小兒出疹性疾病

by Dr. lee

https://docs.google.com/leaf?id=0B278nGJMQBk7MTYxZWY2NWQtNWYxMC00MzdiLTg2MTUtNWYzZTI1MzVlMDZi&hl=zh_TW

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即便是用IGRA, 有時也要等大於三個月才能決定TB contact

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接觸TB後，TST大抵上2-12週轉陽，IGRA大抵上6-10週，但IGRA可以長到3個月以上 TB Tests Can Have a Lengthy Window Period Two studies suggest that interferon- release assay conversion sometimes occurs more than 3 months after exposure to active tuberculosis. Increasingly, interferon- release assays (IGRAs) are being used for diagnosing latent tuberculosis (TB). Although the tuberculin skin test (TST) traditionally used for this purpose converts to positive within 2 to 12 weeks after an individual is exposed to someone with active TB, the interval for IGRA conversion has remained unclear. Current guidelines recommend repeating an initially negative IGRA after 6 to 10 weeks, but this recommendation is not based on controlled studies. Two recent investigations address this issue. Anibarro and colleagues conducted a longitudinal prospective analysis among contacts of TB patients in Spain. The 152 contacts received a TST and an IGRA at first visit; for individuals with negative or conflicting results, t...
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National lung screening trial -> 2年後…33%用CT查的人會有false positive result, 有7%會做invasive study, 只有1-2%是true positive

Risk for False-Positive Lung Cancer Screening Is Substantial 一年做一次LDCT的false positive rate 是21%，兩年後是33% Nine percent of patients with false-positives on computed tomography required invasive testing. Despite lack of proven efficacy, lung cancer screening has been widely promoted. In the ongoing National Lung Screening Trial (NLST), about 50,000 current or former smokers have been randomized to screening by either chest x-ray or computed tomography (CT). In a preparative feasibility study for the NLST, 3318 current or past smokers (age range, 55–74) were randomly assigned to receive annual chest radiography or annual low-dose CT. A false-positive was defined as a positive test result followed by a negative completed work-up or no diagnosis of lung cancer within 12 months. After two screening tests 1 year apart, risk for a false-positive result was 15% for participants in the chest radiography group and 33% for those in the CT group. Four percent of those with false-positive chest radiog...
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