How to Continue in the Treatment of Tuberculosis in the Czech Republic?

Overview

Background.
The Czech Republic belongs to low TB burden countries in last years with incidence around 10/100,000. In such countries TB control consist in not only finding and effective treatment of new TB cases but in identification and containment of pool for new TB cases (latent or subclinical TB infection – LTBI) as well. Recently amended recommendations for TB control in other low TB burden countries, US and England and Wales, were published. The objective of the paper was to determine which of the amended recommendations could be used in our country.

Methods and Results.
In England and Wales the BCG vaccination is recommended only in newborns from families with higher TB risk. In these groups it is necessary to seek out new TB cases as well. In TB diagnostic, emphasis is now placed in England and Wales and also in the US on the use of several diagnostic methods. Drug use self check is more appropriate in all health responsible patients. Liquid drug forms or fixed-dose combination tablets are recommended as well. In both above mentioned countries the LTBI diagnostic is done either by tuberculin skin tests (TST) or by in vitro immunological IGRA tests. In England and Wales positive TST is followed by IGRA test, in the US either TST or IGRA test is recommended. LTBI persons are preventively treated.

Conclusions.
In the Czech Republic the introduction of IGRA tests for LTBI diagnostic should have, due to the BCG policy, even higher benefit. Introduction of IGRA tests seems to be inevitable. Persons with supposed LTBI should be offered either preventive treatment or intensive follow up care with the objective to detect early even incipient signs of TB. As TB develops most often soon after LTBI conception this follow up care should last several years after LTBI detection.

Key words:
tuberculosis, latent (subclinical) tuberculous infection, BCG vaccination, chemoprophylaxis, IGRA tests, tuberculin skin test.