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Table 2 Benefits and harms of interpreting minimal CT/PET abnormalities as active/latent disease in asymptomatic close contacts

From: CT and 18F-FDG PET abnormalities in contacts with recent tuberculosis infections but negative chest X-ray

  Benefits Harms
Labeling as active disease with anti-TB treatment Minimizing progression to active TB and potential subsequent TB transmission Anti-TB medication without bacteriological/molecular TB evidence
Minimizing the risk of acquired resistance to LTBI drugs Unnecessary anti-TB medication regimens that is longer and has more side effects than LTBI medication regimens
  Overestimation of TB outbreaks by inflating the number of active TB cases
Labeling as latent disease with follow-up Giving a chance for self-healing with LTBI management Risk for progression to infectious TB and potential subsequent TB transmission while observing
Estimation of the number of active TB cases in outbreaks based on bacteriological/molecular TB evidence Chance of acquired resistance to LTBI drugs‡†
Agreement with the results of conventional contact investigation using X-ray examinations Follow-up may increase radiation exposure to patients‡‡
  1. CT —computed tomography; PET— positron emission tomography; TB —tuberculosis; LTBI —latent tuberculosis infection
  2. A recent LTBI guideline recommends 3- to 4-month rifamycin or rifampin-based regimens instead of 6- to 9-month isoniazid monotherapy [51]
  3. The risk may vary depending on the follow-up interval and preventive measures such as mask-wearing
  4. ‡†The use of isoniazid and rifampicin in LTBI treatment did not significantly increase the chance of acquired resistance to the corresponding drugs in meta-analyses [82, 83]
  5. ‡‡X-ray examinations or computed tomographic imaging can be used to assess radiologic changes