Correspondence

Forgotten but Not Gone

N Engl J Med 2004; 351:1361September 23, 2004

Article

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

2 References

1. 1

   Jha AK, Shojania KG, Saint S. Forgotten but not gone. N Engl J Med 2004;350:2399-2404
   Full Text | Web of Science | Medline

2. 2

   Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247
   Web of Science | Medline

Author/Editor Response

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

1 References

1. 1

   Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247
   Web of Science | Medline