Prevalence of latent tuberculosis infection among patients with interstitial lung disease requiring immunosuppression

Abstract

Objective: To characterize the prevalence of latent tuberculosis infection (LTBI) in patients with interstitial lung diseases (ILDs) requiring immunosuppression. Only 5 to 10% of individuals infected with Mycobacterium tuberculosis develop tuberculosis, and certain groups of patients have an increased risk of illness, such as the immunocompromised. Patients with ILDs are frequently treated with immunosuppressants and, therefore, might have a higher risk of developing the disease. Methods: Prospective study conducted at the ILD reference center of the Federal University of Paraná from January 2019 to December 2020. The screening of LTBI was performed with the use of the tuberculin skin test (TST). Results: The sample consisted of 88 patients, of whom 64.8% were women, with a mean age of 61.4 years. The most frequent diagnoses were autoimmune rheumatic disease ILD (38.6%) and hypersensitivity pneumonitis (35.2%). The most common immunosuppressant in use at the time of the TST was prednisone, either in combination with mycophenolate (19.3%) or alone (17.1%). The majority of participants had fibrotic lung disease, characterized by a reticular interstitial pattern on chest computed tomography (79.5%) and moderate to severe functional impairment (mean FVC 69.2%). A prevalence of LTBI of 9.1% (CI 95%, 2.1%-15.1%) was found, with a TST median of 13. Conclusion: Patients with ILD who are treated with immunosuppressants are not commonly screened for LTBI, despite being under a greater risk of progression to active disease. This study suggests the need for a more cautious approach to these patients.

Fechar O Cerco: Estratégias Na Busca Ativa De Comunicantes De Tuberculose

“…Existe uma discussão sobre a necessidade de se caracterizar um perfil epidemiológico do território; quanto antes a equipe multiprofissional identificar pacientes com HIV, maiores de 60 anos, tabagistas, por meio da busca ativa de comunicantes, maior a oportunidade em delimitar a extensão territorial da doença ( 10;11 ). Considera-se que pacientes imunode-primidos, tabagistas e PVHIV, podem desenvolver formas grave de tuberculose a partir da ILTB [10][11] . Considerando a epidemia de PVHIV, terapias imunossupressoras, ou pacientes imunodeprimidos, se faz necessária uma forma de diagnóstico preciso de ILTB 20 .…”

Connective tissue disease-associated interstitial lung disease

“…Evaluation for latent tuberculosis and other infectious disease (hepatitis B and C, HIV) is advised. 80 Lung transplantation and evaluation for palliative care should be considered when diseases progress despite treatment ( Figure 7 ).…”

“…Recomenda-se avaliação para tuberculose latente e outras doenças infecciosas (hepatite B e C, HIV). (80) Transplante pulmonar e avaliação para cuidados paliativos devem ser considerados quando houver progressão das doenças apesar do tratamento (Figura 7).…”