Does “Latent Tuberculosis Infection” (LTBI)” Really Exist? Genealogy of a Medical Nosology

Abstract

Introduction: The diagnosis of latent tuberculosis infection (LTBI) is based on secular ways: chest radiography and tuberculin skin test (TST). In front of a recent enthusiasm for LTBI, this paper reports a historical perspective of this concept. Method: Bibliometric analysis and literature review from medical databases, using the terms “latent tuberculosis infection (“LTBI”), “primary tuberculosis”, “tuberculin skin test”, “tuberculosis”, and from reference books on tuberculosis. Results: In the PubMED/MEDLINE search for LTBI, a total of 7787 articles were found between 1901 and 2020, 95% from 2000 to 2020. In the first part of the 20th century, LTBI term was used for sub-clinical tuberculosis disease, the latency being also called “primary tuberculosis” or “abortive tuberculosis infection”. From 1960, randomized prospective therapeutic studies mentioned “tuberculosis chemoprophylaxis”. By the end of the 20th century, the epidemic of AIDS impeded tuberculosis decrease, making LTBI search more efficient. In 2000, the American Thoracic Society and the Centers for Disease Controls and Prevention proposed the systematic used of LTBI, relayed through public health policies. A significant higher scientific production about LTBI was noted, supported by IGRA tests commercialization. Conclusion: In the recent years, health public policies, combined with epidemiologic and economic factors, strengthened the use of LTBI terminology.