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Cribado y tratamiento de la tuberculosis latente en adultos: informe de evidencia y revisión sistemática para el
Leila C Kahwati1, Cynthia Feltner2, Michael Halpern1
1RTI International-University of North Carolina at Chapel Hill Evidence-Based Practice Center2RTI International, Research Triangle Park, North Carolina.
JAMA
|September 7, 2016
Resumen
La detección y el tratamiento específicos de la infección por tuberculosis latente (LTBI) reducen el riesgo de enfermedad por tuberculosis activa (TB). Si bien las pruebas cutáneas de tuberculina (TST) y los ensayos de liberación de interferón gamma (IGRA) son efectivos, el tratamiento con isoniazida aumenta el riesgo de hepatotoxicidad.
Área de la Ciencia:
- Salud pública
- Epidemiología de las enfermedades infecciosas
- La medicina preventiva
Sus antecedentes:
- La infección de tuberculosis latente (LTBI) afecta al 5-10% de las personas, con progresión a la enfermedad de tuberculosis activa (TB).
- La identificación y el tratamiento de la LTI son cruciales para reducir la carga mundial de la tuberculosis.
Objetivo del estudio:
- Revisar la evidencia sobre el cribado y el tratamiento dirigidos para la LTI en adultos de atención primaria.
- Informar sobre las actualizaciones de las recomendaciones del Grupo de Trabajo de Servicios Preventivos de los Estados Unidos.
Principales métodos:
- Revisión sistemática de los estudios en inglés sobre el cribado y el tratamiento de la LTI.
- Busqué en MEDLINE, en la Biblioteca Cochrane y en los registros de los juicios.
- Metaanálisis utilizado para las estimaciones combinadas de sensibilidad, especificidad y resultados del tratamiento.
Principales resultados:
- No hubo estudios que compararan el cribado con la ausencia de cribado.
- Las pruebas cutáneas de tuberculina (TST) y las pruebas de liberación de interferón gamma (IGRA) demostraron una sensibilidad moderada y una alta especificidad.
- El tratamiento con LTBI redujo el riesgo de TB activa; la isoniazida aumentó el riesgo de hepatotoxicidad en comparación con el placebo o la rifampicina.
Conclusiones:
- Los TST y los IGRA son herramientas efectivas de detección en entornos de baja carga de tuberculosis.
- El tratamiento de LTBI es eficaz en la prevención de la TB activa.
- La hepatotoxicidad es una preocupación significativa con el tratamiento con isoniazida.
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