First of all, I am completely new here, so hello! I have been scouring the internet trying to find out more about the relationship (if there is one) between latent Tb and swine/H1N1 flu with very little luck. The WHO has casually mentioned a possible link between active Tb and increased hospitalization/mortality in H1N1 patients. It seems like the WHO and CDC are keeping the information on what the "underlying conditions" are in people succumbing to the virus.
On to my question - let's assume that a healthy person is recently diagnosed with latent Tb. Their x-rays are clear and they are in good health otherwise. This person has been given the option to begin treatment with a 4 month course of Rifampin. Let's also assume that they live in an area with a regional H1N1 outbreak. I have read that Rifampin "lowers the immune system" and more specifically, I have read that it "increases NO release by cytokine-stimulated cells", (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1346828) and while I am not a scientist or medical professional, this does not sound good to me, especially considering the theory that pandemic flu strains such as the 1918 flu are particularly harmful to healthy adults because of cytokine storms. However, the H1N1 virus does not seem to be doing this in the US, the deaths here have been in people with "underlying conditions", whatever that means. I also read a theory that with Tb being prevalent in Mexico, some of the healthy young adults that died from H1N1 may actually have had latent Tb.
Given this information (well, lack of info really), would you begin treatment for latent Tb with Rifampin amidst a H1N1 outbreak? Especially if beginning treatment now means still being in treatment when the regular flu season begins (and if theories hold true, H1N1 picks up speed and becomes a serious issue)? Also, keep in mind that discontinuing treatment increases the risk of the Tb becoming resistant.
