The Indonesian Journal of Health Science Volume 13.
No.
Desember 2021 Identification Latent Tuberculosis Infection In Hemodialysis Patients: A Systematic Review Hamidah Retno Wardani Nursing Study Program.
Universitas Bondowoso.
Indonesia Email: hamidah@unibo.
Abstract Background and Aim: Tuberculosis is a chronic infectious disease that can spread through sputum droplets containing Mycobacterium tuberculosis (Mt.
Infection Mtb can give an asymptomatic condition that can persist for years in the host called latent tuberculosis infection (LTBI).
LTBI is a dormant condition of the Mycobacterium tuberculosis.
It is often defined as a condition without symptom with the tuberculosis organisms in the lung tissue, without clinical signs, or radiological signs.
LTBI can become active tuberculosis (TB) in immunosuppressed hosts such as patients with end-stage renal disease (ESRD).
Screening TB infection using examination tests such as the TST.
QFT-G, and complete treatment in hemodialysis patients can avoid the progression of LTBI into active-TB.
This study identified the incidence of LTBI in hemodialysis patients using the TST and QFT-G.
Methods: A Systematic Review study to identify LTBI in hemodialysis patients using the Prefered Reporting Items for Systematic Review and Meta-analysis The three main electronic databases used are PubMed.
EMBASE.
Google Scholar.
Results: Derived from 67 related articles and obtained 4 articles based on inclusion criteria.
Totally 516 hemodialysis patients and the study showed that the incidence of LTBI using TST .
ut off Ou 10 m.
and QFT-G (Ou 35 IU/m.
showed that TST /QFT-G positive 68 patients .
47%), only positive TST 22 patients .
97 %), only positive QFT-G 77 patients .
92%).
Conclusion: This study showed that a high incidence of LTBI in hemodialysis Early detection and complete treatment of LTBI should be performed in hemodialysis patients to avoid the reactivation of LTBI into active TB.
Keywords: ESRD.
Hemodialysis patient.
LTBI.
TST.
QFT-G
How to cite this article: Wardani.
Identification latent tuberculosis infection in hemodialysis patients: A systematic review.
The Indonesian Journal of Health Science.
, 203-211.
DOI: 10.
32528/ijhs.
Copyright: A2021 Wardani.
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.
0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Published by: Universitas Muhammadiyah Jember ISSN (Prin.
: 2087-5053 ISSN (Onlin.
: 2476-9614 DOI: 10.
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The Indonesian Journal of Health Science Volume 13.
No.
Desember 2021
INTRODUCTION
Tuberculosis infection defined is an infectious disease caused by Mycobacterium tuberculosis, leading cause of morbidity and mortality in worldwide for 1.
5 million deaths each year (Houben & Dodd, 2016.
Tang & Johnston, 2.
Globally, it is estimated that there are 10 million incidents of tuberculosis infection and 6 million cases of death due to TB disease occurred in 2017.
WHO End TB Strategy has conducted as one of the main strategies for tuberculosis identification with latent tuberculosis One of strategy to reduce TB is to give effective treatment for latent TB has been shown to reduce the risk of progression and increase.
This can contribute to reducing the incidence of LTBI globally (WHO, 2.
LTBI infection is a condition of dormant tuberculosis organisms.
Often defined as an asymptomatic condition in which Mycobacterium tuberculosis is present in the lungs tissue without any clinical or radiological signs.
LTBI
can become active-TB in hosts who experience immunosuppression due to comorbid disease or medical therapy (Campbell.
Krot & Mara, 2.
This condition also occurs in patients with ESRD in hemodialysis center who are receiving hemodialysis therapy and undergoing immunosuppression.
The Tuberculosis infection are also higher in patients undergoing hemodialysis (HD) than in the general population (Chung, et al, 2.
Patients with endstage renal disease (ESRD) develop immune dysfunction which increases the risk of infection.
At the stage of weak immunity, patients with latent tuberculosis infection (LTBI) will increase their reactivation and become active-TB (Campbell.
Krot & Mara.
DOI: 10.
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Currently no gold standard for identifying LTBI in a population primarily of hemodialysis patients.
The diagnostic tests such as the TST and QFT-G are commonly used in combination in diagnosing Latent Tuberculosis Infection.
The purpose of this research to detect the incidence of LTBI in patients ESRD who hemodialysis center with QFT-G and two step TST examinations.
Using systematic review to investigate the incidence of LTBI in hemodialysis METHODS This study uses PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalysi.
which was carried out systematically by following the correct research stages or protocols.
The procedure of this systematic review consists of several steps, namely .
identification of research .
arrange of protocol.
Searching literature.
Selection .
Practical screen.
Quality checklist and procedures.
Data Extraction strategy.
The researcher also scans the list of references to match the citations related to the research The database search was conducted from 12 to 17 August 2019.
The keywords used were: AoESRDAo, 'Hemodialysis patientsAo.
Latent Tuberculosis infection', 'TST', 'QFT-G', .
The inclusion criteria in this study were English articles, full text, prospective study, diagnostic test using two step-TST and QFT-G in hemodialysis patients who were then followed up.
Interventions unrelated to the topic were excluded.
The three main electronic databases used are The Indonesian Journal of Health Science Volume 13.
No.
Desember 2021 PubMed.
EMBASE.
Google Scholar published from 2010-2019.
Each journal is extracted Parameters were extracted from each research journal including research information .
uthor, year of population demographics .
ender, age, screening criteria, and results .
wo step-TST / QFT-G cut-off, positive and negative count.
RESULTS
This study identified from 4 Journal identification was carried out by screening based on appropriateness following the inclusion criteria (Table .
The population in this study was published in the international journals with the topic of LTBI in hemodialysis The sample in this study is Identified articles from three main electronics databases : PubMed.
EMBASE.
Google Scholar .
Articles screened .
Full text articles screened for appropriateness .
Articles included in the inclusion criteria .
published in an international journal with the topic of detection of LTBI in ESRD hemodialysis using two step-TST and QFT-G.
The inclusion criteria in this study are: .
English language.
Full text article.
Published in 2010-2019.
using prospective study.
The topic of LTBI research in hemodialysis .
The diagnostic of LTBI uses the two-step TST and QFT-G.
The number of sources obtained from the database includes PubMed 44.
EMBASE 12, google scholar 11.
Analysis of the 4 articles that have been identified shows that all journals use the prospective study method.
The analyzed data based on the author's diagnostic method, cut-off and results.
The results of data extraction in the Duplicate removed .
Record excluded due to tittle and/or abstract .
Full text articles exclude due to :
Abstract only .
No diagnostic data .
Not a prospective cross sectional .
Cut-off O 10 mm .
Test diagnostic not only two step-TST and QFT .
Figure 1.
Article identification flow LTBI infection was evaluated in four journals using two step-TST and DOI: 10.
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QFT-G.
All studies reported positive TST results with a cutoff Ou 10 mm and The Indonesian Journal of Health Science Volume 13.
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Desember 2021 positive QFT results with IFN-gamma response to TB antigen Ou 0.
35 IU / ml.
Based on table 1, totally 516 hemodialysis patients from this study.
Data shows that there were 74 patients ESRD hemodialysis and had two-step TST and QFT-G examinations result with 28 .
8%) positive patients.
QFT-G examinations result 26 .
positive patients and two-step TST examination 10 .
5%) positive The second article contained 200
ESRD
hemodialysis unit and 2-step TST, and QFT-G tests with positive results as much 21 .
5%) patients, 44 .
%) patients were positive for QFT-G, and 5 .
5%) patients were positive for TST.
In the third article, there were 52
ESRD
hemodialysis unit.
2-step TST and QFT-G tests were carried out with positive results as much 15 .
patients, 3 .
8%) patients with positive results.
in QFT-G and 5 .
6%) patients with positive TST In the fourth article, there were 190 patients with ESRD in the hemodialysis unit, and 2-step TST and QFT-G examinations were carried out with 32 patients .
4%) positive results on QFT-G and 42 .
Table 1.
The results of extraction data Tittle Author and Year Detection of LTBI in hemodialysis comparison between the QFT-G and the TST Comparison of the TST and QFT-G test for the diagnosis of latent infection in Hussein.
Yousef & Ali.
Value of the TST and IGRA in patients after exposure to M.
Anibarro et
, 2012
High prevalence of LTBI in patients using the IGRA and TST Leet et al.
Jahdali et al.
Setting HD unit at the Sohag University Hospital.
Sohag.
Egypt
Hemodialys is unit of King Abdul
Aziz
Medical CityNational Guard
HospitalRiyadh
(KAMC-R)
Saudi Arabia
Spanyol
Taiwan Total
Follow
Subject
Inclusion
Criteria
Interventi 74 adults ESRD on 2-step
TST
QFT-G
QFT-G/TST
, 26 .
QFT-G , 10
TST
200 adults oh HD
two-step
TST
QFT-G
QFT-G/TST
, 44 .
QFT-G , 5
5%) TST
ESRD
sis unit
ESRD
two-step
TST
QFT-G
QFT-G /TST
, 3 .
QFT-G , 5
6%) TST
two-step
TST and QFT-G
QFT-G 32
4%).
TST
Result HD Hemodialysis.
TST Tuberculin skin test.
QFT-G Quanti-FERON Tuberculosis-Gold.
ESRD End-stage renal disease DOI: 10.
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The Indonesian Journal of Health Science Volume 13.
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DISCUSSION
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, globally, affecting about 10 million people every year, and is one of the leading of mortality.
present in airborne droplets from patients with active TB, so droplets remain suspended in the air and can be transmitted person to person when About 90% individual who Mycobacterium tuberculosis infection with granuloma formation, without showing clinical symptoms of activeTB and cannot transmit the disease, this condition known as latent Tuberculosis infection or LTBI.
LTBI
is defined as a state of persistent immune response to Mycobacterium tuberculosis (Mt.
without clinical symptom of active-TB.
End TB Strategy from WHO to reducing 90% of TB mortality and 80% of TB incidence in 2030.
The best strategy to reduce the TB burden is to avoid further TB transmission through early diagnosis and complete treatment of LTBI in 10% of infected people and Mycobacterium reactivation from LTBI into active-TB (Wu et, al.
, 2021.
Kim & Kim, 2018.
Salgame, 2.
One of the risk groups that are easily infected with Mycobacterium tuberculosis are patients with ESRD.
Based on the analysis carried out on 4 selected articles, it was found that all studies used the same examination, namely two-step Tuberculin Skin Test .
ut-off Ou of 10 m.
and QFT-G (IFNgamma Ou 0.
35 IU/m.
In our study, the total number of patients from the four studies was 516 hemodialysis patients.
The data obtained showed that there was a high incidence of LTBI in ESRD patients in hemodialysis center.
Patients with ESRD who undergo DOI: 10.
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hemodialysis experience immune dysfunction which increases the risk of infection (Jha et al.
, 2013.
Anand.
Bitton & Gaziano, 2013.
Anderson et In hemodialysis patient, tuberculosis develops and more high risk to reactivating from LTBI to active TB.
Patients hemodialysis are ten to twenty-five times to have LTBI reactivation than .
ttp://w.
ca/tb standards-2.
Identification of LTBI in hemodialysis patients is an effort to provide treatment for infection can prevent morbidity and mortality associated with TB reactivation (Campbell.
Krot & Mara, 2.
This systematic review identified the prevalence of LTBI in ESRD patients undergoing hemodialysis at the hemodialysis center unit which was obtained from 4 selected studies conducted in various countries such as Egypt.
Saudi Arabia.
Spain, and Taiwan using the same type of study, namely the prospective study.
Each country has a different incidence of LTBI because it is also caused by differences in the incidence of tuberculosis in that country.
In 2014, the global LTBI burden was 23%, or an estimated 1.
7 billion individuals.
Southeast Asia.
West Pacific, and African regions are the regions with the highest prevalence and accounting for 80% of LTBI infection.
The prevalence of new infections is 0.
% UI: 0.
7% A 0.
9%) of the global Totaling 55.
5 million people .
% UI: 48.
2 A 63.
residing in the high risk of TB disease, 10.
% UI: 10.
2% A 11.
8%) were resistant to isoniazid.
The South-East Asia Region contribute for more than 40% of the global burden, including nearly 35% of LTBI burden It is estimated that 43.
The Indonesian Journal of Health Science Volume 13.
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Desember 2021 million of the 587 million people living with LTBI include children under 15 years, namely 7% (WHO.
The prevalence of LTBI in several countries in East Asia also show a high number and shows the difference in the prevalence of several countries such as Malaysia .
6%).
Japan .
South-Korea .
2%),Taiwan .
5%),
India .
%), and China .
(Almufty.
Abdulrahman & Merza.
Based on 4 identified articles, it was found that the study conducted by Hussein.
Yousef & Ali reported a high prevalence of LTBI .
8%) from a total of 74 patients with ESRD, and the research by Jahdali et al.
reported the incidence LTBI .
5%) which was lower compared to a later study of 200
ESRD
The conducted in the third article by Anibarro et al.
, reported that there was a high LTBI prevalence with positive QFT and two-step TST examination results .
8%) in 52 hemodialysis ESRD hemodialysis unit.
Research conducted in the fourth article by Lee et al.
reported that hemodialysis patients from countries with moderate TB burden also had a high prevalence of LTBI incidence using QFT-G positive .
4%) and two-step TST with a cutoff Ou 10 mm .
9%) from total 190 According in this research, all hemodialysis patients were identified from a history of TB, history of BCG immunization, comorbid disease, chest x-rays, clinical examination for signs and symptoms, weight loss and none of them had active TB.
Hemodialysis patients are not only more high risk for reactivation into TB but also more high risk to get transmission from other DOI: 10.
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patient in the hemodialysis center unit (Lee et al.
, 2.
Based on the analysis of the systematic review conducted on 4 selected articles, it was found that all studies used the same examination, namely TST with a cutoff Ou 10 mm and positive QFT-G results with IFNgamma response to TB antigen Ou 0.
IU / ml.
Two of these methods can be used to screen individuals exposed to Mtb with LTBI conditions, namely TST and QFT-G.
TST was developed over a century ago at a lower cost and is more widely used.
IGRA was applied to clinical practice more than some years ago, but distribution, and implementation cost a lot higher (Salgame et al.
, 2.
WHO .
recommends diagnosis using QFT-G and T-SPOT-TB).
The diagnostic examination, and clinical evaluation in LTBI are specifically for peoples who are at high risk of getting M.
tuberculosis infection and developing into active TB.
The examination consists of a clinical evaluation, and radiological evaluation that can rule out and determine the increased risk to active TB.
In conditions with active TB, immunological examination is needed (Salgame et al.
, 2.
According to the 2019 CDC states that groups at risk who experience .
prednisone 15 mg/day is equivalent to one month or more, using TNF- antagonist.
can be said to be LTBI positive with TST examination if the cutoff is> 5 mm.
However, the TST test results can be false positive in conditions that cause anergy, such as in patients with ESRD.
Then the IGRA such as Quanti-FERON or T-Spot TB are more recommended than TST because it has higher specificity and sensitivity than TST.
IGRA is a diagnostic test which is used to The Indonesian Journal of Health Science Volume 13.
No.
Desember 2021 measure of IFN-gamma response to a specific antigen M.
(Druszcynska et al.
, 2.
Based on a systematic review of data from 4 articles, it was identified that all respondents who were declared to have had LTBI were also given treatment according to the guidelines.
All patients with LTBI should also undergo continued treatment until the second test and other medical Treatment recommended in some high-risk contacts, even the positive result TST or IGRA test.
This should be consulted with TB control programs for the management of people who have history of close contact with TB.
LTBI
treatment that can be run according to the guidelines includes: .
If a person is exposed to TB that is known to be sensitive to drugs or unknown drug sensitivity and the TST or IGRA results are positive then they are treated with the INH regimen and 12dose RPT for individuals aged 2 years or more, or with INH or RIF regardless of age.
If a person is exposed to TB that is resistant to INH and the TST or IGRA result is positive then he / she is treated with RIF for 4 months.
If a person is exposed to TB that is resistant to RIF and the TST or IGRA result is positive then it is treated with INH alone.
If someone is exposed to TB with known MDR and positive TST or IGRA results, consult an expert in MDR TB treatment (CDC, 2.
Re-treatment can be indicated for individuals at high risk of reinfection and developing TB disease .
young children, and people who are immunocompromised person.
(CDC.
The high prevalence of TST and QFT-G examination results can also be caused by several risk factors such as TB endemic areas, frequency of DOI: 10.
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decreased immunity, especially in ESRD patients (Sayarlioglu et al.
CONCLUSION
Based on tracing results from a systematic study by examining publications in the last 10 years, it was found that a high incidence of LTBI in patients with ESRD on hemodialysis Total sample of 516 patients through QFT-G and two-step TST This can be because patients with ESRD on hemodialysis center experience decreased immunity.
Therefore, screening and complete treatment of LTBI in ESRD patients is needed to determine the incidence of LTBI in hemodialysis patients and prevent LTBI reactivation from progressing to active TB.
REFERENCES