Multi-drug-resistant tuberculosis secondary prevention

Secondary prevention for tuberculosis includes methods for screening and early diagnosis, such as tuberculin skin test (TST) and IGRAs; and to guarantee the correct treatment regimen at the right time to prevent disease progression.

• Children with close contact with a TB confirmed case should be evaluated for tuberculosis infection.
• TST is the test of choice for screening for tuberculosis infection.

• IGRA can be used in place of (but not in addition to) TST in screening for M. tuberculosis infection in the following conditions:^[1]

• A patient have received BCG vaccination
• Groups that historically have poor rates of return for TST reading.

• TST preferred compared to IGRA for TB screening due to its low cost and high accessibility.^[2]

• Early detection of tuberculosis disease is important to give treatment at the appropriate time and prevent complications.
• All patients should be routinely asked about:^[3]

• History of TB exposure, infection, or disease
• Symptoms or signs of TB disease
• Medical conditions that increase their risk for TB disease

• Patients with the following characteristics should be tested for tuberculosis:^[3]

• Cough for ≥3 weeks
• Loss of appetite
• Unexplained weight loss
• Night sweats
• Hemoptysis
• Hoarseness
• Fever
• Fatigue
• Chest pain
• Patient from an endemic area of TB

• Empiric therapy should be started as soon as a patient has tuberculosis disease confirmed.
• Sputum specimens should be sent for culture and DST before starting treatment.

• WHO has devised a new strategy to manage MDR-TB using the second line of drugs wihin the DOTS strategy in middle and low income countries. They must be implemented in well functioning national TB programs . The best way to avoid future MDR- TB epidemics is through prevention of development of future drug resistance.

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