TB Contacts - docbiryani

[ArchivalUser]

In close TB contacts, first step is PPD. INH 9 months if positive.

what in case of children and immuno compromised who had close contacts but PPD turns negative. Archers say start INH, repeat PPD after 10 weeks again if negative stop INH. UW says no INH if PPD is negative in the first time itself ??

Thanks

[ArchivalUser]

In immunodeficient negative PPD may be because of anergy. These patients should be tested with Candida antigen to establish if those are negative because of anergy or not.

[ArchivalUser]

Archer has standard guidelines in preventive medicine. starting INH in children < 5 and immunodeficient contacts is correct. Starting prophylaxis or not depends on the the characteristic of contact like too young or immunodeficiency.

Window period is period between exposure and time when PPD turns positive. Usually, 8 to 12 weeks. For healthy people, we can wait and repeat PPD after 8 weeks but for people at risk of rapid progression , Prophylactic INH is warranted

Window-period prophylaxis is recommended as an option for contacts aged

[ArchivalUser]

Window Prophylaxis
Window prophylaxis is the practice of treating TST-negative contacts to TB cases with
anti-tuberculosis therapy during the early phase when the TST may not yet have become
positive.
• Window prophylaxis prevents rapid progression to TB soon after infection.
• Individuals at very high risk of progressing to TB if infected (very young children,
immunocompromised contacts, close contacts to very contagious individuals) are
targeted for window prophylaxis.
• Contacts should be screened by history, physical exam, and chest radiograph to
rule out early TB disease before initiating window prophylaxis.
• Contacts are typically treated for 8 to 10 weeks from the end of risk of transmission,
and then the TST is repeated. If the skin test has become positive, treatment for
LTBI is completed. If the skin test remains negative, window prophylaxis is stopped,
unless the contact is at risk for anergy (immunosuppressed or an infant younger
than 6 months of age).
• Window prophylaxis for MDR-TB should be considered in consultation with TB
experts for the following two groups: very young children, and HIV-infected individuals with very intimate and prolonged contact with individuals likely to be contagious
(smear-positive, cavitary disease, coughing source case, and TST conversions
among other contacts indicating transmission of TB).

[ArchivalUser]

sorry link is http://www.nationaltbcenter.edu/drtb/doc...ageCon.pdf

Good one

[ArchivalUser]

Missyd ,that is great.
thanks

[ArchivalUser]

awesome..thanks misshyd !

[ArchivalUser]

"Contacts should be screened by history, physical exam, and chest radiograph to
rule out early TB disease before initiating window prophylaxis."

so what is the role of cxr bfr starting INH ? do it irrespective of PPD results to rule out active disease. can we expect subtle changes in cxr even with PPD negative.

Thanks again misshyd..

[ArchivalUser]

docbiryani, PPD

[ArchivalUser]

docbiryani, PPD may not be positive so early but CXR is done to rule out pre-existing TB here because we are starting only one drug INH assuming the TB is latent