잠복결핵감염의 진단과 치료
Diagnosis and Treatment of Latent Tuberculosis Infection
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초록
국내에서도 결핵의 근절을 위해서는 잠복결핵감염에 대한 접근이 필요하다. 그러나 아직 활동성 결핵의 유병률이 높은 국내 사정을 고려할 때 활동성 결핵의 조기 진단 및 조기 치료로 전염성 방지에 더 역점을 두어야 하며, 아울러 결핵발병 고위험군 잠복결핵감염자에 대한 예방치료가 병행되어야 할 것이다. 고위험군의 정의는 국내 결핵역학의 변화에 맞추어 변화되어야 할 것이다. 새로운 결핵감염 검사인 인터페론감마 검사와 기존의 투베르쿨린 검사를 어떻게 적절히 조합하여 사용할지에 대한 추가연구가 필요하며, 현재 기본 LTBI 치료법은 isoniazid 단독 9개월 치료이지만, rifampicin 단독 4개월 혹은 isoniazid/rifampicin 병합 3개월 요법과 같은 단기 요법이 점차 각광을 받을 것으로 예상된다.
Abstract
In order to control and eliminate tuberculosis (TB), the management of latent TB infection (LTBI) as well as active TB is inevitable. Diagnosis and treatment ofLTBI is targeted for high risk individuals for developing TB. High risk groups involve recent contacts with infectious TB patients, subjects with immunosuppressed conditions, and health care personnels. Diagnosis of LTBI is done using tuberculin skin test or recently developed ex-vivo interferon-gamma releasing assays after excluding active TB clinically. The main LTBI treatment regimen is 9 months of isoniazid treatment, and additional regimens include rifampicin monotherapy (4 months in adults and 6 months in children) or a combined regimen of isoniazid and rifampicin for 3 months. (Korean J Med 2012;82:284-290)
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