Inactive fibrotic lesions versus pulmonary tuberculosis with negative bacteriology.
This article analyzes the concept of inactive fibrotic lesions of presumed tuberculous origin (old healed tuberculosis), defined by radiological characteristics and a positive tuberculin skin test (TST), and we examine the evidence-based foundation for the indication of treatment of latent tuberculosis infection in these cases. We explore the risk of reactivation in older and recent literature, and the problems raised by the differential diagnosis with active tuberculosis with negative bacteriology. We also analyze data on the prevalence of fibrotic lesions in the recent literature. We examine the possible role of Interferon Gamma Release Assays (IGRAs) versus TST and other molecular antigen detection techniques in sputum that can aid in establishing the diagnosis and we discuss the current indications for chemoprophylaxis and the different options available. We propose diagnostic guidelines and therapeutic algorithms based on risk stratification by age and other factors in the management of radiological lesions that raise a differential diagnosis between fibrotic lesions and active pulmonary tuberculosis with negative bacteriology.
Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron, Barcelona, España. Electronic address: jsolsona@vhebron.net.
Jordi
J
Solsona Peiró
Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron, Barcelona, España.
Maria Luiza
ML
de Souza Galvão
Unitat de Tuberculosi de Drassanes, Hospital Universitari Vall d'Hebron, Barcelona, España.
Maria Neus
MN
Altet Gómez
D000367:Age Factors; D000465:Algorithms; D000995:Antitubercular Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D002921:Cicatrix / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D005355:Fibrosis; D015658:HIV Infections / Q000150:complications / Q000276:immunology; D006801:Humans; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D008168:Lung / Q000473:pathology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
D000995:Antitubercular Agents
Factor de riesgo; Fibrotic lesion; Infección tuberculosa latente; Interferon Gamma Release Assay; Latent tuberculous infection; Lesión fibrótica; Old healed tuberculosis; Prueba de la tuberculina; Riesgo de reactivación; Risk factor; Risk of reactivation; Tuberculin skin test; Tuberculosis; Tuberculosis antigua curada