Serial Tuberculin Skin Tests Improve the Detection of Latent Tuberculosis Infection in Patients With Inflammatory Bowel Disease

Taxonera, Carlos; Ponferrada, Ángel; Riestra, Sabino; Bermejo, Fernando; Saro, Cristina; Martín-Arranz, María Dolores; Cabriada, José Luis; Acosta, Manuel Barreiro‐de; Castro, María Luisa de; López-Serrano, Pilar; Barrio, Jesús; Suárez, Cristina Justo; Iglesias, Eva; Argüelles-Arias, Federico; Ferrer, Isabel; Marín-Jiménez, Ignacio; Hernández-Camba, Alejandro; Bastida, Guillermo; Domselaar, Manuel Van; Martínez-Montiel, Pilar; Olivares, David; Rivero, Montserrat; Fernández-Salazar, Luis; Nantes, Óscar; Merino, Olga; Alba, Cristina; Gisbert, Javier P.

doi:10.1093/ecco-jcc/jjy104

Cited by 17 publications

(8 citation statements)

References 33 publications

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“…However, the susceptibility to new M. tuberculosis infection might be higher in the KTR group than in the KTC population ( Figure 2B ), possibly due to the process and immunosuppression therapy used for the transplantation [ 30 , 31 ]. The QFT conversion rates in the KTR groups were similar, with 7–8.5% conversion at the 12-month follow-up [ 32 , 33 ] and 13.6% conversion at the 24-month follow-up [ 34 ] among patients with rheumatoid disease receiving biologic agents. Therefore, this result indicates that, in addition to pretransplantation screening, surveillance of LTBI is also needed after transplantation.…”

Section: Discussionmentioning

confidence: 99%

Latent Tuberculosis Infection Increases in Kidney Transplantation Recipients Compared With Transplantation Candidates: A Neglected Perspective in Tuberculosis Control

Tsai

Lin

Wang

et al. 2020

Clinical Infectious Diseases

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Abstract Background The prevalence and incidence of latent tuberculosis infection (LTBI) in patients with kidney transplantation remain unclear. Methods In this prospective study, we enrolled kidney transplantation candidates (KTCs) and recipients (KTRs) from 2014 to 2018. We defined LTBI as a positive result of QuantiFERON-TB Gold In-tube (QFT). We analyzed the predictors for LTBI acquisition and followed up on QFT assay test for 2 years among those initially without LTBI. Results Of 425 patients enrolled, 305 (71.8%) patients belonged to the KTC group and 120 (28.2%) to the KTR group. The initial QFT showed positive results in 32 (10.5%) and 24 (20.0%) patients in the KTC and KTR groups, respectively (P = .009). The QFT response value in patients with LTBI was higher in the KTR group than in the KTC group (1.85 vs 1.06 IU/mL, P = .046). Multivariate logistic regression showed that old age, absence of bacillus Calmette–Guérin (BCG) scar, presence of donor-specific antibody, and KTR group were independent factors for positive LTBI. For participants with initial negative QFT, positive QFT conversion within a 2-year follow-up was higher after kidney transplantation (20%) than in KTCs (5.5%) (P = .034). Conclusions This study is the first cohort to follow up LTBI status in patients with kidney transplantation and shows its higher prevalence and incidence in KTRs. It indicates that surveillance of LTBI after renal transplantation is important. In addition to status of kidney transplantation, old age, no BCG vaccination, and positive donor-specific antibody are also positive predictors for LTBI.

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Section: Discussionmentioning

confidence: 99%

Latent Tuberculosis Infection Increases in Kidney Transplantation Recipients Compared With Transplantation Candidates: A Neglected Perspective in Tuberculosis Control

Tsai

Lin

Wang

et al. 2020

Clinical Infectious Diseases

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“…[275] In patients treated with methotrexate or azathioprine, a short course of corticosteroids, or cyclosporine, several studies showed that the risk of TB is not higher when compared to placebo alone and thus no treatment of LTBI is recommended in these patients. [271,276,277] Due to TB cases diagnosed in patients treated with anti-TNF agents despite a negative TB screening prior to anti-TNF therapy, [278,279] annual re-screening could be considered, [280] especially for patients with a higher TB risk [living or travelling in intermediate or high TB incidence area]. The risk of TB in IBD patients on anti-TNF agents is dependent on the local disease burden of TB.…”

Section: Mycobacterium Tuberculosismentioning

confidence: 99%

ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease

Kucharzik

Ellul

Greuter

et al. 2021

Journal of Crohn's and Colitis

258

235

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“…The first issue is the conversion rate with the different TB screening tests. Data from the literature have shown that the conversion rate is higher for TST (0-37%) [20,[30][31][32][33][34][35][36][37][38] than the T-SPOT.TB (0-15%) [20,36,39] and the QFT-GIT (0-12%) [20-23, 33-36, 40, 41] tests. Similar findings were observed in our cohort study where during the 7-year follow-up period, 30% of patients converted in at least 1 TB screening assay.…”

Section: Inh Therapymentioning

confidence: 99%

Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment

Thomas

Hadziyannis

Hatzara

et al. 2020

PAI

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Background: To determine the conversion and reversion rates of tuberculosis (TB) screening tests (Tuberculin Skin Test-TST, Interferon Gamma Release Assay-IGRA: T-SPOT.TB) during biologic treatment in patients with rheumatic diseases and negative baseline screening.Methods: This was a long-term, longitudinal cohort study of 50 patients with rheumatic diseases and negative baseline TB screening (TST: < 5 mm, negative T-SPOT.TB) treated with tumor necrosis factor inhibitors (TNFi) or other non-TNFi biologics. Patients were rescreened at a mean time of 1.4 (first rescreening) and 6.9 (second rescreening) years from baseline, with both assays. The conversion (negative to positive) and reversion (positive to negative) rate was calculated for each TB screening test.Results: Fifty patients (mean age = 60 years) with various rheumatic diseases (rheumatoid arthritis: n = 24, spondyloarthropathies: n = 23, other: n = 3) were enrolled. During the first phase (baseline to first rescreening), all patients were treated with TNFi while during the second phase (first to second rescreening), TNFi (54%) and non-TNFi (46%) were used. Fifteen patients (30%) displayed conversion of at least 1 screening assay during follow-up (10 at the first and 5 at the second rescreening). This conversion rate was higher with TST (n = 11, 22% or 3.47/100 patient-years) compared to T-SPOT.TB (n = 4, 8% or 1.74/100 patient-years). Among the 10 converters at the first rescreening, 5 received isoniazid (INH) preventive therapy and 5 did not; an equal number of patients (3/5, 60%) reverted to negative with or without INH therapy. None of the patients developed active TB during follow-up (6.9 ± 1.0 years).Conclusions: Approximately one-third of patients with rheumatic diseases and negative baseline TB screening developed conversion of at least 1 screening test during long-term biologic treatment. This occurred most often with TST and was usually a transient event. These findings do not support routine serial TB retesting in biologic-treated patients with rheumatic diseases in the absence of TB risk factors.

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Serial Tuberculin Skin Tests Improve the Detection of Latent Tuberculosis Infection in Patients With Inflammatory Bowel Disease

Abstract: Serial TST at 1 year can detect LTBI in IBD patients receiving anti-TNF therapy with negative baseline TST. Serial TST seems to be advisable to reduce the risk of TB cases associated with inability to detect LTBI in pre-treatment screening.

Cited by 17 publications

References 33 publications

Latent Tuberculosis Infection Increases in Kidney Transplantation Recipients Compared With Transplantation Candidates: A Neglected Perspective in Tuberculosis Control

Latent Tuberculosis Infection Increases in Kidney Transplantation Recipients Compared With Transplantation Candidates: A Neglected Perspective in Tuberculosis Control

ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease

Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment

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