Latent TB Infection: Patient Monitoring

Latent TB Infection: Guide for Diagnosis and Treatment

Patient Monitoring

To ensure safe and efficacious treatment for LTBI, the health care provider should periodically assess the patient’s progress. This evaluation involves clinical monitoring and laboratory testing, as well as patient education.

Clinical Monitoring

• Patients should visit the health care provider who is managing their treatment on a monthly basis to be assessed for the following:
  • Adherence to the prescribed regimen;
  • Signs and symptoms of TB disease; and
  • Signs and symptoms of adverse effects, especially hepatitis (i.e., jaundice, loss of appetite, fatigue, and/or muscle and joint aches).
• Patients being treated for LTBI who experience possible adverse reactions should be advised to stop medication and consult their health care provider immediately.

Laboratory Testing

• Baseline laboratory testing (measurements of serum AST, ALT, and bilirubin) is not routinely necessary.
• Laboratory testing at the start of LTBI therapy is recommended for patients with any of the following factors:
  • Liver disorders
  • History of liver disease (e.g., hepatitis B or C, alcoholic hepatitis, or cirrhosis)
  • Regular use of alcohol
  • Risks for chronic liver disease
  • HIV infection
  • Pregnancy or the immediate postpartum period (i.e., within 3 months of delivery)
• Baseline testing can be considered on an individual basis, especially for patients taking other medications for chronic medical conditions.
• After baseline testing, routine periodic retesting is recommended for persons who had abnormal initial results and other persons at risk for hepatic disease.
• At any time during treatment, whether or not baseline tests were done, laboratory testing is recommended for patients who have symptoms suggestive of hepatitis (e.g., fatigue, weakness, malaise, anorexia, nausea, vomiting, abdominal pain, pale stools, dark urine, chills) or who have jaundice. Patients should be instructed, at the start of treatment and at each monthly visit, to stop taking treatment and to seek medical attention immediately if symptoms of hepatitis develop and not wait until the next clinic visit to stop treatment.
• It is generally recommended that medication be withheld if a patient’s transaminase level exceeds 3 times the upper limit of normal if associated with symptoms or 5 times the upper limit of normal if the patient is asymptomatic.

Post-Treatment Follow-up

• Patient should receive documentation that includes TST or IGRA results, chest radiograph results, names and dosages of medication and duration of treatment. The patient should be instructed to present this document any time future TB testing is required.
• Providers should re-educate patient about the signs and symptoms of TB disease and advise them to contact the medical provider if he or she develops any of these signs or symptoms.
• Regardless of whether the patient completes treatment for LTBI, serial or repeat chest radiographs are not indicated unless the patient develops signs or symptoms suggestive of TB disease.