Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Because there is no tuberculin screening schedule currently recommended for adults, we used a Markov process in a cost-effectiveness analysis to determine an optimal strategy. We simulated the prognosis of a cohort of black 20-year-olds to evaluate the effects of various screening schedules with intradermal tuberculin and administration of isoniazid prophylaxis to those with positive results. The schedule with the lowest cost-effectiveness ratio is a single screening at 50 years of age, which costs $41,672 per quality-adjusted life year (QALY) gained. The cost-effectiveness ratio is nearly the same for all schedules involving a single screening between 30 and 70 years of age. Repeated screening strategies are less cost effective. Sensitivity analysis shows that the range of acceptable screening strategies changes significantly under alternate assumptions about the mortality from isoniazid hepatitis. However, screening at 50 years of age remains nearly optimal under the alternatives considered. Altering the values of other parameters generally produced only small changes. Tuberculin screening at 50 years of age should be added to primary care preventive practices because the strategy is as cost effective as standard health interventions and is robust to alternative assumptions. If further research confirms the base case assumptions about isoniazid toxicity, consideration should be given to increasing screening to every 10 years, which would produce a larger health benefit, albeit at substantially higher cost.
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PMID:Tuberculin screening: cost-effectiveness analysis of various testing schedules. 211 87

The incidence of tuberculosis (TB) presenting to the University Hospital, Geneva, Switzerland, was studied over 2 years. Clinical data on all children receiving antituberculous drug therapy was collected. Of the 43 identified cases, 42% had active disease (i.e. clinical evidence of organ involvement), the remaining 58% being asymptomatic. All 43 children originated from countries other than Switzerland. Symptomatic, drug induced hepatitis necessitated temporary interruption of therapy in 2 children (5%). Contact screening yielded three new cases of pulmonary TB, three previously diagnosed cases and seven instances of a positive medical history in relatives living in other countries. Of the 34 families in this study, contact screening could not be completed in 8. The results of this study indicate that children with TB are primarily associated with families originating from countries other than Switzerland, particularly those in which TB remains endemic. Tuberculin skin testing should therefore be targeted at this group. Contact tracing has also been shown to be beneficial.
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PMID:Childhood tuberculosis at a Swiss university hospital: a 2-year study. 822 81

There is very high incidence of tuberculosis (TB) in dialysis and renal transplant (RT) recipients in developing countries. Clinical manifestation of TB may be atypical or obscure in initial stages. Common clinical abnormalities include pyrexia, pulmonary infiltrates, exudative pleural effusion, and exudative ascites. Aggressive investigations must be done in patients with pyrexia, pulmonary abnormalities, scanty sputum, and weight loss. BAL and computed tomography (CT) scan of the chest should be done in such cases. Tuberculin skin test is not helpful in the majority of patients. New blood tests to quantitate PPD reactivity in vivo and tests to distinguish between latent M tuberculosis infection from BCG-induced reactivity have been devised recently. Side effects of anti-TB drugs, especially hepatitis, need close observation because of the frequent occurrence of viral hepatitis in such cases. Tests to confirm latent TB are desirable before starting chemoprophylaxis in RT recipients. INH prophylaxis cannot be recommended universally in all RT recipients.
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PMID:Challenge of tuberculosis in renal transplantation. 1744 91

Despite dramatic advances in diagnosis and treatment, tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide. World Health Organization (WHO) reports that one-third of the global population is infected by M. tuberculosis. Direct identification of individuals who are latently infected with live M. tuberculosis without active disease is currently not possible (Latent TB Infection, LTBI). Available immunodiagnostic tests, i.e. Tuberculin Skin Testing and Interferon-gamma Release Assay, ascertain a state of M. tuberculosis specific immune response; they have several limitations in their ability to predict the risk of developing TB disease. Protective efficacy of isoniazid preventive treatment for 6 to 12 months was proved among non-HIV-infected and HIV-infected individuals. The frequency of symptomatic hepatitis due to isoniazid has been estimated to be 1 to 3 per 1,000 persons. The protection of isoniazid treatment in HIV-infected persons appears to be short-lasting (1-2.5 years), in areas with a high incidence of TB. Isoniazid plus rifampicin for 3 months has proven efficacy. There are not sufficient data on preventive treatment for contacts of patients with drug-resistant TB; existing recommendations are based on expert opinions. Rifampicin for 4 months is a choice for the treatment of individuals exposed to an index case with isoniazid-resistant TB. WHO does not recommend anti-TB second-line drugs for preventive therapy.
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PMID:[Diagnosis and treatment of latent tubercular infections]. 2106 7