Good Agreement between an Interferon Gamma Release Assay and Tuberculin Skin Tests in Testing for Latent Tuberculosis Infection among HIV-Infected Patients in Indonesia

Reviono Reviono,Leli Saptawati,Dhani Redhono,Betty Suryawati 대한의학회 2019 Journal of Korean medical science Vol.34 No.40

Background: Latent tuberculosis infection is a condition where there is a persistent immune response to Mycobacterium tuberculosis without clinical manifestations of tuberculosis. Currently, there is no gold standard to diagnose latent tuberculosis infection. The tuberculin skin test and interferon-gamma release assay are currently used to diagnose latent tuberculosis infection. However, studies have shown inconsistencies regarding the level of agreement between these tests in different settings. In this study, we aimed to evaluate the agreement between these two tests for diagnosing latent tuberculosis infection in human immunodeficiency virus (HIV)-infected individuals. Methods: We screened HIV patients with no clinical symptoms of tuberculosis, a normal chest X-ray, and no history of tuberculosis or use of antituberculous drugs. Participants were tested with tuberculin skin test (TST) and T-SPOT.TB (an interferon gamma release assay) simultaneously. Participants' HIV stage was determined by measuring the level of CD4+ T-lymphocytes. Tuberculosis status was confirmed by sputum examination using GeneXpert. The level of agreement between the TST and T-SPOT.TB results was measured using Cohen's κ coefficient. Results: Of the 112 participants, 20 had a positive T-SPOT.TB test result, and 21 had a positive TST result. The TST and T-SPOT.TB test results showed a high level of agreement (κ = 0.648, P < 0.001). Performance of the tests did not vary with CD4+ level. However, in participants with CD4+ < 200 cells/mm3 , T-SPOT.TB detected more latent tuberculosis infections than the TST. Conclusion: There was good agreement between the TST and T-SPOT.TB results of latent tuberculosis infection in participants. TST is the preferred test for diagnosing latent tuberculosis infection in HIV-infected patients, especially in resource-limited settings, because it is simple and cost-effective. However, T-SPOT.TB may be useful to rule out latent tuberculosis infection in patients with severe immunodeficiency.

잠복결핵에 감염된 의료인의 치료 경험에 대한 현상학적 연구

김희수(Hee soo Kim),이혜진(Lee Hye Jin) 인문사회과학기술융합학회 2018 예술인문사회융합멀티미디어논문지 Vol.8 No.10

우리나라는 결핵환자의 계속적인 증가로 인해 결핵접촉자에게 잠복결핵 검사를 시행하고 치료를 권고하도록 결핵관리지침이 개정되었다. 이에 따라 그동안은 시행하지 않았던 잠복결핵의 검사와 치료가 시행되고 있다. 본 연구는 잠복결핵에 감염된 종합병원의 의료진이 겪는 치료 경험을 이해하기 위해서 시도되었다. 연구대상자는 현재 잠복결핵을 진단받고 치료중인 8명의 의료진을 편의표집하였다. Colaizzi의 현상학적 연구 방법으로 분석하여 4개의 범주와 11개의 주제가 도출되었다. 도출된 4개의 핵심범주는 ‘잠복결핵의 감염에 대한 심리적 충격’, ‘잠복결핵 치료에 대한 거부감’, ‘잠복결핵의 치료를 수용함’, ‘재감염에 대한 불안감’이었다. 이상의 결과들은 잠복결핵에 감염된 의료진을 심리사회적으로 이해하는데 유용한 자료를 제공할 것이며, 이를 통해 잠복결핵 관리의 장애요인을 파악하고 의료진, 의료기관과 국가 차원에서 잠복결핵 관리에 대한 시사점을 제시하여 결핵에 대한 전략 수립을 마련하는 계기가 되기를 기대한다. As Korea continued to increase tuberculosis patients, Guidelines for Tuberculosis management was revised so as to conduct latent tuberculosis tests on TB contacts and recommend treatment. As a result, latent tuberculosis that has not been conducted has been examined and treated so far. This study aims to understand the world of treatment experience of medical staff at general hospitals identified as positive in latent tuberculosis diagnosis. The subjects were eight doctors under treatment for latent tuberculosis, convenience sampling, and analysis of phenomenological method of Colaizzi was derived or 4 categories and 11 themes. The 4 major categories were psychological impact for infectious diseases of latent tuberculosis , refusal to treat , do not accept treatment for latent tuberculosis , Anxiety . The above results provide data useful for psychosocial understanding of medical staff infected with latent tuberculosis so that it can grasp the disability factors of latent tuberculosis management and identify medical staff, medical institutions and the state We hope to present a suggestion of hidden tuberculosis management at the level and prepare strategies for tuberculosis.

소아청소년 결핵 접촉자 검진 및 잠복결핵감염의 치료 현황: 2014–2017 단일 기관 연구

황우진,이고운,김소현,조은영 대한소아감염학회 2019 Pediatric Infection and Vaccine Vol.26 No.1

Purpose: In order to prevent tuberculosis transmission early, it is important to diagnose and treat tuberculosis infection by investigating people who have contact with patients with active tuberculosis. Methods: From July 2014 to June 2017, the intrafamilial childhood contacts of the patients who were diagnosed with active tuberculosis at Chungnam National University Hospital were investigated for the presence of tuberculosis infection. We also retrospectively analyzed the treatment status of children treated with latent tuberculosis infection (LTBI) during the same period. Results: Among the 269 children who had intrafamilial contact with active tuberculosis patient, 20 (7.4%) did not receive any screening. At the first screening, one (0.4%) was diagnosed with pulmonary tuberculosis, seven (2.8%) had a previous history of tuberculosis infection, and 42 patients (16.9%) were diagnosed with LTBI. At the second screening, 29 patients (11.6%) were diagnosed with LTBI, and 61 patients did not finish the investigation. Only 188 (69.9%) out of 269 patients completed the investigation. Ninety patients received treatment for LTBI and 83 patients (92.2%) completed the treatment, of which 18 patients had side effects such as rash, fatigue, and gastrointestinal symptoms. However, there were no serious side effects requiring treatment discontinuation. Conclusions: The completion rate of childhood tuberculosis contact investigation was low, but the completion rate of LTBI treatment was high in children without serious side effects. In order to prevent and manage the spread of tuberculosis, active private-public partnership efforts and education of the patient and guardian are needed. 목적: 결핵 전파를 조기에 차단하기 위해서는, 활동성 결핵 환자와 접촉한 사람들을 조사하여 결핵 질환 및 잠복결핵감염을 진단하고 치료하는 것이 매우 중요하며, 국내에서는 민간-공공협력 결핵관리사업을 통해 적극적인 접촉자 조사 활동을 지원하고 있다. 본 연구에서는 최근 3년간 단일기관에서 이루어진 소아청소년 연령에서의 접촉자 검진과 소아 잠복결핵감염 치료 현황에 대해 조사하였다. 방법: 2014년 7월 1일부터 2017년 6월 30일까지 충남대학교병원에서 활동성 결핵 환자로 진단받은 환자들을 대상으로 가족 내 소아청소년 접촉자에 대한 검진을 시행하여 접촉자 검진 완료율 및 결과를 분석하였고, 이와 함께 동일 기간 동안 잠복결핵감염으로 치료 받은 소아청소년 환자들의 치료 현황을 후향적으로 검토하였다. 결과: 연구 기간 동안 본 기관에서 활동성 결핵 환자는 총 1,002명 진단되었고, 그 중 소아청소년 가족접촉자가 있는 환자는 171명이었다. 소아청소년 접촉자 269명 중 20명(7.4%)은 검진을 전혀 받지 않았다. 1차 검진을 받은 249명 중 폐결핵이 1명 (0.4%) 진단되었고, 7명(2.8%)은 과거의 결핵 감염 병력이 있었으며, 42명(16.9%)이 잠복결핵감염으로 진단되었다. 2차 검진 시 29명(11.6%)이 추가로 잠복결핵감염으로 진단되었으며, 2차 검진까지 필요하였으나 검진을 완료하지 않은 사람이 61명으로 총 접촉자 269명 중 188명(69.9%)만이 필요한 검진을 완료하였다. 잠복결핵감염으로 치료받은 소아청소년 환자는 90명이었으며 83명(92.2%)이 치료를 완료하였고, 이 중 18명이 발진(8명), 피로(5명), 위장장애(5명) 등의 부작용을 호소하였으나 치료 중단이 필요한 심각한 부작용은 없었다. 결론: 민간-공공협력 결핵관리사업 도입 및 보편화 후에도 소아청소년 연령에서의 결핵 접촉자 검진 완료율은 낮았으며, 잠복결핵감염으로 진단받은 소아의 항결핵제 치료 시 심각한 부작용의 발생 없이 투약 완료율이 높게 나타났다. 향후 결핵 전파의 예방 및 관리를 위해 더욱 적극적인 민관 협동 노력 및 환자, 보호자 교육이 필요하겠다.

새로 진단된 결핵 환자의 가족 내 2차 감염 양상 조사

이민현,성재진,은병욱,조혜경 대한소아감염학회 2015 Pediatric Infection and Vaccine Vol.22 No.1

Purpose: The purpose of this study is to investigate secondary infections within the households of newly diagnosed tuberculosis patients. Methods: We collected data on household infections of tuberculosis patients by retrospective review of medical records and telephone surveys. Results: Out of 321 newly diagnosed tuberculosis cases, a total of 253 patients who received telephone surveys were enrolled in this study. Less than 50% of the patients had household contacts screened for tuberculosis infection, and most of the patients were not aware of the necessity of testing. Out of 562 household contacts, there were 8 cases of secondary tuberculosis (1.4%, 8/562) in 7 households. There were 15 cases of latent infection (2.7%, 15/562) in 13 households. Out of 110 child and adolescent household contacts, there were no cases of secondary tuberculosis, and there were 8 cases of latent infection (7.3%) in 7 households, which was 20.5% among child and adolescent contacts screened for tuberculosis infection. In 3 of the cases (13.0%) that had secondary tuberculosis or latent infection in their households, the source of infection was extrapulmonary tuberculosis. There was no correlation between the frequency of household infections and the presence of pulmonary cavities, sputum AFB smear results, and microbiologically confirmed results. Conclusions: For effective investigation of tuberculosis contacts, it is necessary to raise general awareness on the necessity of investigating household contacts, and there should also be a continued assessment on tuberculosis contact investigation since government-supported programs. 목적: 결핵 전파의 주요 원인인 가족 내 2차 감염 관리의 실태를 조사하고 특히 18세 이하 소아청소년에서의 결핵 노출 시의 관리 실태를 분석하는 것이다. 방법: 2011년 10월 1일부터 2012년 9월 30일까지 가천대 길병원에서 결핵균 감염에 의한 질환으로치료받은 환자들을 대상으로 진단을 받은 시기로부터 1년이 지난 시점에 후향적으로 전화 설문 및 의무 기록을 조사하였다. 결과: 총 321명의 연구 대상자들 중 전화 응답이 가능했던 253명의 새로 진단된 결핵 환자들 중에서가족 접촉자에 대한 결핵 감염 여부를 확인하기 위해 검사를 받은 경우는 50% 미만 밖에 되지 않았고, 검사의 필요성에 대한 인식이 부족한 경우가 많았다. 총 562명의 가족 내 접촉자 중 2차 환자가 발생한 경우는 7가족 내 8명(1.4%, 8/562)이었고, 가족 내 잠복결핵감염 환자가 발생한 경우는 13가족 내15명(2.7%, 15/562)이었다. 가족 내 소아∙청소년 접촉자 110명 중 2차 환자는 없었으며 잠복결핵감염은 7가족 내 8명으로 전체 소아∙청소년 접촉자 중에는 7.3%, 검진을 받은 소아∙청소년 접촉자 중에는 20.5%였다. 가족 내에 추가 환자 및 잠복결핵감염자 중 감염원이 폐외 결핵인 경우가 3명(13.0%) 이 있었다. 감염원의 폐공동 존재 여부와 객담 도말 검사 결과 및 미생물학적 확진 여부는 가족 내 접촉자의 감염 여부와는 상관 관계가 없었다. 결론: 효과적인 결핵 접촉자 검진을 위해서 환자의 가족 내 접촉자 검진에 대한 인식의 개선이 필요하며 결핵 접촉자 검진 국가 지원 사업 이후 관리 실태 개선 여부에 대한 평가를 위해 지속적인 조사가 필요하다.

Host Blood Transcriptional Signatures as Candidate Biomarkers for Predicting Progression to Active Tuberculosis

Jaehee Lee,Chang Ho Kim,Gahye Choi 대한결핵및호흡기학회 2023 Tuberculosis and Respiratory Diseases Vol.86 No.2

A recent understanding of the dynamic continuous spectrum of Mycobacterium tuberculosis infection has led to the recognition of incipient tuberculosis, which refers to the latent infection state that has begun to progress to active tuberculosis. The importance of early detection of these individuals with a high-risk of progression to active tuberculosis is emphasized to efficiently implement targeted tuberculosis preventive therapy. However, the tuberculin skin test or interferon-γ release assay, which is currently used for the diagnosis of latent tuberculosis infection, does not aid in the prediction of the risk of progression to active tuberculosis. Thus, a novel test is urgently needed. Recently, simultaneous and systematic analysis of differentially expressed genes using a high-throughput platform has enabled the discovery of key genes that may serve potential biomarkers for the diagnosis or prognosis of diseases. This host transcriptional investigation has been extended to the field of tuberculosis, providing promising results. The present review focuses on recent progress and challenges in the field of blood transcriptional signatures to predict progression to active tuberculosis.

소아청소년기 잠복결핵 감염의 치료

김종현 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.5

Tuberculosis continues to cause an unacceptably high toll of disease and death among children worldwide. Whereas intense scientific and clinical research efforts into novel diagnostic, therapeutic, and preventive interventions have focused on tuberculosis in adults, childhood tuberculosis has been relatively neglected. However, children are particularly vulnerable to severe disease and death following infection, and those with latent infection become the reservoir for future transmission following disease reactivation in adulthood, fuelling future epidemics. Therefore, it is very important to understand the significance, diagnosis and treatment of latent tuberculous infection to decrease a future disease burden of tuberculosis. Unfortunately, these concept still have not fully implicated in Korean National Tuberculosis Control Program, it should be engaged and enforced as soon as possible. 결핵은 아직도 전세계적으로 소아에서 높은 유병률과 사망률을 보이는 질환이다. 아쉽게도 결핵에 대한 새로운 진단법, 치료법, 예방법에 대한 과학적 혹은 임상 연구는 주로 성인에 초점을 맞추어 왔으며 소아 결핵은 상대적으로 등한시되어 왔다. 그러나 특히 소아 결핵은 감염 후 중한 질환으로 진행되기 쉬우며 이는 사망을 초래하기도 한다. 또한 소아청소년기의 잠복결핵 감염은 후일 결핵균의 재활성으로 인하여 미래의 감염원으로 작용한다. 따라서 미래의 결핵 발생을 줄이기 위해서는 잠복결핵 감염에 대한 특징, 진단, 치료에 대해 이해하는 것이 매우 중요한다. 그러나 우리나라의 국가 결핵관리정책에는 이러한 개념들이 완전히 적용되지 않았으므로, 가능한 빨리 포함되고 시행되어져야 한다.

잠복결핵에 관한 온라인 건강 상담 현황

최연수(Yeon-Soo Choi),박동영(Dong-Young Park),송윤경(Yun-Kyoung Song),박혜영(Hae-Young Park),권진원(Jin-Won Kwon) 대한약학회 2024 약학회지 Vol.68 No.2

The study’s objective is to explore the health information needs of latent tuberculosis patients and their communities by analyzing data from the online health counselling platform, Naver Jisik-iN. Initially, 3,261 questions related to ‘latent tuberculosis’ were collected. Following the removal of duplicates and irrelevant image information, the final dataset for analysis comprised 2,198 questions. Text pre-processing, Latent Dirichlet Allocation (LDA) topic modelling, and Long Short-Term Memory (LSTM)-based text summarization model were used. Manual categorization was added to supplement the unsupervised learning process. Seven topics were identified using LDA, from which five specific topics (‘side effects’, ‘treatment’, ‘army’, ‘interaction’, and ‘infectiousness’) were derived. Subsequently, manual classification was conducted based on these five topics. Manual summary and LSTM-based text summarization results were consistent. Numerous individuals sought information about the potential for curing latent tuberculosis and the risk of tuberculosis development. Moreover, questions related to the interpretation of test results and interactions with other substances were widespread. Concerning side effects, issues predominantly revolved around drug discontinuation due to skin problems and elevated liver function tests. The findings reveal the prevalent concerns and inquiries of society regarding latent tuberculosis. The identified topics offer valuable insights into the key aspects of interest related to this condition.

Interferon-gamma Release Assay의 임상적 이용

우광숙,김경희 대한진단검사의학회 2016 Laboratory Medicine Online Vol.6 No.1

Mycobacterium tuberculosis infection remains an important problem in Korea and globally. Interferon-gamma release assays (IGRAs) are blood-based tests that measure the amount of interferon-gamma released by T lymphocytes after stimulation by antigens specific for M. tuberculosis. IGRAs are not recommended for diagnosis of active pulmonary tuberculosis because they cannot distinguish between latent tuberculosis infection (LTBI) and the active disease. For extrapulmonary tuberculosis, IGRAs are considered adjuvant diagnostic tools. The diagnostic performance of IGRAs differs according to infection site. The sensitivity of IGRAs in children is suboptimal in low- and middle-income countries. In Korea, for children who have received a M. bovis bacille Calmette-Guérin (BCG) vaccine after 1 yr of age or have been inoculated with the BCG vaccine twice or more, IGRA is recommended instead of the tuberculin skin test (TST). Diagnosis and treatment of LTBI before the initiation of anti-tumor necrosis factor (TNF) agents are recommended in patients with immune-mediated inflammatory diseases because anti-TNF therapy is associated with an increased risk of developing tuberculosis. A strategy using both TST and IGRA is used for immunocompromised adults in Korea; positive results obtained by either test confirm a diagnosis of LTBI. Negative results of only TST are not considered conclusively negative for LTBI. In addition to interferon-gamma, a biomarker to discriminate between active and latent tuberculosis is required, and IP-10 and IL-2 are currently being investigated in this regard. The use of IGRA would improve the diagnosis of extrapulmonary tuberculosis and LTBI. Mycobacterium tuberculosis 감염은 국내와 전세계적으로 여전히 중요한 문제이다. Interferon-gamma release assay (IGRA)는 M. tuberculosis 특이항원으로 말초혈액 내의 T 림프구를 자극한 후에 유리된 interferon-gamma의 양을 측정하여 결핵균에 감염되었는지를 검출하는 검사이다. IGRA는 잠복결핵감염과 활동성 결핵을 감별할 수 없기 때문에 활동성 폐결핵의 진단에는 추천되지 않지만 폐외결핵의 진단에 보조적인 진단 방법으로 이용될 수 있다. 폐외결핵에서의 IGRA 진단적 성능은 감염 부위에 따라 다르다. 소아에서의 IGRA 민감도는 소득수준이 낮거나 중간 정도인 국가에서는 기대에 미치지 못하는 것으로 보고되고 있다. 국내에서는 BCG 백신을 1세 이후에 맞았거나, 2회 이상 접종 받은 경우에는 투베르쿨린 검사 대신에 IGRA로만 결핵 감염 여부를 확인하도록 권장하고 있다. Tumor necrosis factor (TNF) 길항제 치료는 결핵 발생의 위험을 증가시키기 때문에 TNF 길항제 치료 예정자인 경우에는 잠복 결핵 감염을 진단, 치료하도록 해야 한다. 국내에서는 성인 면역저하자인 경우 IGRA 단독 혹은 IGRA와 투베르쿨린 검사 병합법을 사용할 수 있으며, 투베르쿨린 검사 단독으로 잠복 결핵 감염 음성으로 진단하는 것은 권고하지 않는다. interferon-gamma 외에도 IP-10과 IL-2가 활동성 결핵과 잠복결핵감염을 구별할 수 있는 표지자로 연구가 진행되고 있다. 요약하면 IGRA의 사용은 잠복결핵감염과 폐외결핵의 진단에 도움이 되고 있다.

폐결핵 접촉력을 가진 소아에서 잠복 결핵 감염의 진단을 위한 결핵 특이항원 자극 인터페론-감마 측정의 유용성

성지연 ( Ji Yeon Sung ),김주화 ( Joo Hwa Kim ),양미애 ( Mi Ae Yang ),김소희 ( So Hee Kim ),은병욱 ( Byung Wook Eun ),김남희 ( Nam Hee Kim ),박경운 ( Kyoung Un Park ),이진아 ( Jina Lee ),최은화 ( Eun Hwa Choi ),이환종 ( Hoan Jong L 대한소아감염학회 2008 Pediatric Infection and Vaccine Vol.15 No.1

목 적 : 잠복 결핵 감염 진단 시 사용되는 고전적인 방법인 투베르쿨린 피부 반응 검사(TST) 외 전혈에서 인터페론 감마의 분비능을 측정하는 검사가 개발된 이후 많은 연구들이 그 유용성을 입증하였으나, 소아에서는 그러한 평가가 제한되어 있다. 본 연구는 결핵에 노출된 소아의 잠복 결핵 감염 진단에 있어 QuantiFERON-TB Gold 검사의 유용성을 알아보고자 하였다. 방 법 : 2006년 1월부터 2007년 12월까지 분당 서울 대학교 병원에 결핵 환자와 접촉하여 내원한 소아를 대상으로 흉부 방사선 사진, TST 및 QuantiFERON-TB Gold 검사를 시행하였다. 초기 TST가 음성인 경우, 3개월 뒤 추적 검사를 시행하였다. TST 결과에 따라 초기 TST가 양성인 경우 감염 여부는 확실치 않으나 잠복 감염의 가능성이 있는 군, 초기 TST는 음성이었으나 3개월 뒤 검사에서 양성 전환된 경우는 잠복 결핵 감염군, 처음과 3개월 뒤 TST가 모두 음성인 경우는 감염되지 않은 군으로 정의하였다. 초기 TST가 음성이었으나 추적검사를 하지 않은 경우는 분석에서 제외시켰다. 결 과 : 대상군은 총 49명(남자 22명, 여자 27명) 이었으며, 중앙 연령은 75세(범위; 3개월-14.7세)이었다. QuantiFERON-TB Gold 검사 양성을 보인 소아는 총 5명으로, 감염 여부는 확실치 않으나 잠복 감염의 가능성이 있는 13명 중 3례(23.1%), 잠복 결핵 감염으로 진단된 8명 중 1례(13%), 그리고 감염되지 않은 21명 중 1례(5%)가 포함되었다. QuantiFERON-TB Gold와 TST의 일치도는 0.72이었다(к=0.101). TST와 비교하였을 때 QuantiFERON-TB Gold의 민감도는 12.5%(1/8), 특이도는 95.2%(20/ 21)으로 나타났다. 결 론 : 결핵에 노출된 소아의 잠복결핵감염의 진단에 있어서 QuantiFERON-TB Gold 검사는 TST에 비하여 민감도가 매우 낮아서 임상적 유용성이 불확실하며 더 많은 연구가 필요하다. Purpose : Whole blood interferon-γ assay was developed and many studies showed its usefulness in diagnosing tuberculosis (TB) including latent tuberculosis infection (LTBI). However, assessment in children has been limited. This study was undertaken to evaluate the usefulness of QuantiFERON-TB Gold for the diagnosis of LTBI in children exposed to pulmonary TB. Methods : Children who visited Seoul National University Bundang Hospital with a history of TB exposure were enrolled from January 2006 to December 2007. They were evaluated with chest x-rays, tuberculin skin test (TST) and QuantiFERON-TB Gold test. TST was retested 3 months later for those with initial negative reactivity. Definition of LTBI was made on the basis of the TST reactivity. Results : Among the 103 children with a history of TB exposure, 49 children were tested with chest x-ray, TST, and QuantiFERON-TB Gold. Twenty-two were males. Median age was 7.5 years (range; 3 months to 14.7 years). According to TST reactivity, LTBI was in 8 (19%), no infection was in 21 (50%), possible LTBI was in 13 (31%). QuantiFERON-TB Gold test was positive in 5 of the 49 subjects (10%); 3 of the 13 subjects (23.1%) in unknown status, 1 of the 8 subjects (13%) in LTBI, and 1 of the 21 subjects (5%) without infection. The agreement between the QuantiFERON-TB Gold and the TST was poor (κ=0.101). Conclusion : QuantiFERON-TB Gold showed poor sensitivity for the diagnosis of LTBI in children with exposure to TB. QuantiFERON-TB Gold alone does not seem to be useful in the diagnosis of LTBI in children. (Korean J Pediatr Infect Dis 2008;15:50-57)

폐결핵 환자와 접촉한 소아의 잠복결핵 진단에 영향을 미치는 위험 요소

민동훈 ( Dong Hoon Min ),위화현 ( Hwa Hyun Wy ),심재원 ( Jae Won Shim ),김덕수 ( Duk Soo Kim ),정혜림 ( Hye Lim Jung ),박문수 ( Moon Soo Park ),심정연 ( Jung Yeon Shim ) 대한천식알레르기학회 2017 Allergy Asthma & Respiratory Disease Vol.5 No.2

Purpose: Tuberculosis (TB) is a common and possibly fatal infectious disease, and its incidence and prevalence is quite high in Korea compared to other Organization for Economic Co-operation and Development countries. Patients who have active TB can cause latent tuberculosis infection (LTBI) in children, which may progress to reactivated tuberculosis. This study was performed to analyze the risk of adult TB that affects children`s LTBI. Methods: From June 2013 to May 2014, 60 children (32 boys, 28 girls) who came into close contact with adult patients diagnosed with pulmonary TB underwent LTBI tests. The children were divided into the 2 groups: the first group was finally diagnosed to LTBI, and the second group was proven not to have LTBI. We compared the risk of adult patients with pulmonary TB between children with LTBI and those without through a medical record review. Results: The number of adult patients with TB was 36 (father 68%, mother 23%, grandparents 8%). The patients who came into close contact with the LTBI group were older (47.0±12.8 years vs. 41.3±6.6 years) and had higher erythrocyte sedimentation rate (ESR) levels than those of the second group. The rate of negative acid-fast-bacilli smear with positive culture results in patients who came into contact with the LBTI group was higher than in the second group. The cutoff value of ESR for the diagnosis of LTBI was 31 mm/hr with a sensitivity of 0.75 and a specificity of 0.85 (area under curve=0.748). Conclusion: Adult pulmonary TB patients who are older and have higher ESR levels may be risk factors for LTBI in children coming into close contact with them. (Allergy Asthma Respir Dis 2017:5:105-110)