LTBI

1. Latent TB Infection
D R . M D . S H A F I Q U L I S L A M D E WA N
R E S I D E N T ( P U L M O N O L O G Y )
R E S P I R A T O R Y M E D I C I N E D E P A R T M E N T
D H A K A M E D I C A L C O L L E G E H O S P I T A L

2. Latent tuberculosis infection (LTBI)
Latent tuberculosis infection (LTBI) is defined as a state of persistent immune
response to stimulation by Mycobacterium tuberculosis antigens without
evidence of clinically manifested active TB.
Lifetime risk of an individual with LTBI for progression to active TB is 5–10%.
Among them the majority develop TB disease within the first five years after
initial infection.
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 2

3. Screening test for LTBI
There are no direct tests to diagnose LTBI definitively, latent TB remains a clinical
diagnosis based on evidence of prior TB infection and exclusion of active
disease.
There are only two approaches available to identify individuals with
asymptomatic TB infection: tuberculosis skin testing (TST) and interferon-
gamma release assays (IGRAs).
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 3

4. DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 4

5. Risk Factors
• Diabetics
• Other clinical vulnerabilities
• CKD with or without on dialysis
• Anti-TNF treatment
• Transplantation (including candidate)
• Silicosis
• Smoking
• Substance abuse
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 5

6. Algorithms for diagnosis of LTBI
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 6

7. Management Strategy of LTBI
Management of LTBI involves a comprehensive package of interventions that
includes_
Identification and testing of pre-defined at-risk population (household and
close contacts, esp. Children below 5 years and ≥60 years, PLHIV and other
immune-compromised patients etc.)
Ruling out active tb disease.
Delivering an effective and safe treatment with no or minimal loss to follow up
and adverse events.
Systematic monitoring and evaluation of the process.
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 7

8. Treatment options for LTBI
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 8

9. DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 9

10. Adverse events monitoring
Individuals who receive treatment for LTBI do not have active disease, and therefore, it is
mandatory to minimize risks during treatment.
While most adverse drug reactions are minor and occur rarely, special attention should given to
prevention of drug induced hepatotoxicity.
Baseline laboratory testing should be undertaken for individuals with the following risk
cofactors:
History of liver disease,
Regular use of alcohol,
Chronic liver disease,
HIV infection and
Pregnancy or the immediate postpartum period (i.e., Within three months of delivery).
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 10

11. Preventive treatment for contacts of MDR-TB cases
TPT for contacts of DR-TB patient is not recommended in
NTP Bangladesh yet.
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 11

12. DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 12
Thank You