, MD, PhD has the following disclosures to make:

More information

Evaluation and Treatment of TB Contacts Tyler, Texas April 11, 2014

Evaluation and Treatment of TB Contacts Tyler, Texas April 11, 2014 Evaluation and Treatment of TB Contacts Tyler, Texas April 11, 2014 Interferon Gamma Release Assays: Understanding the Test David Griffith, BA, MD April 11, 2014 David Griffith, BA, MD has the following

More information

Latent TB Infection (LTBI) Strategies for Detection and Management

Latent TB Infection (LTBI) Strategies for Detection and Management Latent TB Infection (LTBI) Strategies for Detection and Management Patrick T. Dowling MD,MPH Professor and Chair Dept of Family Medicine David Geffen School of Medicine at UCLA Pri-Med March 29 2014 Pdowling@mednet.ucla.edu

More information

TB Nurse Case Management San Antonio, Texas July 18 20, 2012

TB Nurse Case Management San Antonio, Texas July 18 20, 2012 TB Nurse Case Management San Antonio, Texas July 18 20, 2012 IGRA s and Their Use in TB Nurse NCM Lisa Armitige, MD, PhD July 18, 2012 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict

More information

Pre-Treatment Evaluation. Treatment of Latent TB Infection (LTBI) Initiating Treatment: Patient Education. Before initiating treatment for LTBI:

Pre-Treatment Evaluation. Treatment of Latent TB Infection (LTBI) Initiating Treatment: Patient Education. Before initiating treatment for LTBI: Pre-Treatment Evaluation Before initiating treatment for LTBI: Treatment of Latent TB Infection (LTBI) Amee Patrawalla, MD Associate Professor, New Jersey Medical School Attending Physician, NJMS Global

More information

Tuberculosis Intensive

Tuberculosis Intensive Tuberculosis Intensive San Antonio, Texas April 3 6, 2012 Tuberculosis Pathogenesis Lynn Horvath, MD April 3, 2012 Lynn Horvath, MD has the following disclosures to make: No conflict of interests No relevant

More information

Why need to havetb Clearance. To Control and Prevent Tuberculosis

Why need to havetb Clearance. To Control and Prevent Tuberculosis Why need to havetb Clearance To Control and Prevent Tuberculosis How to ID Tuberculosis There are two kinds of tests that are used to determine if a person has been infected with TB bacteria: the tuberculin

More information

TB Intensive San Antonio, Texas August 7-10, 2012

TB Intensive San Antonio, Texas August 7-10, 2012 TB Intensive San Antonio, Texas August 7-10, 2012 ATS/CDC Guidelines for Treating Latent TB Infection Timothy Aksamit, MD August 7, 2012 Timothy Aksamit, MD has the following disclosures to make: No conflict

More information

These recommendations will remain in effect until the national shortage of PPD solution has abated.

These recommendations will remain in effect until the national shortage of PPD solution has abated. Maryland Recommendations Regarding the National Shortage of Purified Protein Derivative (PPD) Solution; Attachment to Health Officer Memorandum National Shortages of Tubersol and Aplisol for TB Skin Testing;

More information

TB is Global. Latent TB Infection (LTBI) Sharing the Care: Working Together. September 24, 2014

TB is Global. Latent TB Infection (LTBI) Sharing the Care: Working Together. September 24, 2014 Sharing the Care: Working Together to Meet the Challenge of TB Presented by: Barbara Cole, RN, PHN, MSN Director, Disease Control County of Riverside Department of Public Health Curry International TB

More information

TB Intensive San Antonio, Texas

TB Intensive San Antonio, Texas TB Intensive San Antonio, Texas August 2-5, 2011 Pediatric TB Jeffrey Starke, MD August 5, 2011 Jeffrey Starke, MD has the following disclosures to make: Is on a data safety monitoring board for Hoffman

More information

Tuberculosis: Where Are We Now?

Tuberculosis: Where Are We Now? Tuberculosis: Where Are We Now? Amee Patrawalla MD MPH Rutgers - NJ Medical School Global TB Institute Rutgers, The State University of New Jersey Learning Objectives Understand the current epidemiologic

More information

Management of Pediatric Tuberculosis in New Jersey

Management of Pediatric Tuberculosis in New Jersey Management of Pediatric Tuberculosis in New Jersey Helen Aguila, MD NJMS Global TB Institute December 15, 2011 This presentation is in part adapted from Pediatric Tuberculosis by Ann Loeffler, MD : Francis

More information

11/1/2017. Disclosures. Update In Tuberculosis, Indiana Outline/Objectives. Pathogenesis of M.tb Global/U.S. TB Burden, 2016

11/1/2017. Disclosures. Update In Tuberculosis, Indiana Outline/Objectives. Pathogenesis of M.tb Global/U.S. TB Burden, 2016 Disclosures Update In Tuberculosis, Indiana 2017 Bradley Allen, MD, PhD, FACP, FIDSA Indiana University School of Medicine Division of Infectious Diseases Roudebush VAMC Indianapolis Medical Consultant,

More information

Contact Investigation

Contact Investigation Tuberculosis Ann Raftery, RN, PHN, MSc GHS Learning Objectives Upon completion of this session, participants will be able to: Describe the criteria used and method for determining the infectious period

More information

TB in the Patient with HIV

TB in the Patient with HIV TB in the Patient with HIV Lisa Y. Armitige, MD, PhD May 11, 2017 TB Intensive May 9 12, 2017 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD, has the following disclosures to

More information

TB Intensive San Antonio, Texas November 11 14, 2014

TB Intensive San Antonio, Texas November 11 14, 2014 TB Intensive San Antonio, Texas November 11 14, 2014 Interferon Gamma Release Assays Lisa Armitige, MD, PhD November 12, 2014 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of

More information

Tuberculosis: A Provider s Guide to

Tuberculosis: A Provider s Guide to Tuberculosis: A Provider s Guide to Diagnosis and Treatment of Active Tuberculosis (TB) Disease and Screening and Treatment of Latent Tuberculosis Infection (LTBI) Alameda County Health Care Services Agency

More information

TB Intensive Houston, Texas October 15-17, 2013

TB Intensive Houston, Texas October 15-17, 2013 TB Intensive Houston, Texas October 15-17, 2013 Interferon Gamma Release Assays (IGRA s) Lisa Armitige, MD, PhD October 16, 2013 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict

More information

Tuberculosis Pathogenesis

Tuberculosis Pathogenesis Tuberculosis Pathogenesis Renuka Khurana, MD, MPH May 12, 2015 TB for Community Providers May 12, 2015 Phoenix, Arizona EXCELLENCE EXPERTISE INNOVATION Renuka Khurana, MD, MPH has the following disclosures

More information

Transmission and Pathogenesis of Tuberculosis

Transmission and Pathogenesis of Tuberculosis Transmission and Pathogenesis of Tuberculosis 2011 John Bernardo, M.D. Pulmonary Center Boston University School of Medicine Massachusetts Department of Public Health Division of TB Prevention and Control

More information

TB PREVENTION: TREATMENT OF LATENT TB INFECTION AND BCG VACCINATION

TB PREVENTION: TREATMENT OF LATENT TB INFECTION AND BCG VACCINATION TB PREVENTION: TREATMENT OF LATENT TB INFECTION AND BCG VACCINATION Michelle Haas, M.D. Denver Metro Tuberculosis Program Denver Public Health DISCLOSURES No relevant financial relationships OBJECTIVES

More information

LATENT TUBERCULOSIS SCREENING AND TREATMENT:

LATENT TUBERCULOSIS SCREENING AND TREATMENT: LATENT TUBERCULOSIS SCREENING AND TREATMENT: TB or not TB Christopher Kwong, MD and William Rifkin, MD Week 14 Educational Objectives: 1. Understand who should be screened for latent TB infection and why

More information

The Most Widely Misunderstood Test of All

The Most Widely Misunderstood Test of All The Most Widely Misunderstood Test of All Lee B. Reichman, MD, MPH NJMS Global Tuberculosis Institute History of Treatment of Latent Tuberculosis Infection For more than 4 decades, treatment of persons

More information

Pediatric TB Lisa Armitige, MD, PhD September 28, 2011

Pediatric TB Lisa Armitige, MD, PhD September 28, 2011 TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Pediatric TB Lisa Armitige, MD, PhD September 28, 2011 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of interest.

More information

Interpretation of TST & IGRA results. Objectives

Interpretation of TST & IGRA results. Objectives Interpretation of TST & IGRA results Randall Reves, MD, MSc Volunteer Clinician Denver Metro TB Program and Division of Infectious Diseases, Department of Medicine University of Colorado Denver Objectives

More information

Diagnosis and Treatment of Tuberculosis, 2011

Diagnosis and Treatment of Tuberculosis, 2011 Diagnosis of TB Diagnosis and Treatment of Tuberculosis, 2011 Alfred Lardizabal, MD NJMS Global Tuberculosis Institute Diagnosis of TB, 2011 Diagnosis follows Suspicion When should we Think TB? Who is

More information

Conflict of Interest Disclosures:

Conflict of Interest Disclosures: Mady Slater, M.D. Stanford University Medical Center Division of Infectious Diseases 04/23/14 WOEMA webinar Conflict of Interest Disclosures: I have no financial relationships with commercial entities

More information

Contact Investigation San Antonio, Texas January 14-15, 2013

Contact Investigation San Antonio, Texas January 14-15, 2013 Contact Investigation San Antonio, Texas January 14-15, 2013 Assigning Priorities to Contacts Patrick Moonan, PhD, MPH January 14, 2013 Patrick Moonan, PhD, MPH has the following disclosures to make: No

More information

CHAPTER 3: DEFINITION OF TERMS

CHAPTER 3: DEFINITION OF TERMS CHAPTER 3: DEFINITION OF TERMS NOTE: TB bacteria is used in place of Mycobacterium tuberculosis and Mycobacterium tuberculosis complex in most of the definitions presented here. 3.1 Acid-fast bacteria

More information

Communicable Disease Control Manual Chapter 4: Tuberculosis

Communicable Disease Control Manual Chapter 4: Tuberculosis Provincial TB Services 655 West 12th Avenue Vancouver, BC V5Z 4R4 www.bccdc.ca Communicable Disease Control Manual Definitions Page 1 2.0 DEFINITIONS Many of the definitions that follow are taken from

More information