From the Guidelines
Individuals with a positive Quantiferon Gold test should consult with a healthcare provider for evaluation of latent tuberculosis infection (LTBI) and potential treatment, as this significantly reduces the lifetime risk of developing active tuberculosis. The primary precaution is to complete a recommended course of preventive therapy, typically isoniazid (INH) 300mg daily for 6-9 months, rifampin 600mg daily for 4 months, or a combination of INH and rifapentine weekly for 12 weeks under direct observation 1. During treatment, regular liver function monitoring is necessary, especially for those over 35, pregnant women, or individuals with liver disease or alcohol use. Patients should avoid alcohol while taking these medications and report any symptoms like nausea, vomiting, abdominal pain, or yellowing of skin to their provider immediately. No isolation is required as LTBI is not contagious. However, patients should be vigilant for symptoms of active TB (persistent cough, fever, night sweats, weight loss) which would require immediate medical attention.
Some key points to consider:
- The Quantiferon Gold test result can remain positive after treatment of latent TB, and caution should be exercised when using this test 1.
- Yearly testing for latent TB should be done in patients at high risk, such as those in contact with individuals with active TB or with selected underlying medical conditions 1.
- An annual chest radiograph may be considered at the discretion of the treating dermatologist, especially for patients taking TNF-a inhibitors 1.
- Regular monitoring of liver function and screening for skin cancer are also important considerations for patients with a positive Quantiferon Gold test, especially those taking biologics 1.
It is essential to note that the management of LTBI should be individualized, taking into account the patient's medical history, risk factors, and current health status. Therefore, consultation with a healthcare provider is crucial to determine the best course of action.
From the Research
Precautions for Individuals with a Positive Quantiferon Gold Test
Individuals with a positive Quantiferon Gold test result are considered to have latent tuberculosis (TB) infection. The following precautions are necessary:
- Avoid close contact with people who have weakened immune systems, such as the elderly, young children, and those with chronic illnesses 2
- Cover the mouth and nose when coughing or sneezing to prevent the spread of TB bacteria 3
- Avoid sharing food, drinks, or utensils with others 4
- Practice good hygiene, such as washing hands frequently and thoroughly 5
- Avoid traveling to areas with high TB prevalence without proper precautions and medical clearance 3
Medical Precautions
- Individuals with a positive Quantiferon Gold test result should undergo further medical evaluation to rule out active TB disease 4, 5
- They may be prescribed preventive therapy, such as isoniazid or rifampicin, to prevent the development of active TB disease 3, 2
- Regular follow-up appointments with a healthcare provider are necessary to monitor the effectiveness of treatment and detect any potential side effects 6
Special Considerations
- Individuals with a positive Quantiferon Gold test result who are planning to start anti-tumor necrosis factor (TNF) therapy should undergo thorough screening for latent TB infection before initiating treatment 2
- Those who have recently traveled to areas with high TB prevalence or have been exposed to someone with active TB disease should be screened for latent TB infection 3, 4