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tb

Tuberculosis

source: Pocket Medicine, 2022, 台灣肺結核診治指引第七版

Definitions

  • Primary: new Mycobacterium tuberculosis (TB) in a naïve host; symptomatic or asymptomatic; 90% of infected normal hosts will never develop clinically evident disease
  • Latent: well-controlled infection without clinical or radiographic evidence of active disease; can persist for years to decades
  • Reactivated: activation of latent; more likely in the setting of immunosuppression.
  • Milliary: disseminated lympho-hematogenous spread due to primary or reactivated TB
  • Multidrug-resistant (MDR): resistant to isoniazid (INH) & rifampin. Can occur as 1° infxn.
  • Extensively drug-resistant (XDR): resistant to INH, rifampin (RIF), fluoroquinolones (FQ), and at least one of amikacin, kanamycin, or capreomycin

Latent tuberculosis infection

source: Pocket Medicine, 2022; 台灣肺結核診治指引

Whom to screen

  • 一個月內新生兒：都要治療
  • Open TB：都要檢查
  • Smear (-), culture (+)：<13歲、免疫力低下接觸者和同住家人要檢查
  • Culture(-)：照CXR即可
  • 肺外結核、指標個案<5歲：≥5歲接觸者照CXR
  • 1個月至未滿2歲：TST x 2 (一個月內、暴露滿八週後且與前次間隔八週）
    • 判讀標準：已打BCG ≥ 10mm，未打BCG, HIV, 接受anti-lymphokines 或其他免疫抑制治療者 ≥ 5mm為陽性
    • 治療期滿後TST < 5mm再補打BCG
  • 2歲以上：暴露滿八週後IGRA