Forgotten but Not Gone
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《新英格兰医药杂志》
To the Editor: The interesting case of systemic tuberculosis infection reported by Jha et al. (June 3 issue)1 requires clarification. The authors report that two physicians involved in the patient's care had positive tests for mycobacterium exposure and were treated for six months. Current guidelines state that patients with latent tuberculosis infection should receive nine months of therapy.2
Marc S. Itskowitz, M.D.
Allegheny General Hospital
Pittsburgh, PA 15212
mitskowi@wpahs.org
References
Jha AK, Shojania KG, Saint S. Forgotten but not gone. N Engl J Med 2004;350:2399-2404.
Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247.
The authors reply: We appreciate Dr. Itskowitz's point that current guidelines for treatment of latent tuberculosis infection in fact call for nine months of isoniazid therapy. At the time the providers contracted latent tuberculosis, six months of therapy with isoniazid was still accepted as reasonable and was considered more cost-effective for patients who were not infected with the human immunodeficiency virus and who had a negative chest x-ray.1
Ashish K. Jha, M.D., M.P.H.
Harvard Medical School
Boston, MA 02115
ajha@hsph.harvard.edu
Kaveh G. Shojania, M.D.
University of Ottawa
Ottawa, ON K1Y 4E9, Canada
Sanjay Saint, M.D., M.P.H.
University of Michigan Medical School
Ann Arbor, MI 48109-0429
References
Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247.
Marc S. Itskowitz, M.D.
Allegheny General Hospital
Pittsburgh, PA 15212
mitskowi@wpahs.org
References
Jha AK, Shojania KG, Saint S. Forgotten but not gone. N Engl J Med 2004;350:2399-2404.
Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247.
The authors reply: We appreciate Dr. Itskowitz's point that current guidelines for treatment of latent tuberculosis infection in fact call for nine months of isoniazid therapy. At the time the providers contracted latent tuberculosis, six months of therapy with isoniazid was still accepted as reasonable and was considered more cost-effective for patients who were not infected with the human immunodeficiency virus and who had a negative chest x-ray.1
Ashish K. Jha, M.D., M.P.H.
Harvard Medical School
Boston, MA 02115
ajha@hsph.harvard.edu
Kaveh G. Shojania, M.D.
University of Ottawa
Ottawa, ON K1Y 4E9, Canada
Sanjay Saint, M.D., M.P.H.
University of Michigan Medical School
Ann Arbor, MI 48109-0429
References
Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247.