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Tuberculosis

Management of Latent Tuberculosis Infection

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JAMA

Published Online: January 19, 2023

JAMA Insights

Article Information and Disclosures

Steven Kim, MD¹;

Rebecca Thal, MSN, NP^2,3;

Daria Szkwarko, DO, MPH^4,5

Author Affiliations

¹Department of Internal Medicine, The Warren Alpert Medical School at Brown University, Providence, Rhode Island
²Family Health Center of Worcester, Worcester, Massachusetts
³Tan Chingfen Graduate School of Nursing, University of Massachusetts, Worcester
⁴Department of Family Medicine, Providence, The Warren Alpert Medical School at Brown University, Providence, Rhode Island
⁵UMass Chan Medical School, Worcester, Massachusetts

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In the US, approximately 13 million people have latent tuberculosis infection (LTBI), defined as people who are infected with Mycobacterium tuberculosis who do not have symptoms and do not transmit the disease. Without treatment, approximately 5% to 10% of immunocompetent persons with LTBI develop active TB disease in their lifetimes.¹

In 2016, the US Preventive Services Task Force recommended screening all at-risk adults older than 18 years for LTBI with a blood test (interferon-gamma release assay) or a tuberculin skin test. At-risk individuals include those from TB-endemic regions and those who are immunocompromised or are starting an immunosuppressive medication, such as tumor necrosis factor antagonists or systemic corticosteroids at a dose of at least 15 mg of prednisone per day, or take immunosuppressive drugs after organ transplant.² Evaluation for LTBI should include a medical history, physical examination, and chest radiographic imaging to rule out active TB disease. After confirmation that active TB is not present, LTBI treatment can be initiated. This article reviews the 2020 Centers for Disease Control and Prevention and National Tuberculosis Controllers Association LTBI treatment recommendations.¹

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Article Information

Corresponding Author: Daria Szkwarko, DO, MPH, 111 Brewster St, Pawtucket, RI 02860 (Szkwarkd@gmail.com).

Published Online: January 19, 2023. doi:10.1001/jama.2022.24362

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Szkwarko was partially supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the NIH, which funds Advance Clinical and Translational Research. Dr Kim was supported by NIH/NIAID under R25AI140490 Emerging Infectious Disease Scholars Program at Brown University.

Role of the Funder/Sponsor: The funders had no role in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Advance-CTR, or Emerging Infectious Disease Scholars.

Additional Contributions: All authors contributed equally. The authors would like to thank John Bernardo, MD (Massachusetts Department of Public Health), who did not receive compensation, for his support in formalizing this article.

References

Sterling TR , Njie G , Zenner D , et al. Guidelines for the treatment of latent tuberculosis infection. MMWR Recomm Rep. 2020;69(1):1-11. PubMed Google Scholar Crossref

Latent Tuberculosis Infection. Centers for Disease Control and Prevention; 2020.

Menzies D , Adjobimey M , Ruslami R , et al. Four months of rifampin or nine months of isoniazid for latent tuberculosis in adults. N Engl J Med. 2018;379(5):440-453. doi:10.1056/NEJMoa1714283 PubMed Google Scholar Crossref

Sterling TR , Villarino ME , Borisov AS , et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365(23):2155-2166.PubMed Google Scholar Crossref

International Union Against Tuberculosis Committee on Prophylaxis. Efficacy of various durations of isoniazid preventive therapy for tuberculosis. Bull World Health Organ. 1982;60(4):555-564.PubMed Google Scholar

CDC estimates for latent TB infection (LTBI) treatment costs. Centers for Disease Control and Prevention. Accessed November 10, 2022. https://www.cdc.gov/tb/publications/infographic/ltbi-treatment-costs.htm

Update on rifamycin issues. Centers for Disease Control and Prevention. Accessed December 30, 2022. https://www.cdc.gov/tb/publications/letters/Rifamycin_Update.html

Laboratory analysis of rifampin/rifapentine products. US Food and Drug Administration. Accessed May 29, 2022. https://www.fda.gov/drugs/drug-safety-and-availability/laboratory-analysis-rifampinrifapentine-products

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.