Preventing Tuberculosis Flare in Patients with Inflammatory Rheumatic Diseases Receiving Tumor Necrosis Factor-α Inhibitors in India — An Audit Report

Abstract

With the use of these 4 TB screening tests in India, where TB is highly prevalent, TB could be excluded with a high degree of certainty (NPV 0.97). However, as even this combination of tests has only moderate sensitivity and specificity and poor PPV for detecting TB, vigilance may be advisable even if only one of the tests is positive.

Should Tuberculin Skin Test Be Positive to Give Latent Tuberculosis Treatment Before Tumor Necrosis Factor-α Inhibitors in Selected Patients in Developing Countries?: Table 1.

“…We read with interest the report by Malaviya, et al about tuberculosis (TB) and inflammatory rheumatic disease (IRD) patients receiving tumor necrosis factor-α (TNF-α) inhibitor agents 1 . Mexico also has a "high TB burden," with estimated prevalence of at least 23 per 100,000 2 .…”

Dr. Malaviya, et al reply

“…We are grateful to Dr. Abud-Mendoza, et al for their observations on our report 1 . We fully agree that tuberculin skin test (TST) alone may not be an ideal method for screening of latent tuberculosis infection (LTBI), especially in high-burden TB regions.…”

Dr. Malaviya, et al reply

“…One of their patients was in a pediatric age group. We had also reported post infliximab TB infection in one of our patients despite following the latent TB infection (LTBI) screening strategy that we recommended 1 . We had, therefore, cautioned vigilance against TB flare especially in high TB-burden countries like India.…”

“…Kharbanda, et al report development of tuberculosis (TB) infection in 2 of their patients, 3 weeks and 3 months after the last dose of infliximab, despite following the LTBI screening strategy suggested in our publication 1 . One of their patients was in a pediatric age group.…”