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[Chemoprophylaxis for tuberculosis].

Fumio Yamagishi1

  • 1Department of Respiratory Diseases, National Hospital Organization Chiba-East National Hospital, 673 Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712, Japan. yamagisf@chibae.hosp.go.jp

Kekkaku : [Tuberculosis]
|November 22, 2005
PubMed
Summary

To prevent tuberculosis, Japan now recommends chemoprophylaxis for individuals on immunosuppressants, expanding beyond age-based guidelines. This proactive approach aims to reduce tuberculosis incidence in high-risk populations.

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Area of Science:

  • Infectious Diseases
  • Public Health
  • Pharmacology

Context:

  • Current Japanese tuberculosis chemoprophylaxis targets individuals 29 or younger who have had recent contact with a tuberculosis patient.
  • The American Thoracic Society (ATS) and Centers for Disease Control and Prevention (CDC) define chemoprophylaxis as treatment for latent tuberculosis infection, irrespective of age, when tuberculosis development is likely.
  • Tuberculosis (TB) is increasingly observed in patients receiving Infliximab, a biologic agent targeting anti-tumor necrosis factor-alpha, particularly in rheumatoid arthritis patients.

Purpose:

  • To compare and contrast current tuberculosis chemoprophylaxis guidelines in Japan with international standards (ATS/CDC).
  • To highlight the growing concern of tuberculosis in patients undergoing treatment with immunosuppressants like Infliximab.
  • To propose an updated, age-independent chemoprophylaxis strategy for high-risk individuals in Japan.

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Summary:

  • The standard treatment for latent tuberculosis infection involves isoniazid for at least 6 months, with 9 months being more optimal.
  • In Japan, 11 out of 2,000 rheumatoid arthritis patients developed tuberculosis after 6 months of Infliximab treatment, indicating a significant risk.
  • Joint guidelines from the Japanese Society for Tuberculosis and the Japan College of Rheumatology now recommend chemoprophylaxis for individuals on immunosuppressants if they show positive tuberculin reactions, chest X-ray evidence of TB, or a high likelihood of infection, regardless of age.

Impact:

  • Implementing active chemoprophylaxis irrespective of age is expected to decrease tuberculosis rates among high-risk groups.
  • This revised approach broadens the scope of tuberculosis prevention, aligning with international best practices for managing latent infection.
  • Early and targeted chemoprophylaxis can mitigate the risk of developing active tuberculosis, especially in immunocompromised individuals.