Summary
International standards of TB care recommend prompt and accurate diagnosis of tuberculosis based on sputum microscopy and culture. Treatment should follow recommended treatment regimens of adequate duration with appropriate case management and monitoring. Essential public health responsibilities include evaluating and managing close contacts and reporting new cases and outcomes. Accurate diagnosis and effective treatment are core to controlling tuberculosis. The standards emphasize bacteriological confirmation of diagnosis where possible. Treatment regimens and duration should follow WHO guidelines. Response to treatment and microbiological response should be monitored. The standards aim to unify public and private sectors in providing quality care. They are evidence-based, widely accepted, and complement WHO guidelines and local policies. Professional societies should endorse and educate on the standards. Collaboration with national TB programmes can promote standards adherence. TB care providers should use the standards to improve care, increase treatment success, and achieve control targets. Government commitment, diagnosis, standardised treatment, uninterrupted drug supply, and monitoring - the DOTS strategy - are essential for controlling tuberculosis. Controlling coinfection and drug resistance is complex. Intensifying measures to identify and treat latent infection can further reduce incidence. Monitoring drug levels and adjusting treatment can optimise outcomes. Commercial tests vary in performance; sensitivity is higher in smear-positive samples. Specificity is higher in healthy volunteers. More data are needed on accuracy in smear-negative, child, and HIV patients. Serological tests may extend testing but a blood test is more practical where sputum is difficult. However, overall commercial tests vary in performance. Anda-TB IgG shows limited sensitivity and inconsistent specificity. Specificity is higher in healthy volunteers. Data are lacking on most commercial tests in smear-negative patients, children, and HIV patients.
Consensus Meter
TB can be ended in a generation with investments in care,research and responsibility. Strategies to help high-risk groups and diagnose cases are key, as are increased research funding and shared responsibility for funding and progress
Published By:
…, CL Hanson, M Harrington, N Herbert, PC Hopewell… - The Lancet, 2019 - thelancet.com
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The study analyzed TB in San Francisco from 1991 to 2003, showing a decrease in annual case rate from 1992 to 1999 with a plateau thereafter. There was also a significant reduction in clustered cases during this time, indicating the need for enhanced measures to combat TB.
Published By:
A Cattamanchi, PC Hopewell… - … and Lung Disease, 2006 - ingentaconnect.com
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New studies show detecting TB in households increases case finding and reduces spread in poor nations; policies on testing and treating latent TB remain.
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J Morrison, M Pai, PC Hopewell - The Lancet infectious diseases, 2008 - thelancet.com
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Rate of reinfection tuberculosis higher than rate of new tuberculosis after successful treatment. WHO guidelines for national TB programs.
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…, L Gooze, M Narita, PC Hopewell… - … infectious diseases, 2010 - thelancet.com
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A review found 19.9% of TB cases were multidrug resistant, 2% extensively so; XDR TB led to higher death rates.However, with proper diagnosis and treatment, governments can curb this curable disease.
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PC Hopewell, M Pai, D Maher, M Uplekar… - … infectious diseases, 2006 - thelancet.com
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Chemical and physical treatments of sputum improve tuberculosis diagnosis compared to direct smears, according to 83 studies. Centrifugation with chemicals increased sensitivity 18% in 32 studies; sodium hypochlorite 13% in 17 studies; sodium hydroxide 17% in 4 studies.Sedimentation with chemicals sensitivity 23% in 4 studies; 9% in 4 studies.
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KR Steingart, V Ng, M Henry, PC Hopewell… - … infectious diseases, 2006 - thelancet.com
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Drug resistance mutations can come with a fitness cost, but compensatory evolution may help mitigate this. Isoniazid-resistant isolates can be categorized based on specific mutations.
Published By:
…, K DeRiemer, A Enciso, S Muñoz, PC Hopewell… - PLoS …, 2006 - journals.plos.org
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Commercial tests for diagnosing pulmonary TB vary widely in performance, with sensitivity higher in smear-positive samples. Specificity is higher in healthy volunteers compared to patients suspected of TB. There is limited data on the accuracy of these tests in smear-negative patients, children, or those with HIV.
Published By:
KR Steingart, M Henry, S Laal, PC Hopewell… - PLoS …, 2007 - journals.plos.org
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Serological tests offer advantages over microscopy for diagnosing active TB, with results available in hours using ELISA or minutes using immunochromatographic assays. They could potentially replace microscopy or extend testing to lower levels of health services.
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…, I Schiller, S Laal, A Ramsay, PC Hopewell… - PLoS …, 2011 - journals.plos.org
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Mycobacterial lineages are adapted to specific human populations. Observations suggest this adaptation.
Published By:
…, MC Gutierrez, M Hilty, PC Hopewell… - Proceedings of the …, 2006 - National Acad Sciences
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