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id="toc-Risk_factors" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Risk_factors"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Risk factors</span> </div> </a> <ul id="toc-Risk_factors-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Tuberculin_skin_testing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Tuberculin_skin_testing"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Tuberculin skin testing</span> </div> </a> <ul id="toc-Tuberculin_skin_testing-sublist" class="vector-toc-list"> <li id="toc-Mantoux_test" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Mantoux_test"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1.1</span> <span>Mantoux test</span> </div> </a> <ul id="toc-Mantoux_test-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Heaf_test" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Heaf_test"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1.2</span> <span>Heaf test</span> </div> </a> <ul id="toc-Heaf_test-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Tuberculin_conversion" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Tuberculin_conversion"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1.3</span> <span>Tuberculin conversion</span> </div> </a> <ul id="toc-Tuberculin_conversion-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Boosting" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Boosting"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1.4</span> <span>Boosting</span> </div> </a> <ul id="toc-Boosting-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Interpretation" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Interpretation"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1.5</span> <span>Interpretation</span> </div> </a> <ul id="toc-Interpretation-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Interferon-γ_testing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Interferon-γ_testing"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Interferon-γ testing</span> </div> </a> <ul id="toc-Interferon-γ_testing-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Drug-resistant_strains" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Drug-resistant_strains"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Drug-resistant strains</span> </div> </a> <ul id="toc-Drug-resistant_strains-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul 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</ul> </li> <li id="toc-Evidence_for_treatment_effectiveness" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Evidence_for_treatment_effectiveness"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>Evidence for treatment effectiveness</span> </div> </a> <ul id="toc-Evidence_for_treatment_effectiveness-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment_efficacy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Treatment_efficacy"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.5</span> <span>Treatment efficacy</span> </div> </a> <ul id="toc-Treatment_efficacy-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Controversy" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Controversy"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Controversy</span> </div> </a> <ul id="toc-Controversy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label 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For the airport, see <a href="/wiki/Eski%C5%9Fehir_Airport" class="mw-redirect" title="Eskişehir Airport">Eskişehir Airport</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Latent tuberculosis</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Latent tuberculosis infection</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Infectious_disease_(medical_specialty)" class="mw-redirect" title="Infectious disease (medical specialty)">Infectious disease</a></td></tr></tbody></table> <p><b>Latent tuberculosis</b> (<b>LTB</b>), also called <b>latent tuberculosis infection</b> (<b>LTBI</b>) is when a person is infected with <i><a href="/wiki/Mycobacterium_tuberculosis" title="Mycobacterium tuberculosis">Mycobacterium tuberculosis</a></i>, but does not have active <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a> (TB). Active tuberculosis can be contagious while latent tuberculosis is not, and it is therefore not possible to get TB from someone with latent tuberculosis. The main risk is that approximately 10% of these people (5% in the first two years after infection and 0.1% per year thereafter) will go on to develop active tuberculosis. This is particularly true, and there is added risk, in particular situations such as <a href="/wiki/Immunosuppression" title="Immunosuppression">medication that suppresses the immune system</a> or advancing age. </p><p>The identification and treatment of people with latent TB is an important part of controlling this disease. Various treatment regimens are in use for latent tuberculosis. They generally need to be taken for several months. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=1" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The latent tuberculosis is worldwide, approximately one third of the world's population is latently infected with M. tuberculosis,<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> with a new case occurring approximately every second.<sup id="cite_ref-WHO2004data_2-0" class="reference"><a href="#cite_note-WHO2004data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>The spread of tuberculosis is uneven throughout the world, with approximately 80% of the population in many Asian and African countries testing positive on tuberculin tests, while only 5–10% of the US population tests positive.<sup id="cite_ref-Robbins_3-0" class="reference"><a href="#cite_note-Robbins-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Transmission">Transmission</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=2" title="Edit section: Transmission"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Latent_disease">Latent disease</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=3" title="Edit section: Latent disease"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <blockquote><p>TB Bacteria Are Spread Only from a Person with Active TB Disease ... In people who develop active TB of the lungs, also called pulmonary TB, the TB skin test will often be positive. In addition, they will show all the signs and symptoms of TB disease, and can pass the bacteria to others. So, if a person with TB of the lungs sneezes, coughs, talks, sings, or does anything that forces the bacteria into the air, other people nearby may breathe in TB bacteria. Statistics show that approximately one-third of people exposed to pulmonary TB become infected with the bacteria, but only one in ten of these infected people develops active TB disease during their lifetimes.<sup id="cite_ref-WhatIsTB_4-0" class="reference"><a href="#cite_note-WhatIsTB-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></p></blockquote><p>However, exposure to tuberculosis is very unlikely to happen when one is exposed for a few minutes in a store or in a few minutes social contact. "It usually takes prolonged exposure to someone with active TB disease for someone to become infected.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> After exposure, it usually takes 8 to 10 weeks before the TB test would show if someone had become infected."<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></p><blockquote><p>Depending on ventilation and other factors, these tiny droplets [from the person who has active tuberculosis] can remain suspended in the air for several hours. Should another person inhale them, he or she may become infected with TB. The probability of transmission will be related to the infectiousness of the person with TB, the environment where the exposure occurred, the duration of the exposure, and the susceptibility of the host.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></p></blockquote><p>In fact, "it isn't easy to catch TB. You need consistent exposure to the contagious person for a long time. For that reason, you're more likely to catch TB from a relative than a stranger."<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>If a person had latent tuberculosis, they do not have active/contagious tuberculosis. Once exposed, people very often have latent tuberculosis. To convert to active tuberculosis, the bacteria must become active.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p><p>In some countries like Canada people have <a href="/wiki/Medical_privacy" title="Medical privacy">medical privacy</a> or "confidentiality" and do not have to reveal their active tuberculosis case to family, friends, or co-workers; therefore, the person who gets latent tuberculosis may never know who had the active case of tuberculosis that caused the latent tuberculosis diagnosis for them. Only by required testing (required in some jobs)<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> or developing symptoms of active tuberculosis and visiting a medical doctor who does testing will a person know they have been exposed. Because tuberculosis is not common in the United States, doctors may not suspect tuberculosis; therefore, they may not test. If a person has symptoms of tuberculosis, it is wise to be tested.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2020)">citation needed</span></a></i>]</sup> </p><p>Persons with diabetes may have an 18% chance of converting to active tuberculosis.<sup id="cite_ref-Dooley_9-0" class="reference"><a href="#cite_note-Dooley-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> In fact, death from tuberculosis was greater in diabetic patients.<sup id="cite_ref-Dooley_9-1" class="reference"><a href="#cite_note-Dooley-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Persons with HIV and latent tuberculosis have a 10% chance of developing active tuberculosis every year. "HIV infection is the greatest known risk factor for the progression of latent <i>M. tuberculosis</i> infection to active TB. In many African countries, 30–60% of all new TB cases occur in people with HIV, and TB is the leading cause of death globally for HIV-infected people."<sup id="cite_ref-ethnomed1_10-0" class="reference"><a href="#cite_note-ethnomed1-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Reactivation">Reactivation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=4" title="Edit section: Reactivation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Once a person has been diagnosed with Latent Tuberculosis (LTBI) and a medical doctor confirms no active tuberculosis, the person should remain alert to symptoms of active tuberculosis for the remainder of their life. Even after completing the full course of medication, there is no guarantee that the tuberculosis bacteria have all been killed.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2020)">citation needed</span></a></i>]</sup> "When a person develops active TB (disease), the symptoms (cough, fever, <a href="/wiki/Night_sweats" title="Night sweats">night sweats</a>, <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a> etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others."<sup id="cite_ref-who.int_11-0" class="reference"><a href="#cite_note-who.int-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Tuberculosis does not always settle in the lungs. If the outbreak of tuberculosis is in the brain, organs, kidneys, joints, or others areas, the patient may have active tuberculosis for an extended period of time before discovering that they are active. "A person with TB disease may feel perfectly healthy or may only have a cough from time to time."<sup id="cite_ref-lung.org_TB_Symptoms_12-0" class="reference"><a href="#cite_note-lung.org_TB_Symptoms-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> However, these symptoms do not guarantee tuberculosis, and they may not exist at all, yet the patient may still have active tuberculosis. A person with symptoms listed may have active tuberculosis, and the person should immediately see a physician so that tuberculosis is not spread. If a person with the above symptoms does not see a physician, ignoring the symptoms can result in lung damage, eye damage, organ damage and eventually death.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p><p>When tuberculosis settles in other organs (rather than lungs) or other parts of the body (such as the skeletal), symptoms may be different from when it settles in the lungs (such as the symptoms listed above). Thus, without the cough or flu-like symptoms, a person can unwittingly have active tuberculosis. Other symptoms include back pain, flank pain, PID symptoms, confusion, coma, difficulty swallowing, and many other symptoms that would be a part of other diseases.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> (Please see the reference for more information on symptoms.) Therefore, seeing a physician and asking for a tuberculosis test is absolutely necessary to rule out tuberculosis when a patient has symptoms without a diagnosis of disease.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Risk_factors">Risk factors</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=5" title="Edit section: Risk factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Situations in which tuberculosis may become reactivated are: </p> <ul><li>if there is onset of a disease affecting the <a href="/wiki/Immune_system" title="Immune system">immune system</a> (such as AIDS) or a disease whose treatment affects the immune system (such as <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a> in cancer or systemic steroids in asthma or Enbrel, Humira or Orencia in rheumatoid arthritis);<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2024)">citation needed</span></a></i>]</sup></li> <li>malnutrition (which may be the result of illness or injury affecting the <a href="/wiki/Digestive_system" class="mw-redirect" title="Digestive system">digestive system</a>, or of a prolonged period of not eating, or disturbance in food availability such as during famine or residence in a refugee or <a href="/wiki/Concentration_camp" title="Concentration camp">concentration camp</a>);</li> <li>degradation of the immune system due to aging;<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup></li> <li>certain systemic diseases such as diabetes,;<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li> <li>other conditions such as debilitating disease (especially haematological and some solid cancers), use of steroid medication long-term, end-stage renal disease, <a href="/wiki/Silicosis" title="Silicosis">silicosis</a>, gastrectomy, and jejuno-ileal bypass;<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></li> <li>being elderly;<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> and</li> <li>young age.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=6" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are two classes of tests commonly used to identify patients with latent tuberculosis: <a href="/wiki/Tuberculin" title="Tuberculin">tuberculin</a> skin tests and IFN-γ (<a href="/wiki/Interferon-%CE%B3" class="mw-redirect" title="Interferon-γ">Interferon-gamma</a>) tests.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p><p>The skin tests currently include the following two:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <dl><dd><ul><li><a href="/wiki/Mantoux_test" title="Mantoux test">Mantoux test</a></li> <li><a href="/wiki/Heaf_test" title="Heaf test">Heaf test</a></li></ul></dd></dl> <p>IFN-γ tests include the following three: </p> <dl><dd><ul><li><a href="/wiki/T-SPOT.TB" title="T-SPOT.TB">T-SPOT.TB</a></li> <li><a href="/wiki/QuantiFERON-TB_Gold" class="mw-redirect" title="QuantiFERON-TB Gold">QuantiFERON-TB Gold</a></li> <li><a href="/wiki/QuantiFERON-TB_Gold" class="mw-redirect" title="QuantiFERON-TB Gold">QuantiFERON-TB Gold</a> In-Tube</li></ul></dd></dl> <div class="mw-heading mw-heading3"><h3 id="Tuberculin_skin_testing">Tuberculin skin testing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=7" title="Edit section: Tuberculin skin testing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The tuberculin skin test (TST) in its first iteration, the <a href="/wiki/Mantoux_test" title="Mantoux test">Mantoux Test</a>, was developed in 1908. Tuberculin (also called purified protein derivative or PPD) is a standardised dead extract of cultured TB, injected into the skin to measure the person's immune response to the bacteria. So, if a person has been exposed to the bacteria previously, they should express an immune reaction to the injection, usually a mild swelling or redness around the site. There have been two primary methods of TST: the Mantoux test, and the Heaf test. The Heaf test was discontinued in 2005 because the manufacturer deemed its production to be financially unsustainable, though it was previously preferred in the UK because it was felt to require less training to administer and involved less inter-observer variation in its interpretation than the Mantoux test. The Mantoux test was the preferred test in the US, and is now the most widely used TST globally.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading4"><h4 id="Mantoux_test">Mantoux test</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=8" title="Edit section: Mantoux test"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <dl><dd><i>See: <a href="/wiki/Mantoux_test" title="Mantoux test">Mantoux test</a></i></dd></dl> <p>The Mantoux test is now standardised by the <a href="/wiki/World_Health_Organization" title="World Health Organization">WHO</a>. 0.1 ml of tuberculin (100 units/ml), which delivers a dose of 5 units is given by <a href="/wiki/Intradermal" class="mw-redirect" title="Intradermal">intradermal</a> injection into the surface of the lower forearm (<a href="/wiki/Subcutaneous_injection" class="mw-redirect" title="Subcutaneous injection">subcutaneous injection</a> results in false negatives). A waterproof ink mark is drawn around the injection site so as to avoid difficulty finding it later if the level of reaction is small. The test is read 48 to 72 hours later.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> The area of <a href="/wiki/Induration" class="mw-redirect" title="Induration">induration</a> (NOT of <a href="/wiki/Erythema" title="Erythema">erythema</a>) is measured <a href="/wiki/Transverse_plane" title="Transverse plane">transversely</a> across the forearm (left to right, not up and down) and recorded to the nearest millimetre.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Heaf_test">Heaf test</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=9" title="Edit section: Heaf test"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <dl><dd><i>See:<a href="/wiki/Heaf_test" title="Heaf test">Heaf test</a></i></dd></dl> <p>The Heaf test was first described in 1951.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> The test uses a Heaf gun with disposable single-use heads; each head has six needles arranged in a circle. There are standard heads and pediatric heads: the standard head is used on all patients aged 2 years and older; the pediatric head is for infants under the age of 2. For the standard head, the needles protrude 2 mm when the gun is actuated; for the pediatric heads, the needles protrude 1 mm. Skin is cleaned with alcohol, then tuberculin (100,000 units/ml) is evenly smeared on the skin (about 0.1 ml); the gun is then applied to the skin and fired. The excess solution is then wiped off and a waterproof ink mark is drawn around the injection site. The test is read 2 to 7 days later.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <ul><li>Grade 0: no reaction, or <a href="/wiki/Induration" class="mw-redirect" title="Induration">induration</a> of 3 or less puncture points;</li> <li>Grade 1: <a href="/wiki/Induration" class="mw-redirect" title="Induration">induration</a> of four or more puncture points;</li> <li>Grade 2: <a href="/wiki/Induration" class="mw-redirect" title="Induration">induration</a> of the six puncture points coalesce to form a circle;</li> <li>Grade 3: <a href="/wiki/Induration" class="mw-redirect" title="Induration">induration</a> of 5 mm; or more</li> <li>Grade 4: <a href="/wiki/Induration" class="mw-redirect" title="Induration">induration</a> of 10 mm or more, or <a href="/wiki/Ulcer_(dermatology)" title="Ulcer (dermatology)">ulceration</a></li></ul> <p>The results of both tests are roughly equivalent as follows:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2024)">citation needed</span></a></i>]</sup> </p> <ul><li>Heaf grade 0 & 1 ~ Mantoux less than 5 mm;</li> <li>Heaf grade 2 ~ Mantoux 5–14 mm;</li> <li>Heaf grade 3 & 4 ~ Mantoux 15 or greater</li></ul> <div class="mw-heading mw-heading4"><h4 id="Tuberculin_conversion">Tuberculin conversion</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=10" title="Edit section: Tuberculin conversion"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><i>Tuberculin conversion</i> is said to occur if a patient who has previously had a negative tuberculin skin test develops a positive tuberculin skin test at a later test. It indicates a change from negative to positive, and usually signifies a new infection.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading4"><h4 id="Boosting">Boosting</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=11" title="Edit section: Boosting"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The phenomenon of <i>boosting</i> is one way of obtaining a false positive test result. Theoretically, a person's ability to develop a reaction to the TST may decrease over time – for example, a person is infected with latent TB as a child, and is administered a TST as an adult. Because there has been such a long time since the immune responses to TB has been necessary, that person might give a negative test result. If so, there is a fairly reasonable chance that the TST triggers a hypersensitivity in the person's immune system – in other words, the TST reminds the person's immune system about TB, and the body overreacts to what it perceives as a reinfection. In this case, when that subject is given the test again (as is standard procedure, see above) they may have a significantly greater reaction to the test, giving a very strong positive; this can be commonly misdiagnosed as Tuberculin Conversion. This can also be triggered by receiving the BCG vaccine, as opposed to a proper infection. Although boosting can occur in any age group, the likelihood of the reaction increases with age.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>Boosting is only likely to be relevant if an individual is beginning to undergo periodic TSTs (health care workers, for example). In this case the standard procedure is called two-step testing. The individual is given their first test and in the event of a negative, given a second test in 1 to 3 weeks. This is done to combat boosting in situations where, had that person waited up to a year to get their next TST, they might still have a boosted reaction, and be misdiagnosed as a new infection.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p><p>Here there is a difference in US and UK guidelines; in the US testers are told to ignore the possibility of false positive due to the BCG vaccine, as the BCG is seen as having waning efficacy over time. Therefore, the CDC urges that individuals be treated based on risk stratification regardless of BCG vaccination history, and if an individual receives a negative and then a positive TST they will be assessed for full TB treatment beginning with X-ray to confirm TB is not active and proceeding from there.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Conversely, the UK guidelines acknowledge the potential effect of the BCG vaccination, as it is mandatory and therefore a prevalent concern – though the UK shares the procedure of administering two tests, one week apart, and accepting the second one as the accurate result, they also assume that a second positive is indicative of an old infection (and therefore certainly LTBI) or the BCG itself. In the case of BCG vaccinations confusing the results, <a href="/wiki/Interferon_gamma_release_assay" title="Interferon gamma release assay">Interferon-γ (IFN-γ)</a> tests may be used as they will not be affected by the BCG.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2024)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading4"><h4 id="Interpretation">Interpretation</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=12" title="Edit section: Interpretation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>According to the U.S. guidelines, there are multiple size thresholds for declaring a positive result of latent tuberculosis from the Mantoux test: For testees from high-risk groups, such as those who are HIV positive, the cutoff is 5 mm of induration; for medium risk groups, 10 mm; for low-risk groups, 15 mm. The U.S. guidelines recommend that a history of previous BCG vaccination should be ignored. For details of tuberculin skin test interpretation, please refer to the CDC guidelines (reference given below). </p><p>The UK guidelines are formulated according to the Heaf test: In patients who have had BCG previously, latent TB is diagnosed if the Heaf test is grade 3 or 4 and have no signs or symptoms of active TB; if the Heaf test is grade 0 or 1, then the test is repeated. In patients who have not had BCG previously, latent TB is diagnosed if the Heaf test is grade 2, 3 or 4, and have no signs or symptoms of active TB. Repeat Heaf testing is not done in patients who have had BCG (because of the phenomenon of boosting). For details of tuberculin skin test interpretation, please refer to the BTS guidelines (references given below). </p><p>Given that the US recommendation is that prior BCG vaccination be ignored in the interpretation of tuberculin skin tests, false positives with the Mantoux test are possible as a result of: (1) having previously had a BCG (even many years ago), or (2) periodical testing with tuberculin skin tests. Having regular TSTs boosts the immunological response in those people who have previously had BCG, so these people will falsely appear to be tuberculin conversions. This may lead to treating more people than necessary, with the possible risk of those patients developing adverse drug reactions. However, as <a href="/wiki/Bacille_Calmette-Gu%C3%A9rin" class="mw-redirect" title="Bacille Calmette-Guérin">Bacille Calmette-Guérin</a> 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<sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items" title="Wikipedia:Manual of Style/Dates and numbers"><span title="The time period mentioned near this tag is ambiguous. (July 2022)">when?</span></a></i>]</sup> US policy seems to reflect a desire to err on the side of safety. </p><p>The U.S. guidelines also allow for tuberculin skin testing in immunosuppressed patients (those with <a href="/wiki/HIV" title="HIV">HIV</a>, or who are on <a href="/wiki/Immunosuppressive_drugs" class="mw-redirect" title="Immunosuppressive drugs">immunosuppressive drugs</a>), whereas the UK guidelines recommend that tuberculin skin tests should not be used for such patients because it is unreliable.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2024)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Interferon-γ_testing"><span id="Interferon-.CE.B3_testing"></span>Interferon-γ testing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=13" title="Edit section: Interferon-γ testing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The role of <a href="/wiki/Interferon_gamma_release_assay" title="Interferon gamma release assay">IFN-γ tests</a> is undergoing constant review and various guidelines have been published with the option for revision as new data becomes available.<a rel="nofollow" class="external text" href="https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5415a4.htm">CDC:MMWR</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20090404215424/http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1214808549127">Health Protection Agency:UK</a> </p><p>There are currently two commercially available <a href="/wiki/Interferon-%CE%B3_release_assays" class="mw-redirect" title="Interferon-γ release assays">interferon-γ release assays</a> (IGRAs): <a href="/wiki/QuantiFERON-TB_Gold" class="mw-redirect" title="QuantiFERON-TB Gold">QuantiFERON-TB Gold</a> and <a href="/wiki/T-SPOT.TB" title="T-SPOT.TB">T-SPOT.TB</a>.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> These tests are not affected by prior BCG vaccination, and look for the body's response to specific TB antigens not present in other forms of mycobacteria and BCG (<a href="/wiki/ESAT-6" title="ESAT-6">ESAT-6</a>). Whilst these tests are new they are now becoming available globally. </p><p> CDC:<style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style></p><blockquote class="templatequote"><p>CDC recommends that QFT-G may be used in all circumstances in which the TST is currently used, including contact investigations, evaluation of recent immigrants, and sequential-testing surveillance programs for infection control (e.g., those for health-care workers). </p></blockquote><p> HPA Interim Guidance:<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1244412712"></p><blockquote class="templatequote"><p>The HPA recommends the use of IGRA testing in health care workers, if available, in view of the importance of detecting latently infected staff who may go on to develop active disease and come into contact with immunocompromised patients and the logistical simplicity of IGRA testing.</p></blockquote> <div class="mw-heading mw-heading3"><h3 id="Drug-resistant_strains">Drug-resistant strains</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=14" title="Edit section: Drug-resistant strains"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>It is usually assumed by most medical practitioners in the early stages of a diagnosis that a case of latent tuberculosis is the normal or regular strain of tuberculosis. It will therefore be most commonly treated with <a href="/wiki/Isoniazid" title="Isoniazid">Isoniazid</a> (the most used treatment for latent tuberculosis.) Only if the tuberculosis bacteria does not respond to the treatment will the medical practitioner begin to consider more virulent strains, requiring significantly longer and more thorough treatment regimens. </p><p>There are 4 types of tuberculosis recognized in the world today: </p> <ul><li>Tuberculosis (TB)</li> <li>Multi-drug-resistant tuberculosis (MDR TB)<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup></li> <li>Extensively drug-resistant tuberculosis (XDR TB)<sup id="cite_ref-autogenerated1_27-0" class="reference"><a href="#cite_note-autogenerated1-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup></li> <li>Totally drug-resistant tuberculosis (TDR TB)<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=15" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Tuberculosis_treatment" class="mw-redirect" title="Tuberculosis treatment">Tuberculosis treatment</a></div> <p>The treatment of latent tuberculosis infection (LTBI) is essential to controlling and eliminating TB by reducing the risk that TB infection will progress to disease. Latent tuberculosis will convert to active tuberculosis in 10% of cases (or more in cases of immune compromised patients). Taking medication for latent tuberculosis is recommended by many doctors.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p>In the U.S., the standard treatment is nine months of <a href="/wiki/Isoniazid" title="Isoniazid">isoniazid</a>, but this regimen is not widely used outside of the US.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Terminology">Terminology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=16" title="Edit section: Terminology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There is no agreement regarding terminology: the terms <i>preventive therapy</i> and <i>chemoprophylaxis</i> have been used for decades, and are preferred in the UK because it involves giving medication to people who have no disease and are currently well: the reason for giving medication is primarily to prevent people from becoming unwell. In the U.S., physicians talk about <i>latent tuberculosis treatment</i> because the medication does not actually prevent infection: the person is already infected and the medication is intended to prevent existing silent infection from becoming active disease. There are no convincing reasons to prefer one term over the other.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Specific_situations">Specific situations</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=17" title="Edit section: Specific situations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>"Populations at increased risk of progressing to active infection once exposed:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <ul><li>Persons with recent TB infection [those infected within the previous two years]</li> <li>Congenital or acquired immunosuppressed patients (in particular, HIV-positive patients)</li> <li>Illicit intravenous drug users; alcohol and other chronic substance users</li> <li>Children (particularly those younger than 4 years old)</li> <li>Persons with comorbid conditions (ie, chronic <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a>, diabetes, malignancy, hematologic cancers, body weight of at least 10% less than ideal, silicosis, gastrectomy, jejunoileal bypass, asthma, or other disorders requiring long-term use of corticosteroids or other immunosuppressants)."<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Treatment_regimens">Treatment regimens</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=18" title="Edit section: Treatment regimens"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>It is essential that assessment to rule out active TB be carried out before treatment for LTBI is started. To give treatment for latent tuberculosis to someone with active tuberculosis is a serious error: the tuberculosis will not be adequately treated and there is a serious risk of developing drug-resistant strains of TB. </p><p>There are several treatment regimens currently in use: </p> <ul><li>9H — <a href="/wiki/Isoniazid" title="Isoniazid">isoniazid</a> for 9 months is the gold standard (93% effective, in patients with positive test results and fibrotic pulmonary lesions compatible with tuberculosis<sup id="cite_ref-ReferenceA_31-0" class="reference"><a href="#cite_note-ReferenceA-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup>).</li> <li>6H — Isoniazid for 6 months might be adopted by a local TB program based on cost-effectiveness and patient compliance. This is the regimen currently recommended in the UK for routine use. The U.S. guidance excludes this regimen from use in children or persons with radiographic evidence of prior tuberculosis (old fibrotic lesions) (69% effective).</li> <li>6 to 9H<sub>2</sub> — An intermittent twice-weekly regimen for the above two treatment regimens is an alternative if administered under <a href="/wiki/Directly_observed_therapy" class="mw-redirect" title="Directly observed therapy">Directly observed therapy</a> (DOT).</li> <li>4R — <a href="/wiki/Rifampicin" title="Rifampicin">rifampicin</a> for 4 months is an alternative for those who are unable to take isoniazid or who have had known exposure to isoniazid-resistant TB.</li> <li>3HR — Isoniazid and <a href="/wiki/Rifampin" class="mw-redirect" title="Rifampin">rifampin</a> may be given daily for three months.</li> <li>2RZ — The two-month regimen of <a href="/wiki/Rifampin" class="mw-redirect" title="Rifampin">rifampin</a> and <a href="/wiki/Pyrazinamide" title="Pyrazinamide">pyrazinamide</a> is no longer recommended for treatment of LTBI because of the greatly increased risk of drug-induced hepatitis and death.<sup id="cite_ref-Schechter2006_32-0" class="reference"><a href="#cite_note-Schechter2006-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup></li> <li>3HP – three-month (12-dose) regimen of weekly <a href="/wiki/Rifapentine" title="Rifapentine">rifapentine</a> and isoniazid.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> The 3HP regimen has to be administered under DOT. A self-administered therapy (SAT) of 3HP is investigated in a large international study.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Evidence_for_treatment_effectiveness">Evidence for treatment effectiveness</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=19" title="Edit section: Evidence for treatment effectiveness"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A 2000 Cochrane review containing 11 double-blinded, randomized control trials and 73,375 patients examined six and 12 month courses of isoniazid (INH) for treatment of latent tuberculosis. HIV positive and patients currently or previously treated for tuberculosis were excluded. The main result was a relative risk (RR) of 0.40 (95% confidence interval (CI) 0.31 to 0.52) for development of active tuberculosis over two years or longer for patients treated with INH, with no significant difference between treatment courses of six or 12 months (RR 0.44, 95% CI 0.27 to 0.73 for six months, and 0.38, 95% CI 0.28 to 0.50 for 12 months).<sup id="cite_ref-pmid21441678_36-0" class="reference"><a href="#cite_note-pmid21441678-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p>A Cochrane systematic review published in 2013 evaluated four different alternatives regimens to INH monotherapy for preventing active TB in HIV-negative people with latent tuberculosis infection. The evidence from this review found no difference between shorter regimens of Rifampicin or weekly, directly observed Rifapentine plus INH compare to INH monotherapy in preventing active TB in HIV-negative people at risk of developing it . However the review found that the shorter Rifampicin regimen for four months and weekly directly observed Rifapentine plus INH for three months "may have additional advantages of higher treatment completion and improved safety." However the overall quality of evidence was low to moderate (as per GRADE criteria) and none of the included trials were conducted in LMIC nations with high TB transmission and hence might not be applicable to nations with high TB transmission.<sup id="cite_ref-pmid11401954_37-0" class="reference"><a href="#cite_note-pmid11401954-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Treatment_efficacy">Treatment efficacy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=20" title="Edit section: Treatment efficacy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There is no guaranteed "cure" for latent tuberculosis. "People infected with TB bacteria have a lifetime risk of falling ill with TB..."<sup id="cite_ref-who.int_11-1" class="reference"><a href="#cite_note-who.int-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> with those who have compromised immune systems, those with diabetes and those who use tobacco at greater risk.<sup id="cite_ref-who.int_11-2" class="reference"><a href="#cite_note-who.int-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>A person who has taken the complete course of Isoniazid (or other full course prescription for tuberculosis) on a regular, timely schedule may have been cured. "Current standard therapy is isoniazid (INH) which reduce the risk of active TB by as much as 90 per cent (in patients with positive LTBI test results and fibrotic pulmonary lesions compatible with tuberculosis<sup id="cite_ref-ReferenceA_31-1" class="reference"><a href="#cite_note-ReferenceA-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup>) if taken daily for 9 months."<sup id="cite_ref-pmid21441678_36-1" class="reference"><a href="#cite_note-pmid21441678-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> However, if a person has not completed the medication exactly as prescribed, the "cure" is less likely, and the "cure" rate is directly proportional to following the prescribed treatment specifically as recommended. Furthermore, "If you don't take the medicine correctly and you become sick with TB a second time, the TB may be harder to treat if it has become drug resistant."<sup id="cite_ref-lung.org_TB_Symptoms_12-1" class="reference"><a href="#cite_note-lung.org_TB_Symptoms-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> If a patient were to be cured in the strictest definition of the word, it would mean that every single bacterium in the system is removed or dead, and that person cannot get tuberculosis (unless re-infected). However, there is no test to assure that every single bacterium has been killed in a patient's system. As such, a person diagnosed with latent TB can safely assume that, even after treatment, they will carry the bacteria – likely for the rest of their lives. Furthermore, "It has been estimated that up to one-third of the world's population is infected with <i>M. tuberculosis</i>, and this population is an important reservoir for disease reactivation."<sup id="cite_ref-pmid11401954_37-1" class="reference"><a href="#cite_note-pmid11401954-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> This means that in areas where TB is endemic treatment may be even less certain to "cure" TB, as reinfection could trigger activation of latent TB already present even in cases where treatment was followed completely.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Controversy">Controversy</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=21" title="Edit section: Controversy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There is controversy over whether people who test positive long after infection have a significant risk of developing the disease (without re-infection). Some researchers and public health officials have warned that this test-positive population is a "source of future TB cases" even in the US and other wealthy countries, and that this "ticking time bomb" should be a focus of attention and resources.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p><p>On the other hand, Marcel Behr, Paul Edelstein, and <a href="/wiki/Lalita_Ramakrishnan" title="Lalita Ramakrishnan">Lalita Ramakrishnan</a> reviewed studies concerning the concept of latent tuberculosis in order to determine whether tuberculosis-infected persons have life-long infection capable of causing disease at any future time. These studies, both published in the <i><a href="/wiki/British_Medical_Journal" class="mw-redirect" title="British Medical Journal">British Medical Journal</a></i> (<i>BMJ</i>) in 2018 and 2019, show that the incubation period of tuberculosis is short, usually within months after infection, and very rarely more than two years after infection.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> They also show that more than 90% of people infected with <i>M. tuberculosis</i> for more than two years never develop tuberculosis even if their immune system is severely suppressed.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Immunologic tests for tuberculosis infection such as the tuberculin skin test and interferon gamma release assays (IGRA) only indicate past infection, with the majority of previously infected persons no longer capable of developing tuberculosis. Ramakrishnan told the New York Times that researchers "have spent hundreds of millions of dollars chasing after latency, but the whole idea that a quarter of the world is infected with TB is based on a fundamental misunderstanding."<sup id="cite_ref-NYT_42-0" class="reference"><a href="#cite_note-NYT-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p> Writing in <i>The Atlantic</i>, science journalist Katherine J. Wu explains:<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1244412712"></p><blockquote class="templatequote"><p>If the bacteria were lingering, researchers would expect to see a big spike in disease late in life among people with positive skin tests, as their immune system naturally weakens. They would also expect to see a high rate of progression to full-blown TB among people who start taking immunosuppressive drugs or catch HIV. And yet, neither of those trends pans out: At most, some 5 to 10 percent of people who have tested positive by skin test and later sustain a blow to their immune system develop TB disease within about three to five years—a hint that, for almost everyone else, there may not be any MTB left. “If there were a slam-dunk experiment, that’s it,” William Bishai, a TB researcher at Johns Hopkins, told me.</p></blockquote> <p>The first BMJ article disputing widespread latency was accompanied by an editorial written by Dr. <a href="/wiki/Soumya_Swaminathan_(scientist)" class="mw-redirect" title="Soumya Swaminathan (scientist)">Soumya Swaminathan</a>, Deputy Director-General of the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a>, who endorsed the findings and called for more funding of TB research directed at the most heavily afflicted parts of the world, rather than disproportionate attention to a relatively minor problem that affects just the wealthy countries.<sup id="cite_ref-NYT_42-1" class="reference"><a href="#cite_note-NYT-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p>The World Health Organization no longer endorses the concept that all those with immunologic evidence of past TB infection are currently infected and so are at risk of developing TB some time in the future. In 2022, the WHO issued corrigenda to its 2021 Global TB Report to clarify estimates on the worldwide burden of infected people.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> These corrigenda deleted "About a quarter of the world's population is infected with <i>M. tuberculosis</i>" and replaced it with "About a quarter of the world's population has been infected with <i>M. tuberculosis</i>." The corrigenda also removed the prior estimate of the lifetime risk of TB of 5 to 10% among those with evidence of past TB infection, indicating that they no longer have confidence in earlier estimates that a substantial percentage of those with positive immunologic test results will develop the disease. </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=22" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Silent_disease" class="mw-redirect" title="Silent disease">Silent disease</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=23" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFJasmer_R.M.Nahid_P.Hopewell_P.C.2002" class="citation journal cs1">Jasmer R.M., Nahid P., Hopewell P.C. 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Jr. (20 September 2018). <a rel="nofollow" class="external text" href="https://www.nytimes.com/2018/09/20/health/latent-tuburculosis-deaths.html">"<span class="cs1-kern-left"></span>'Latent' tuberculosis? It's not that common, experts find"</a>. <i>The New York Times</i>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20220817035543/https://www.nytimes.com/2018/09/20/health/latent-tuburculosis-deaths.html">Archived</a> from the original on 17 August 2022<span class="reference-accessdate">. Retrieved <span class="nowrap">13 March</span> 2020</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=%27Latent%27+tuberculosis%3F+It%27s+not+that+common%2C+experts+find&rft.date=2018-09-20&rft.aulast=McNeil&rft.aufirst=Donald+G.+Jr.&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2018%2F09%2F20%2Fhealth%2Flatent-tuburculosis-deaths.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALatent+tuberculosis" class="Z3988"></span></span> </li> <li id="cite_note-43"><span class="mw-cite-backlink"><b><a href="#cite_ref-43">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWu2023" class="citation journal cs1">Wu, Katherine J. (2023). <a rel="nofollow" class="external text" href="https://urldefense.com/v3/__https://www.theatlantic.com/science/archive/2023/12/tuberculosis-infection-latent-myth/676355/gift=Xw2VvJVRyjt3gEOPpgAGxVHWXS_nns6JBWmMghOLtq4&utm_source=email&utm_medium=social&utm_campaign=social__;!!K-Hz7m0Vt54!kaceuTOk2Qu2e0dedfKt6AYMcsE83Ea61e1xYy3RyScKNHBOKWlGh4lXlcGfouNX8MZH92b92stg3jSS9PkfM4BouQ$">"A big misconception about the world's greatest infectious killer"</a>. <i>The Atlantic</i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Atlantic&rft.atitle=A+big+misconception+about+the+world%27s+greatest+infectious+killer&rft.date=2023&rft.aulast=Wu&rft.aufirst=Katherine+J.&rft_id=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2F%2Fwww.theatlantic.com%2Fscience%2Farchive%2F2023%2F12%2Ftuberculosis-infection-latent-myth%2F676355%2Fgift%3DXw2VvJVRyjt3gEOPpgAGxVHWXS_nns6JBWmMghOLtq4%26utm_source%3Demail%26utm_medium%3Dsocial%26utm_campaign%3Dsocial__%3B%21%21K-Hz7m0Vt54%21kaceuTOk2Qu2e0dedfKt6AYMcsE83Ea61e1xYy3RyScKNHBOKWlGh4lXlcGfouNX8MZH92b92stg3jSS9PkfM4BouQ%24&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALatent+tuberculosis" class="Z3988"></span></span> </li> <li id="cite_note-44"><span class="mw-cite-backlink"><b><a href="#cite_ref-44">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation book cs1"><a rel="nofollow" class="external text" href="https://cdn.who.int/media/docs/default-source/hq-tuberculosis/tb-report-2021/9789240037021_corrigenda_25.5.22.pdf?sfvrsn=6d4f0239_3"><i>Corrigenda (25 May 2022) Global tuberculosis report 2021</i></a> <span class="cs1-format">(PDF)</span>. World Health Organization. 14 October 2021. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-92-4-003702-1" title="Special:BookSources/978-92-4-003702-1"><bdi>978-92-4-003702-1</bdi></a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20220808130049/https://cdn.who.int/media/docs/default-source/hq-tuberculosis/tb-report-2021/9789240037021_corrigenda_25.5.22.pdf?sfvrsn=6d4f0239_3">Archived</a> <span class="cs1-format">(PDF)</span> from the original on 8 August 2022<span class="reference-accessdate">. Retrieved <span class="nowrap">18 September</span> 2022</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Corrigenda+%2825+May+2022%29+Global+tuberculosis+report+2021&rft.pub=World+Health+Organization&rft.date=2021-10-14&rft.isbn=978-92-4-003702-1&rft_id=https%3A%2F%2Fcdn.who.int%2Fmedia%2Fdocs%2Fdefault-source%2Fhq-tuberculosis%2Ftb-report-2021%2F9789240037021_corrigenda_25.5.22.pdf%3Fsfvrsn%3D6d4f0239_3&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALatent+tuberculosis" class="Z3988"></span></span> </li> </ol></div></div> <p><span class="noviewer" typeof="mw:File"><span><img alt="Public Domain" src="//upload.wikimedia.org/wikipedia/en/thumb/6/62/PD-icon.svg/12px-PD-icon.svg.png" decoding="async" width="12" height="12" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/6/62/PD-icon.svg/18px-PD-icon.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/6/62/PD-icon.svg/24px-PD-icon.svg.png 2x" data-file-width="196" data-file-height="196" /></span></span> This article incorporates <a href="/wiki/Copyright_status_of_works_by_the_federal_government_of_the_United_States" title="Copyright status of works by the federal government of the United States">public domain material</a> from websites or documents of the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a>. </p> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=24" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFJasmerNahidHopewell2002" class="citation journal cs1">Jasmer, R. M.; Nahid, P.; Hopewell, P. C. (2002). "Latent tuberculosis infection". <i><a href="/wiki/New_England_Journal_of_Medicine" class="mw-redirect" title="New England Journal of Medicine">New England Journal of Medicine</a></i>. <b>347</b> (23): 1860–1866. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1056%2FNEJMcp021045">10.1056/NEJMcp021045</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12466511">12466511</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=Latent+tuberculosis+infection&rft.volume=347&rft.issue=23&rft.pages=1860-1866&rft.date=2002&rft_id=info%3Adoi%2F10.1056%2FNEJMcp021045&rft_id=info%3Apmid%2F12466511&rft.aulast=Jasmer&rft.aufirst=R.+M.&rft.au=Nahid%2C+P.&rft.au=Hopewell%2C+P.+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALatent+tuberculosis" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMazurekVillarino2003" class="citation journal cs1">Mazurek, G. H.; Villarino, M. E. (2003). "Guidelines for using the QuantiFERON-TB test for diagnosing latent <i>Mycobacterium tuberculosis</i> infection". <i><a href="/wiki/Morbidity_and_Mortality_Weekly_Report" title="Morbidity and Mortality Weekly Report">Morbidity and Mortality Weekly Report</a></i>. <b>52</b> (RR–2): 15–18.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Morbidity+and+Mortality+Weekly+Report&rft.atitle=Guidelines+for+using+the+QuantiFERON-TB+test+for+diagnosing+latent+Mycobacterium+tuberculosis+infection&rft.volume=52&rft.issue=RR%E2%80%932&rft.pages=15-18&rft.date=2003&rft.aulast=Mazurek&rft.aufirst=G.+H.&rft.au=Villarino%2C+M.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALatent+tuberculosis" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFOrmerodSkinnerMoore-GillonDavies2000" class="citation journal cs1">Ormerod, P.; Skinner, C.; Moore-Gillon, J.; Davies, P.; Connolly, M. (2000). <a rel="nofollow" class="external text" href="http://thorax.bmjjournals.com/cgi/content/full/55/11/887">"BTS Guidelines: control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000"</a>. <i><a href="/wiki/Thorax_(journal)" title="Thorax (journal)">Thorax</a></i>. <b>55</b> (11): 887–901. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1136%2Fthorax.55.11.887">10.1136/thorax.55.11.887</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1745632">1745632</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11050256">11050256</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Thorax&rft.atitle=BTS+Guidelines%3A+control+and+prevention+of+tuberculosis+in+the+United+Kingdom%3A+Code+of+Practice+2000&rft.volume=55&rft.issue=11&rft.pages=887-901&rft.date=2000&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1745632%23id-name%3DPMC&rft_id=info%3Apmid%2F11050256&rft_id=info%3Adoi%2F10.1136%2Fthorax.55.11.887&rft.aulast=Ormerod&rft.aufirst=P.&rft.au=Skinner%2C+C.&rft.au=Moore-Gillon%2C+J.&rft.au=Davies%2C+P.&rft.au=Connolly%2C+M.&rft_id=http%3A%2F%2Fthorax.bmjjournals.com%2Fcgi%2Fcontent%2Ffull%2F55%2F11%2F887&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALatent+tuberculosis" class="Z3988"></span></li></ul> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Latent_tuberculosis&action=edit&section=25" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 1em;line-height:1.5em;text-align:center}.mw-parser-output .navbox-group{white-space:nowrap;text-align:right}.mw-parser-output .navbox,.mw-parser-output .navbox-subgroup{background-color:#fdfdfd}.mw-parser-output .navbox-list{line-height:1.5em;border-color:#fdfdfd}.mw-parser-output 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class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q4254929" class="extiw" title="d:Q4254929">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/R76.1">R76.1</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D055985">D055985</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Blood_film_findings" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a 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scope="row" class="navbox-group" style="width:1%">Size</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anisocytosis" title="Anisocytosis">Anisocytosis</a></li> <li><a href="/wiki/Macrocytosis" title="Macrocytosis">Macrocytosis</a></li> <li><a href="/wiki/Microcytosis" title="Microcytosis">Microcytosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Shape</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Poikilocytosis" title="Poikilocytosis">Poikilocytosis</a></li> <li>Membrane abnormalities <ul><li><a href="/wiki/Acanthocyte" title="Acanthocyte">Acanthocyte</a></li> <li><a href="/wiki/Codocyte" title="Codocyte">Codocyte</a></li> <li><a href="/wiki/Elliptocyte" title="Elliptocyte">Elliptocyte</a> <ul><li><a href="/wiki/Hereditary_elliptocytosis" title="Hereditary elliptocytosis">Hereditary elliptocytosis</a></li></ul></li> <li><a href="/wiki/Spherocytosis" title="Spherocytosis">Spherocyte</a> <ul><li><a href="/wiki/Hereditary_spherocytosis" title="Hereditary spherocytosis">Hereditary spherocytosis</a></li></ul></li></ul></li> <li><a href="/wiki/Dacrocyte" title="Dacrocyte">Dacrocyte</a></li> <li><a href="/wiki/Echinocyte" title="Echinocyte">Echinocyte</a></li> <li><a href="/wiki/Schistocyte" title="Schistocyte">Schistocyte</a></li> <li><a href="/wiki/Degmacyte" title="Degmacyte">Degmacyte</a></li> <li>Sickle cell/drepanocyte <ul><li><a href="/wiki/Sickle_cell_disease" title="Sickle cell disease">Sickle cell disease</a></li></ul></li> <li>Stomatocyte <ul><li><a href="/wiki/Hereditary_stomatocytosis" title="Hereditary stomatocytosis">Hereditary stomatocytosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Colour</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anisochromia" title="Anisochromia">Anisochromia</a></li> <li><a href="/wiki/Hypochromic_anemia" title="Hypochromic anemia">Hypochromic anemia</a></li> <li><a href="/wiki/Polychromasia" title="Polychromasia">Polychromasia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inclusion_bodies" title="Inclusion bodies">Inclusion bodies</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Developmental <ul><li><a href="/wiki/Howell%E2%80%93Jolly_body" title="Howell–Jolly body">Howell–Jolly body</a></li> <li><a href="/wiki/Basophilic_stippling" title="Basophilic stippling">Basophilic stippling</a></li> <li><a href="/wiki/Pappenheimer_bodies" title="Pappenheimer bodies">Pappenheimer bodies</a></li> <li><a href="/wiki/Cabot_rings" title="Cabot rings">Cabot rings</a></li></ul></li> <li>Hemoglobin precipitation <ul><li><a href="/wiki/Heinz_body" title="Heinz body">Heinz body</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Haemoconia" title="Haemoconia">Haemoconia</a></li> <li><a href="/wiki/Red_cell_agglutination" title="Red cell agglutination">Red cell agglutination</a></li> <li><a href="/wiki/Rouleaux" title="Rouleaux">Rouleaux</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/White_blood_cell" title="White blood cell">White blood cells</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Lymphocyte" title="Lymphocyte">Lymphocytes</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Reactive_lymphocyte" title="Reactive lymphocyte">Reactive lymphocyte</a></li> <li><a href="/wiki/Chronic_lymphocytic_leukemia" title="Chronic lymphocytic leukemia">Smudge cell</a> <ul><li><a href="/wiki/Russell_bodies" title="Russell bodies">Russell bodies</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Granulocyte" title="Granulocyte">Granulocytes</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypersegmented_neutrophil" title="Hypersegmented neutrophil">Hypersegmented neutrophil</a> <ul><li><a href="/wiki/Arneth_count" title="Arneth count">Arneth count</a></li></ul></li> <li><a href="/wiki/Pelger%E2%80%93Hu%C3%ABt_anomaly" title="Pelger–Huët anomaly">Pelger–Huët anomaly</a></li> <li><a href="/wiki/D%C3%B6hle_bodies" title="Döhle bodies">Döhle bodies</a></li> <li><a href="/wiki/Toxic_granulation" title="Toxic granulation">Toxic granulation</a></li> <li><a href="/wiki/Toxic_vacuolation" title="Toxic vacuolation">Toxic vacuolation</a></li> <li><a href="/wiki/Critical_green_inclusion" title="Critical green inclusion">Critical green inclusion</a></li> <li><a href="/wiki/Alder%E2%80%93Reilly_anomaly" title="Alder–Reilly anomaly">Alder–Reilly anomaly</a></li> <li><a href="/wiki/Jordans%27_anomaly" title="Jordans' anomaly">Jordans' anomaly</a></li> <li><a href="/wiki/Left_shift_(medicine)" title="Left shift (medicine)">Left shift</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Auer_rod" title="Auer rod">Auer rod</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Tuberculosis" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="3"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Tuberculosis" title="Template:Tuberculosis"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Tuberculosis" title="Template talk:Tuberculosis"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Tuberculosis" title="Special:EditPage/Template:Tuberculosis"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Tuberculosis" style="font-size:114%;margin:0 4em"><a href="/wiki/Tuberculosis" title="Tuberculosis">Tuberculosis</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Symptoms, signs and <br /> associated conditions</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pulmonary_tuberculosis" class="mw-redirect" title="Pulmonary tuberculosis">Pulmonary tuberculosis</a> <ul><li><a href="/wiki/Ghon_focus" title="Ghon focus">Ghon focus</a> / <a href="/wiki/Ghon%27s_complex" title="Ghon's complex">Ghon's complex</a></li></ul></li> <li><a href="/wiki/Extrapulmonary_tuberculosis" title="Extrapulmonary tuberculosis">Extrapulmonary tuberculosis</a> <ul><li><a href="/wiki/Caseous_necrosis" title="Caseous necrosis">Caseous necrosis</a></li> <li><a href="/wiki/Pott_disease" class="mw-redirect" title="Pott disease">Pott disease</a></li> <li><a href="/wiki/Canga%27s_bead_symptom" title="Canga's bead symptom">Canga's bead symptom</a></li> <li><a href="/wiki/Prosector%27s_wart" class="mw-redirect" title="Prosector's wart">Prosector's wart</a></li> <li><a href="/wiki/Lupus_vulgaris" title="Lupus vulgaris">Lupus vulgaris</a></li> <li><a href="/wiki/Tuberculous_lymphadenitis" title="Tuberculous lymphadenitis">Tuberculous lymphadenitis</a></li> <li><a href="/wiki/Tuberculous_meningitis" title="Tuberculous meningitis">Tuberculous meningitis</a></li> <li><a href="/wiki/Miliary_tuberculosis" title="Miliary tuberculosis">Miliary tuberculosis</a></li></ul></li> <li><a class="mw-selflink selflink">Latent tuberculosis</a></li> <li><a href="/wiki/Paronychia" title="Paronychia">Paronychia</a></li> <li><a href="/wiki/Giant_multinucleated_cell" class="mw-redirect" title="Giant multinucleated cell">Giant multinucleated cell</a></li> <li><a href="/wiki/Post-tuberculosis_lung_disease" title="Post-tuberculosis lung disease">Post-tuberculosis lung disease</a></li></ul> </div></td><td class="noviewer navbox-image" rowspan="9" style="width:1px;padding:0 0 0 2px"><div><span typeof="mw:File"><a href="/wiki/File:Mycobacterium_tuberculosis.jpg" class="mw-file-description" title="Mycobacterium tuberculosis"><img alt="Mycobacterium tuberculosis" src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Mycobacterium_tuberculosis.jpg/150px-Mycobacterium_tuberculosis.jpg" decoding="async" width="150" height="145" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Mycobacterium_tuberculosis.jpg/225px-Mycobacterium_tuberculosis.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Mycobacterium_tuberculosis.jpg/300px-Mycobacterium_tuberculosis.jpg 2x" data-file-width="1997" data-file-height="1927" /></a></span></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mycobacterium" title="Mycobacterium">Mycobacterium species</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Mycobacterium_africanum" title="Mycobacterium africanum">Mycobacterium africanum</a></i></li> <li><i><a href="/wiki/Mycobacterium_bovis" title="Mycobacterium bovis">Mycobacterium bovis</a></i></li> <li><i><a href="/wiki/Mycobacterium_caprae" title="Mycobacterium caprae">Mycobacterium caprae</a></i></li> <li><i><a href="/wiki/Mycobacterium_tuberculosis" title="Mycobacterium tuberculosis">Mycobacterium tuberculosis</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Tuberculosis_diagnosis" class="mw-redirect" title="Tuberculosis diagnosis">Tuberculosis diagnosis</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ziehl%E2%80%93Neelsen_stain" title="Ziehl–Neelsen stain">Ziehl–Neelsen stain</a></li> <li><a href="/wiki/Auramine_phenol_stain" title="Auramine phenol stain">Auramine phenol stain</a></li> <li>Culture on <a href="/wiki/L%C3%B6wenstein%E2%80%93Jensen_medium" title="Löwenstein–Jensen medium">Löwenstein–Jensen medium</a> and/or <a href="/wiki/Mycobacteria_growth_indicator_tube" title="Mycobacteria growth indicator tube">MGIT</a></li> <li><a href="/wiki/Chest_photofluorography" title="Chest photofluorography">Chest photofluorography</a></li> <li><a href="/wiki/GeneXpert_MTB/RIF" title="GeneXpert MTB/RIF">GeneXpert MTB/RIF</a></li> <li><a href="/wiki/Interferon_gamma_release_assay" title="Interferon gamma release assay">Interferon gamma release assay</a> <ul><li><a href="/wiki/QuantiFERON" class="mw-redirect" title="QuantiFERON">QuantiFERON</a></li> <li><a href="/wiki/T-SPOT.TB" title="T-SPOT.TB">T-SPOT.TB</a></li></ul></li> <li><a href="/wiki/Microscopic_Observation_Drug_Susceptibility_assay" title="Microscopic Observation Drug Susceptibility assay">Microscopic Observation Drug Susceptibility assay</a></li> <li><a href="/wiki/Tuberculin" title="Tuberculin">Tuberculin</a> <ul><li><a href="/wiki/Heaf_test" title="Heaf test">Heaf test</a></li> <li><a href="/wiki/Mantoux_test" title="Mantoux test">Mantoux test</a></li> <li><a href="/wiki/Tine_test" title="Tine test">Tine test</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Tuberculosis_management" class="mw-redirect" title="Tuberculosis management">Management</a><br />(<a href="/wiki/ATC_code_J04" title="ATC code J04">ATC code J04</a>)</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Isoniazid" title="Isoniazid">Isoniazid</a></li> <li><a href="/wiki/4-Aminosalicylic_acid" title="4-Aminosalicylic acid">4-Aminosalicylic acid</a></li> <li><a href="/wiki/Ethambutol" title="Ethambutol">Ethambutol</a></li> <li><a href="/wiki/Capreomycin" title="Capreomycin">Capreomycin</a></li> <li><a href="/wiki/Cycloserine" title="Cycloserine">Cycloserine</a></li> <li><a href="/wiki/Rifampicin" title="Rifampicin">Rifampicin</a></li> <li><a href="/wiki/Thioacetazone" title="Thioacetazone">Thioacetazone</a></li> <li><a href="/wiki/Streptomycin" title="Streptomycin">Streptomycin</a></li> <li><a href="/wiki/Bedaquiline" title="Bedaquiline">Bedaquiline</a></li> <li><a href="/wiki/Pyrazinamide" title="Pyrazinamide">Pyrazinamide</a></li> <li><a href="/wiki/Rifampicin/isoniazid/pyrazinamide" title="Rifampicin/isoniazid/pyrazinamide">Rifater</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Tuberculosis_vaccines" title="Tuberculosis vaccines">Vaccines</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/BCG_vaccine" title="BCG vaccine">BCG vaccine</a></li> <li>Experimental <ul><li><a href="/wiki/M72/AS01E" title="M72/AS01E">M72/AS01E</a></li> <li><a href="/wiki/MVA85A" title="MVA85A">MVA85A</a></li> <li><a href="/wiki/RBCG30" title="RBCG30">RBCG30</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Resistance</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Multidrug-resistant_tuberculosis" title="Multidrug-resistant tuberculosis">Multidrug-resistant tuberculosis</a></li> <li><a href="/wiki/Extensively_drug-resistant_tuberculosis" title="Extensively drug-resistant tuberculosis">Extensively drug-resistant tuberculosis</a></li> <li><a href="/wiki/Totally_drug-resistant_tuberculosis" title="Totally drug-resistant tuberculosis">Totally drug-resistant tuberculosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/History_of_tuberculosis" title="History of tuberculosis">History of tuberculosis</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Manuel_de_Abreu" title="Manuel de Abreu">Manuel de Abreu</a></li> <li><a href="/wiki/Hermann_Brehmer" title="Hermann Brehmer">Hermann Brehmer</a></li> <li><a href="/wiki/Albert_Calmette" title="Albert Calmette">Albert Calmette</a></li> <li><a href="/wiki/Christopher_Dye" title="Christopher Dye">Christopher Dye</a></li> <li><a href="/wiki/Marcos_Espinal" title="Marcos Espinal">Marcos Espinal</a></li> <li><a href="/wiki/Friedrich_Franz_Friedmann" title="Friedrich Franz Friedmann">Friedrich Franz Friedmann</a></li> <li><a href="/wiki/Max_Gerson" title="Max Gerson">Max Gerson</a></li> <li><a href="/wiki/Philip_D%27Arcy_Hart" title="Philip D'Arcy Hart">Philip D'Arcy Hart</a></li> <li><a href="/wiki/F._R._G._Heaf" title="F. R. G. Heaf">F. R. G. Heaf</a></li> <li><a href="/wiki/George_M._Heath" title="George M. Heath">George M. Heath</a></li> <li><a href="/wiki/Robert_Koch" title="Robert Koch">Robert Koch</a></li> <li><a href="/wiki/Charles_Mantoux" title="Charles Mantoux">Charles Mantoux</a></li> <li><a href="/wiki/Richard_Morton_(physician)" title="Richard Morton (physician)">Richard Morton</a></li> <li><a href="/wiki/Mario_Raviglione" title="Mario Raviglione">Mario Raviglione</a></li> <li><a href="/wiki/Carl_R%C3%BCedi" title="Carl Rüedi">Carl Rüedi</a></li> <li><a href="/wiki/Lucius_R%C3%BCedi" title="Lucius Rüedi">Lucius Rüedi</a></li> <li><a href="/wiki/Madonna_Swan" title="Madonna Swan">Madonna Swan</a></li> <li><a href="/wiki/Edward_Livingston_Trudeau" title="Edward Livingston Trudeau">Edward Livingston Trudeau</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Organizations</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Adirondack_Cottage_Sanitarium" title="Adirondack Cottage Sanitarium">Adirondack Cottage Sanitarium</a></li> <li><a href="/wiki/Campaign_for_Access_to_Essential_Medicines" title="Campaign for Access to Essential Medicines">Campaign for Access to Essential Medicines</a></li> <li><a href="/wiki/Center_for_Global_Infectious_Disease_Research" title="Center for Global Infectious Disease Research">Center for Global Infectious Disease Research</a></li> <li><a href="/wiki/Cure_Cottages_of_Saranac_Lake" class="mw-redirect" title="Cure Cottages of Saranac Lake">Cure Cottages of Saranac Lake</a></li> <li><a href="/wiki/European_and_Developing_Countries_Clinical_Trials_Partnership" title="European and Developing Countries Clinical Trials Partnership">European and Developing Countries Clinical Trials Partnership</a></li> <li><a href="/wiki/Glen_Lake_Children%27s_Camp" title="Glen Lake Children's Camp">Glen Lake Children's Camp</a></li> <li><a href="/wiki/Glen_Lake_Sanatorium" title="Glen Lake Sanatorium">Glen Lake Sanatorium</a></li> <li><a href="/wiki/Glenn_Dale_Hospital" title="Glenn Dale Hospital">Glenn Dale Hospital</a></li> <li><a href="/wiki/The_Global_Fund_to_Fight_AIDS,_Tuberculosis_and_Malaria" title="The Global Fund to Fight AIDS, Tuberculosis and Malaria">The Global Fund to Fight AIDS, Tuberculosis and Malaria</a></li> <li><a href="/wiki/Global_Plan_to_Stop_Tuberculosis" class="mw-redirect" title="Global Plan to Stop Tuberculosis">Global Plan to Stop Tuberculosis</a></li> <li><a href="/wiki/International_Congress_on_Tuberculosis" title="International Congress on Tuberculosis">International Congress on Tuberculosis</a></li> <li><a href="/wiki/International_Union_Against_Tuberculosis_and_Lung_Disease" title="International Union Against Tuberculosis and Lung Disease">International Union Against Tuberculosis and Lung Disease</a></li> <li><a href="/wiki/Millennium_Foundation" title="Millennium Foundation">Millennium Foundation</a></li> <li><a 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