Retrospective evaluation of active tuberculosis cases in our city in terms of chemoprophlaxis indication

Aims: The aim of this study is to evaluate the indications for chemoprophylaxis in active tuberculosis (TB) cases in terms of past history, in order to assess the risk of conversion from latent tuberculosis infection (LTBI) to active disease and to review our decisions regarding the indication for LTBI treatment. The study also aims to determine if there are any gaps in our approach and to contribute to tuberculosis control efforts. Materials and Methods: The study included 422 tuberculosis patients aged 18 and above, diagnosed between 2016 and 2020, who were registered at the Trabzon Province Central Tuberculosis Control Dispensary. Our study was designed as a single-center, retrospective clinical study. The patients' age, gender, occupational risks, comorbidities, tobacco and addictive substance use in the last two years prior to diagnosis, use of immunosuppressive drugs, type of medication used, radiological findings, previous evaluation for chemoprophylaxis, PPD and Quantiferon test results, presence of BCG scar, contact history with infectious tuberculosis cases, age at contact, type of contact, duration of contact, presence of conversion, and use of preventive treatment were recorded. All radiological images of the patients were evaluated by our team. Results: A total of 422 patients were included in the study. Of these, 147 (34.8%) were female and 275 (65.2%) were male. When the distribution of patients was analyzed according to the indications for treatment of latent tuberculosis infection (LTBI) specified in the Tuberculosis Diagnosis and Treatment Guidelines of the Ministry of Health in 2019, it was found that 6 (1.4%) patients had a history of contact, with 3 (50.0%) of these patients being below the age of 34 and 3 (50.0%) being 35 years or older. It was determined that all patients in the group under the age of 34 were evaluated for chemoprophylaxis, and 1 (33.3%) patient was recommended and received prophylactic treatment. Among those who were 35 years or older and had immunosuppression, there was 1 (33.3%) patient with positive LTBI. This patient had malignancy and it was found that prophylaxis was not recommended and not received. One patient with conversion in the last 2 years was identified, and it was observed that this patient received prophylaxis. Among the 153 patients with radiological findings compatible with tuberculosis sequelae on chest X-ray, 136 (88.9%) were 35 years or older and 17 (11.1%) were below the age of 35. It was found that 3 (2.0%) of these patients received prophylaxis. Among immunosuppressed patients with positive LTBI, there were 4 (0.9%) patients receiving Anti-TNF treatment, 5 (1.1%) patients using systemic steroids, and 2 (0.4%) dialysis patients. It was found that 2 (50%) patients in the Anti-TNF group, 1 (20.0%) patient in the systemic steroid group, and 1 (50.0%) patient in the dialysis group received prophylaxis. The number of patients indicated for LTBI treatment according to the tuberculosis diagnosis and treatment guidelines, after adjustments for patients with common criteria, was 164 (38.8%). However, it was found that only 7 (4.2%) of these patients received prophylaxis. Conclusion: Tuberculosis remains an important disease both globally and in our country, and LTBI screening is crucial in preventing the progression to active disease and contributing to tuberculosis control. Therefore, it is essential to take appropriate measures, follow-up, and provide effective treatment to high-risk groups. The low rate of chemoprophylaxis observed in our study emphasizes the importance of LTBI diagnosis and follow-up. It is believed that the data obtained will contribute to the diagnosis and treatment of LTBI.