The diagnosis of latent tuberculosis (LTB), also called latent tuberculosis infection (LTBI) means the patient is infected with Mycobacterium tuberculosis , but the patient does not have active tuberculosis. Active tuberculosis can be transmitted while latent TB is not, and therefore it is not possible to get TB from someone with latent tuberculosis. The main risk is that about 10% of these patients (5% in the first two years after infection and 0.1% per year thereafter) will continue to develop active tuberculosis. This is especially true, and there are additional risks, in certain situations such as drugs that suppress the immune system or old age.
Identification and treatment of people with latent TB is an important part of controlling the disease. Various treatment regimens are used to treat latent tuberculosis, which generally needs to be taken for several months.
Video Latent tuberculosis
Transmission
Latent disease
"TB Bacteria Only Spreads From People With Active TB Disease... In people who develop active pulmonary TB, also called pulmonary TB, TB skin test will often be positive, and they will show all signs and symptoms of TB disease , and can transmit bacteria to others So if someone with lung TB sneezes, coughs, speaks, sings, or does anything that forces the bacteria into the air, other people nearby can breathe TB bacteria. Statistics show that about a third people affected by pulmonary TB are infected with bacteria, but only one in ten of these infected people develop active TB disease during their lifetime. "
However, exposure to tuberculosis is highly unlikely when someone is exposed for several minutes at the store or within minutes of social contact. "Usually requires long exposure to someone with active TB disease in order for someone to become infected.
After exposure, it usually takes 8 to 10 weeks before a TB test will show whether a person has been infected. "Depending on the ventilation and other factors, these small droplets (from people who have active tuberculosis) may remain suspended in the air for several hours. If someone else inhales it, it may be infected with TB. The likelihood of transmission will be related to the transmission of people with TB, the environment in which exposure occurs, the duration of exposure, and host susceptibility. "In fact," it is not easy to catch TB. You need a consistent exposure to people who are contagious for a long time. Therefore, you are more likely to catch TB from relatives than strangers. "
If a person has latent tuberculosis, they have no active/contagious tuberculosis. Once exposed, people very often experience latent tuberculosis. To turn into active tuberculosis, the bacteria must become active.
People have medical privacy or "confidentiality" and should not disclose their case of active tuberculosis to family, friends or co-workers; therefore, people affected by latent tuberculosis may never know who has active tuberculosis cases that lead to the diagnosis of latent tuberculosis for them. Only with required testing (required in some jobs) or developing symptoms of active tuberculosis and visiting a medical doctor who tests will be known that they have been exposed. Since tuberculosis is not common in the United States, doctors may not suspect tuberculosis; therefore, they may not test. If a person has symptoms of tuberculosis, it is wise to be tested.
People with diabetes may have an 18% chance of turning into active tuberculosis. In fact, deaths from tuberculosis are greater in diabetic patients. People with HIV and latent tuberculosis have a 10% chance of developing active tuberculosis every year. "HIV infection is the largest known risk factor for the development of latent M. tuberculosis infection in active TB.In many African countries, 30-60% of all new TB cases occur in people with HIV, and TB is the leading cause of death globally for people infected with HIV. "
Symptoms
Symptoms include:
- cough (starts to dry and progressively be productive with possible blood in sputum)
- flu-like symptoms
- fever
- night sweats
- weight loss
- fatigue
- Other symptoms such as chest pain, short breath etc.
Reactivation
Once a person has been diagnosed with Latent Tuberculosis (LTBI) and the medical doctor insists there is no active tuberculosis, the person should remain alert to the symptoms of active tuberculosis for the rest of his life. Even after completing the entire treatment, there is no guarantee that all tuberculosis bacteria have been killed.
"When a person develops active TB (illness), symptoms (cough, fever, night sweats, weight etc.) may be mild for months, this may cause delays in seeking care, and result in bacterial transmission to others.
Tuberculosis does not always persist in the lungs. If tuberculosis outbreaks exist in the brain, organs, kidneys, joints, or other areas, patients may have active tuberculosis for a long period of time before finding that they are active. "A person with tuberculosis may feel very healthy or may just cough from time to time." However, these symptoms do not guarantee tuberculosis, and they may not be present at all, but patients may still have active tuberculosis. A person with registered symptoms may have active tuberculosis, and the person should immediately see a doctor so that tuberculosis does not spread. If someone with the above symptoms does not see a doctor, ignoring the symptoms can cause lung damage, eye damage, organ damage and eventually death.
When tuberculosis settles in other organs (not the lungs) or other parts of the body (such as skeletal), symptoms may differ from when deposited in the lungs (such as the symptoms listed above). Thus, without symptoms such as cough or flu, a person can have active tuberculosis. Other symptoms include back pain, back pain, PID symptoms, confusion, coma, difficulty swallowing, and many other symptoms that will be part of another illness. (Please see references for more information about symptoms.) Therefore, seeing a doctor and requesting tuberculosis tests is absolutely necessary to rule out tuberculosis when a patient has symptoms without a diagnosis of the disease.
The situation in which tuberculosis can become active again is:
- if there is a beginning of a disease affecting the immune system (such as AIDS) or a disease whose treatment affects the immune system (such as cancer chemotherapy or systemic steroids in asthma or Enbrel, Humira or Orencia in rheumatoid) inflammation);
- malnutrition (which may be caused by an illness or injury that affects the digestive system, or periods of not eating, or disruption of food availability such as hunger, residence in refugee camps or concentration camps, or civil war);
- immune system degradation due to aging.
- certain systemic diseases such as diabetes, and "other conditions: debilitating diseases (especially haematological and some solid cancers), long-term steroids, end-stage renal disease, silicosis and gastrectomy/jejuno-ileal bypass all give increased risks./li>
- "Older patients: latent TB may return to active in elderly patients."
- A very young
Maps Latent tuberculosis
Diagnosis
Currently there are two classes of tests commonly used to identify patients with latent tuberculosis: tuberculin skin test and IFN-? (Interferon-gamma) test. The tuberculin skin test used includes (but is not limited to)
-
- Mantoux test
- Heaf test
Currently there are three IFN-? (interferon-gamma release assay - IGRA test) is available.
-
- T-SPOT.TB
- QuantiFERON-TB Gold
- QuantiFERON-TB Gold In-Tube
Tuberculin skin test
The Tuberculin Skin Test (TST) in its first iteration, the Mantoux Test, was developed in 1908. Conceptually, it is quite simple: tuberculin (also called pure protein derivatives or PPD) is a standard non-cultured TB extract, injected into the skin to measure a person's immune response against bacteria. So, if a person has been exposed to the bacteria before, they should express an immune response to the injection, usually mild swelling or redness around the site. There are two main methods of TST: Mantoux test, and Heaf test. The Heaf test was suspended in 2005 because the manufacturer considers its production financially unsustainable, although it was previously preferred in the UK because it felt it required less training to manage and involved fewer inter-observer variations in its interpretation than the Mantoux test.. The Mantoux test is the preferred test in the US, and is now the most widely used TST globally.
Mantoux Test
- View: Mantoux Test
The Mantoux test is now standardized by WHO. 0.1 ml of tuberculin (100 units/ml), which gives a dose of 5 units given by intradermal injection to the lower forearm surface (the result of subcutaneous injection on false negatives). Waterproof ink signs are picked up around the injection site to avoid the trouble of finding it later if the reaction rate is small. This test is read 48 to 72 hours later. The induration area (NOT erythema) is measured transversely in the forearm (left to right, not up and down) and recorded to the nearest millimeter.
heaf test
- View: Test Heaf
The Heaf test was first described in 1951. This test uses Heaf weapons with disposable disposable heads; each head has six needles arranged in a circle. There are standard heads and pediatric heads: standard heads are used in all patients aged 2 years and older; pediatric head is for infants under 2 years of age. For a standard head, a 2 mm curved needle when the gun is moved; for a pediatric head, a 1 mm protruding needle. The skin is cleaned with alcohol, then tuberkulin (100,000 units/ml) is evenly applied to the skin (about 0.1 ml); The gun was then applied to the skin and fired. The excess solution is then removed and a waterproof ink mark is drawn around the injection site. This test is read 2 to 7 days later.
- Value 0: no reaction, or induration of 3 or less puncture points;
- Level 1: induration of four or more puncture points;
- Class 2: the induration of six piercing points joined in a circle;
- Class 3: 5 mm induration; or more
- Grade 4: induration of 10 mm or more, or ulceration
The results of these two tests are roughly equivalent to the following:
- Grab class 0 & amp; 1 ~ Mantoux less than 5 mm;
- Heaf class 2 ~ Mantoux 5-14 mm;
- Grade 3 & amp; 4 ~ Mantoux 15 or greater
Tuberculin Conversion
Tuberkulin Conversion is said to occur if a patient who has had a negative tuberculin skin test develops a positive tuberculin skin test at the next test. This shows the change from negative to positive, and usually indicates a new infection.
Upgrade
The phenomenon of increase is one way to get false positive test results. Theoretically, a person's ability to develop reactions to TST may decrease over time - for example, a person is infected with latent TB as a child, and given TST as an adult. Since there has been a long time since an immune response to TB is needed, that person may give a negative test result. If so, there is a reasonable possibility that TST triggers hypersensitivity to one's immune system - in other words, the TST reminds one's immune system of TB, and the body overreacts to what it sees as reinfection. In this case, when the subject is given another test (such as standard procedure, see above) they may have a much larger reaction to the test, giving a very strong positive; this can often be misdiagnosed as Tuberculin Conversion. It can also be triggered by receiving BCG vaccine, as opposed to the right infection. Although boosting can occur in all age groups, the likelihood of a reaction will increase with age.
Encouragement may only be relevant if someone starts to undergo regular TST (healthcare worker, for example). In this case the standard procedure is called a two-step test. Individuals are given their first test and in negative terms, are given a second test within 1 to 3 weeks. This is done to combat an increase in situations where, if the person waits up to a year to get the next TST, they may still have a boosted reaction, and are misdiagnosed as a new infection.
Here there are differences in US and English guidelines; in US examiners are told to ignore the possibility of false positives due to BCG vaccine, because BCG is seen to have diminished efficacy over time. Therefore, the CDC insists that individuals be treated on the basis of risk stratification regardless of BCG vaccination history, and if a person receives a negative TST and then is positive, they will be assessed for full TB treatment starting with X-rays to ensure TB is inactive. and proceed from there. In contrast, UK guidelines recognize the potential impact of BCG vaccination, as it is mandatory and therefore of general concern - although the UK shares the procedure of administering two tests, one week apart, and receiving the second as an accurate result, they also consider that a second positive is an indication of an old infection (and of course LTBI) or BCG itself. In the case of BCG vaccination confusing the result, Interferon-? (IFN-?) Test can be used because they will not be affected by BCG.
Interpretation
According to US guidelines, there are several threshold sizes to express the positive results of latent tuberculosis from the Mantoux test: For test participants from high-risk groups, such as those who are HIV-positive, the cutoff is 5 mm induration; for the medium risk group, 10 mm; for low-risk groups, 15 mm. The US Guidelines recommend that prior BCG vaccination history be ignored. For detailed interpretation of the tuberculin skin test, please refer to the CDC guidelines (references given below).
The UK guidelines are formulated according to the Heaf test: In patients who have previous BCG, latent TB is diagnosed if the Heaf test is grade 3 or 4 and has no signs or symptoms of active TB; if the Heaf test is grade 0 or 1, then this test is repeated. In patients who have never received BCG before, latent TB is diagnosed if the Heaf test is grade 2, 3 or 4, and has no signs or symptoms of active TB. Repeat testing of Heaf is not performed on patients who already have BCG (due to increasing phenomenon). For detailed interpretation of the tuberculin skin test, please refer to the BTS guidelines (references are given below).
Given that the US recommendation is that prior to the BCG vaccination being ignored in the interpretation of the tuberculin skin test, a positive error with the Mantoux test is possible as a result of: (1) having previously had BCG (even years ago), and/or (2) with a tuberculin skin test. Having routine TST enhances immunological responses in people who have previously experienced BCG, so these people will erroneously emerge as tuberculin conversion. This can lead to more people treatment than is necessary, with the possible risk of patients suffering from adverse drug reactions. However, since the Bacille Calmette-GuÃÆ' Â © rin vaccine is not 100% effective, and is less protective in adults than in pediatric patients, not treating these patients can cause possible infections. The current US policy seems to reflect a desire to err on the side of security.
US guidelines also allow testing of tuberculin skins in immunosuppressive patients (those with HIV, or who take immunosuppressive drugs), while British guidelines recommend that tuberculin skin testing should not be used for such patients because it is unreliable.
Interferon-? (IFN-?) Testing
The role of IFN-? the tests are undergoing a constant review and various guides have been published with the option to revise when new data becomes available. CDC: MMWR Health Protection Agency: UK
There are currently two commercially available interferons? release tests (IGRAs): QuantiFERON-TB Gold and T-SPOT.TB. These tests were not affected by previous BCG vaccination, and the search for body response to specific TB antigens did not exist in other forms of mycobacteria and BCG (ESAT-6). While these new tests they are now available globally.
CDC:
The CDC recommends that QFT-G be used in all circumstances where current TST is used, including contact investigations, new immigrant evaluations, and sequential test monitoring programs for infection control (for example, they are for health workers).
Panduan Interim HPA:
The HPA recommends the use of IGRA tests to healthcare workers, where available, given the importance of detecting latently infected staff who may continue to develop active disease and make contact with patients with immunologic impairment and simplicity of IGRA testing logistics.
Drug-resistant stress
It is usually assumed by most medical practitioners at an early stage of diagnosis that cases of latent tuberculosis are a normal or common type of tuberculosis. It will therefore most often be treated with Isoniazid (the most widely used treatment for latent tuberculosis.) Only if tuberculosis bacteria do not respond to treatment then medical practitioners will begin to consider a more vicious strain, requiring a much longer and more thorough treatment regimen.
There are four types of tuberculosis that are known in the world today:
- Tuberculosis (TB)
- multi-drug resistant TB (MDR TB)
- Extensively drug-resistant tuberculosis (XDR TB)
- Tuberculosis that is completely drug-resistant (TDR TB)
drug-resistant TB
Drug-resistant TB is a strain of tuberculosis that has developed resistance to Isoniazid or Rifampin, the two most common drugs used to fight TB. MDR can be contracted either by a person's exposure to MDR; or it can be made when a patient does not take the medication properly, take one here and there, or use it for a short time, or stop and start. Inside the body some bacteria die, but some may live through lighter doses of the drug and develop resistance. A regimen consisting of ethambutol and PAS has been used previously. It would make sense to choose a combination of antibiotics based on known sensitivities of the organism. The CDC has recommended a combination of pyrazinamide and ethambutol, with pyrazinamide or fluoroquinolone. Immunocompetent contact should be treated for 6 months; Immunocompromised contact should be treated for 12 months. Extensively_drug-resistant_TB_.28XDR_TB.29 "> Extensively drug-resistant TB (XDR TB)
XDR TB is very similar to MDR, but is significantly less frequent. The difference is purely in the amount of TB resistance that has the opportunity (or luck) to develop, and is transmitted either by exposure of someone with XDR TB or by taking the wrong medication prescribed to fight MDR TB. The XDR TB bacteria have changed enough to avoid the two best antibiotics, INH and RIF, as well as most of the alternative medicines used against MDR TB. These second-line drugs include fluoroquinolone, and at least one of three other anti-TB drugs: amikacin, kanamycin, or capreomycin. To cure this tuberculosis requires two years of treatment.
"Drug-resistant TB (MDR or XDR) is more common in people who:
- Do not take TB medication regularly
- Do not take all of their TB medications as prescribed by their doctor
- Develop TB disease again, after taking TB drugs in the past
- Comes from areas in the world where drug-resistant TB is common
- Have spent time with someone who is known to have drug-resistant TB disease. "
Strongly drug-resistant TB (tuberculosis )
Drug-resistant tuberculosis is the rarest type, with only a few dozen reports worldwide. TDR TB is theoretically untreatable, with no choice of medication or chemotherapy available. TB TDR has not been fully recognized by WHO; what is debated is whether or not there is a TB fact strain that has developed resistance to every drug we have, and further whether a new appointment is needed. Differentiating TB TDR from XDR TB requires a series of in vitro drug susceptibility tests (DSTs) that will be technically challenging and largely unnecessary; there is an XDR strain of TB that is highly resistant to so many second-line treatments, that the strain is more or less untreatable.
Treatment
Treatment of latent tuberculosis (LTBI) infection is essential for controlling and eliminating TB by reducing the risk that TB infection will progress to disease. Latent tuberculosis will turn into active tuberculosis in 10% of cases (or more in the case of patients with impaired immunity). Drinking drugs for latent tuberculosis is recommended by many doctors.
In the US, standard care is nine months of isoniazid, but this regimen is not widely used outside the US.
Terminology
There is no agreement on terminology: the term Custom situations
"The population at increased risk develops into an active infection after exposure:
- People with recent TB infections [those infected within the previous two years]
- Congenital or acquired immunosuppressant patients (especially, HIV-positive patients)
- Users of Dark intravenous drugs; alcohol and other chronic substance users
- Children (especially younger than 4 years old)
- People with comorbid conditions (eg, chronic renal failure, diabetes, malignancy, haematological cancer, weight less than 10% less than ideal, silicosis, gastrectomy, jejunoileal shortcuts, asthma, or other disorders requiring long-term use of corticosteroids or other immunosuppressants). "
Treatment regimen
It is imperative that assessments to exclude active TB are performed before treatment for LTBI begins. To provide treatment for latent TB to a person with active tuberculosis is a serious mistake: tuberculosis will not be treated adequately and there is a serious risk of developing drug-resistant strains of TB.
There are several treatment regimens currently in use:
- 9H - isoniazid for 9 months is the gold standard (93% effective, in patients with positive test results and fibrotic pulmonary lesions compatible with tuberculosis).
- 6H - Isoniazid for 6 months may be adopted by local TB programs based on cost effectiveness and patient compliance. This is the currently recommended regimen in the UK for routine use. US guidelines exclude this regimen from use in children or people with previous tuberculosis radiographic evidence (old fibrotic lesions) (69% effective).
- 6 to 9H 2 - Regimen twice weekly once in a while for the above 2 treatment regimens is an alternative if administered under Directly Observed Therapy (DOT).
- 4R - rifampicin for 4 months is an alternative for those who can not take isoniazid or who have known exposure to isoniazid-resistant TB.
- 3HR - Isoniazid and rifampin can be administered daily for three months.
- 2RZ - A two-month rifampicin and pyrazinamide regimen is no longer recommended for LTBI treatment because it greatly increases the risk of hepatitis and drug-related death.
- 3HP - a three-month (12-dose) regimen of weekly rifapentine and isoniazid. 3HP regimens should be given under DOT. 3HP self-managed self-managed (SAT) therapy is investigated in large international research.
Evidence for treatment effectiveness
A Cochrane 2000 review containing 11 randomized controlled trials, and 73,375 patients examining six and 12 months of isoniazid (INH) programs for the treatment of latent tuberculosis. HIV positive and patients who are currently or previously treated for tuberculosis are excluded. The primary outcome was a relative risk (RR) of 0.40 (95% confidence interval (CI) of 0.31-0.52) for the development of active tuberculosis for two years or more for patients treated with INH, without significant differences between treatment programs six or 12 months (RR 0.44, 95% CI 0.27 to 0.73 for six months, and 0.38, 95% CI 0.28 to 0.50 for 12 months).
A Cochrane systematic review published in 2013 evaluated four different alternative regimens for INH monotherapy to prevent active TB in HIV-negative people with latent tuberculosis infection. The evidence from this review found no difference between the shorter Rifampicin or weekly, Rifapentine and INH regimens observed directly compared to INH monotherapy in preventing active TB in HIV-negative people at risk of developing it. However, the review found that a shorter, four-month and a week of Rifampin regimens directly observing Rifapentine plus INH for three months "may have the added benefit of higher treatment completion and improved safety." However, overall evidence quality is low to moderate (as per GRADE criteria) and none of the included trials are conducted in LMIC countries with high TB ​​transmission and therefore may not apply to countries with high TB ​​transmission.
Treatment efficacy
There is no "healing" guarantee for latent tuberculosis. "People infected with TB bacteria have a lifetime risk of getting sick with TB..." with those with weak immune systems, those with diabetes and those using tobacco are at greater risk. Although many doctors and professionals can talk about Isoniazid and other TB medication remedies as "drugs", in the strictest sense it does not. This is because while the drugs used for Tuberculosis are latent or actively effective, they are not 100% thus; each bacteria has a chance to resist the drug in question. When the appropriate treatment is applied to the active case of Tuberculosis and is considered successful, the patient "heals" as much as the patient's symptoms will subside - Tuberculosis itself is not lost, but only returns to its latent state.
A person who has taken a full course of Isoniazid (or other complete prescription for tuberculosis) with a regular and timely schedule may have been cured. "Current standard therapy is isoniazid (INH), which reduces the risk of active TB by <90% (in patients with positive LTBI test results and compatible fibrotic pulmonary lesions with tuberculosis) if taken daily for nine months. "[Emphasis added] However, if a person has not completed the drug as prescribed," healing "is less likely, and the" healing "rate is directly proportional to following specially prescribed treatments as recommended. Furthermore, "[I] You do not take medication properly and you become ill with TB a second time, TB may be more difficult to treat if it becomes drug resistant." If a patient has to be cured in the strictest word definition, it means that every bacteria in the system is removed or dead, and that person can not get tuberculosis (unless reinfected). However, there are no tests to ensure that any bacteria have been killed in the patient's system. Thus, a person diagnosed with latent TB can safely assume that, even after treatment, they will carry the bacteria - possibly for the rest of their lives. Furthermore, "It is estimated that up to one-third of the world's population is infected with M. tuberculosis, and this population is an important reservoir for reactivation of the disease." This means that in areas where TB is an endemic treatment may be less confident to "cure" TB, because reinfection may trigger latent TB latent activation even in cases where treatment is fully followed.
After a positive skin test is shown, the patient's body will always react to tuberculosis tests even after treatment. This happens because the patient's immune system has recognized the tuberculosis bacteria as an attacker. No need to get another skin test under any circumstances; someone who has had TB either in latent or active form will always get a positive one. Blood tests, however, may be effective in determining whether there is a change in a person's diagnosis in cases where reinfection is a possibility, and should be considered if entering a high-risk area.
Epidemiology
Disclaimer: The test for latent TB is full of complications and is very far from routine by 2018, and has significant reliability problems even in developed countries, let alone the developing world, therefore all numbers should be taken as very loose estimates.
Tuberculosis exists in all countries of the world. Some countries have more people infected with tuberculosis than others. For every 100,000 people, Swaziland has the largest number (627) cases of tuberculosis in the world. The second is Cambodia (560), followed by third position by Zambia (445), fourth is Djibouti (382), fifth is Indonesia (321), sixth is Mali (295), seventh is Zimbabwe (291), eighth is Kenya (291 )), the ninth is Papua New Guinea (283) and the tenth is Gambia (283).
The United States, Sweden and Iceland have one of the lowest population of tuberculosis at 2 per 100,000. with Canada, Netherlands, Jamaica, Norway, Malta, Granada and Antigua and Barbuda with 3 per 100,000. In North America, countries over 10: 100,000 are Mexico (14), Belize (18), Bahamas (19), Panama (28), El Salvador (36), Nicaragua (35), Honduras (46), Guatemala (48), and the worst is the Dominican Republic (88).
Most Western European countries have less than 10 per 100,000 except Spain (14), Estonia (27), Latvia (43), Lithuania (48), while Eastern and Southern European countries have larger numbers with Romania (94) as the highest.
In South America, the largest number of cases of tuberculosis exist in Bolivia (30) with Guyana (18) and Honduras (15) along with the remaining countries having less than 10: 100,000.
"One-third of the world's burden of tuberculosis (TB), or about 4.9 million prevalent cases, is found in the World Health Organization (WHO) Region Southeast Asia."
"About one-third of the world's population has latent TB, meaning people have been infected by TB bacteria but have not (ill) with the disease and are unable to transmit disease," and most of the cases are in developing countries.
"In the US, more than half of all cases of active TB occur in immigrants.The reported cases of active TB in people born overseas remain at 7,000-8000 per year, while the number of cases in people born in the US has dropped from 17,000 people , from 1993 to 6,500 in 2005. As a result, the percentage of active TB cases in immigrants continues to increase (from 29% of all cases in 1993 to 54% in 2005). "and most of those cases exist in developing countries.
Further reading
- Jasmer, R.Ã, M.; Nahid, P.; Hopewell, P.Ã, C. (2002). "Latent tuberculosis infection". The Journal of New England Medicine . 347 (23): 1860-1866. doi: 10.1056/NEJMcp021045. PMID 12466511.
- Mazurek, G.Ã, H.; Villarino, M.Ã, E. (2003). "Guidelines for using the QuantiFERON-TB test to diagnose latent infection Mycobacterium tuberculosis ". Morbidity and Mortality of Weekly Report . 52 (RR-2): 15-18.
- Ormerod, P.; Skinner, C.; Moore-Gillon, J.; Davies, P.; Connolly, M. (2000). "BTS Guide: control and prevention of tuberculosis in the UK: Code of Practice 2000". Thorax . Joint Tuberculosis Committee Of The British Thoracic Society. 55 (11): 887-901. doi: 10.1136/thorax.55.11.887. PMCÃ, 1745632 . PMIDÃ, 11050256.
See also
- Silent Illness
References
This article incorporates public domain material from websites or documents from the Centers for Disease Control and Prevention.
Source of the article : Wikipedia
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