Talk:Latent tuberculosis
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[edit] Risk of untreated TB
Prior to my edit, it said "The main risk is that approximately a quarter of these patients will go on to develop active tuberculosis at a later stage of their life." I changed "a quarter" to "10%" to agree with the Wikipedia article Tuberculosis treatment, which says "The reason for treating people with LTBI is to prevent them progressing to active TB disease later in life (approximately 10% lifetime risk)." The lower figure appears commonly in the literature off Wikipedia.
[edit] US guidelines for BCG
I question the neutrality of this section: "In particular, US recommendation is that prior BCG vaccination be ignored in the interpretation of tuberculin skin tests, which means that many more people (particularly foreign nationals who will almost all have had BCG) who have nothing wrong with them will end up having unnecessary treatment with potentially toxic drugs. There are two reasons for this: (1) people who have previously had BCG (even may years ago) may still have a false positive Mantoux test, and (2) serial testing with tuberculin skin tests boosts the immunological response in those people who have previously had BCG, so these people will falsely appear to be tuberculin converters." It fails to address the fact that BCG is not fully protective, less protective in adults than pediatric, and in areas where QFT is not widely available or cost-effective, the concern over missing an LTBI is great enough that the benefits are considered to outweigh the risks in generally low-prevalence areas such as the USA.
- I concur. The article, as written, seems a bit biased. How does the following sound:
- Given that the US recommendation is that prior BCG vaccination be ignored in the interpretation of tuberculin skin tests, false positives are possible as a result of: (1) people who have previously had BCG (even may years ago) may still have a false positive Mantoux test, and (2) serial testing with tuberculin skin tests boosts the immunological response in those people who have previously had BCG, so these people will falsely appear to be tuberculin converters. This may lead to treating more people than necessary, with the possible risk of those patients suffering adverse drug reactions. However, as Bacille_Calmette-Guérin vaccine is not 100% effective, and is less protective in adults than pediatric patients, not treating these patients could lead to a possible infection. The current US policy seems to a reflect a desire to err on the side of safety (of the general public).
- PS. Please sign all your contributions in the future. Cheers, --bfigura (talk) 04:04, 16 August 2007 (UTC)
