AusDoc 20th Mar

HOW TO TREAT 31 cough, haemoptysis and weight loss. Advise patients that active TB most commonly affects the lungs but can affect any part of the body, so they should report any symptoms that cause concern.

ausdoc. com. au 20 MARCH 2026

HOW TO TREAT 31 cough, haemoptysis and weight loss. Advise patients that active TB most commonly affects the lungs but can affect any part of the body, so they should report any symptoms that cause concern.

The rates of extrapulmonary TB and atypical presentation or disseminated TB are increased in those with LTBI. Have a low threshold of suspicion for the development of active TB in these patients.

Figure created in BioRENDER. com

Referral to an infectious diseases specialist

In general, referring an immunocompromised patient with LTBI to an infectious diseases specialist is appropriate; however, this is not always practical. The situations that may require specialist expertise for their LTBI preventive treatment include those listed in figure 10.

Communication with other health practitioners

Once the course of LTBI preventive treatment has been completed, provide the patient with a letter outlining which agent has been used and the date of treatment completion. This letter should state that the patient has a low risk of TB reactivation unless reinfected. Update the patient’ s medical records to reflect this.

There is no test to confirm successful completion of LTBI preventive treatment and no indication to repeat a chest X-ray, IGRA or TST.

Note that the IGRA and TST may remain positive lifelong, so repeat testing may confuse the situation.

Communication with the doctor who is managing the immunosuppression is important.

Transmissibility and reinfection

Patients are often worried that their LTBI has been transmitted or will be transmitted to their contacts. LTBI is not able to be transmitted to others, so reassure patients of this.

The patient may be reinfected if they are exposed to a case of active TB— either in Australia or if they travel or reside overseas.

Figure 8. When to start latent TB infection( LTBI) preventive treatment in relation to immunosuppression.

Figure created in BioRENDER. com

THE FUTURE IN the past decade, there have
been significant developments in
the diagnosis and management of
LTBI. Identification of LTBI has
improved with the use of interferon-gamma
release assays, which
are undergoing development to
enhance sensitivity and specificity
. Preventive treatments are
evolving beyond single-agent isoniazid
, with shorter courses and
combination therapies; the author
anticipates the increasing use of

these regimens.

The next decade should see a

Figure 9. Patient education for latent TB infection preventive treatment.

substantial increase in the number
of immunosuppressive agents	plan for him to start a TNF-	QuantiFERON makes true LTBI	of single-agent rifampicin. The risk	TNF-alpha inhibitor can be started
on the market, including biologic	alpha antagonist. He has no other	infection likely. There are no symp-	of hepatotoxicity or serious adverse	after four weeks of rifampicin if it is
agents, immunotherapies and cel-	health problems and is not taking	toms or signs to suggest active TB:	events is less than 2 %.	clinically indicated.
lular therapies. The risk of reactivation of LTBI with these agents will need to be quantified as we	any medications. The GP decides to screen for LTBI and performs a QuantiFERON, which comes back	no respiratory symptoms or constitutional symptoms other than fatigue. The risk of TB reactivation over	It is important to offer education to ensure Farid is adherent and vigilant for side effects and to ensure	Case study two Quang, a 76-year-old man, has
gain more experience with their	positive. Farid is at risk of LTBI	Farid’ s lifetime is about 4-5 %, but	he is aware of the risk of drug inter-	been diagnosed with lymphoma.
use. CASE STUDIES Case study one FARID, a 34-year-old man with a	because he was born and grew up in Afghanistan, immigrating at the age of 10. He has no known contacts with active TB, and his chest X-ray is normal.	this increases to about 20 % if he is immunosuppressed with a TNFalpha inhibitor, using the TST calculator. 28 In view of this, it is appropriate to offer LTBI preventive	actions when new medications are started. It is appropriate to contact his rheumatologist and indicate that, although it would be ideal to delay initiation of the TNF-alpha inhibi-	He is undergoing chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone( R-CHOP). He has several other medical conditions,
new diagnosis of psoriatic arthritis,	The combination of an epidemi-	treatment.	tor for four months until the course	including diabetes, ischaemic
is started on methotrexate, with a	ological risk factor and a positive	The author favours four months	of rifampicin is completed, the	heart disease, AF and fatty liver

AusDoc 20th Mar | Page 31

HOW TO TREAT 31 cough, haemoptysis and weight loss. Advise patients that active TB most commonly affects the lungs but can affect any part of the body, so they should report any symptoms that cause concern.

HOW TO TREAT 31 cough, haemoptysis and weight loss. Advise patients that active TB most commonly affects the lungs but can affect any part of the body, so they should report any symptoms that cause concern.