Screening for latent tuberculosis in anti-TNF-α candidate patients in a high tuberculosis incidence setting
Abstract:BACKGROUND: Screening for latent tuberculosis infection (LTBI) using a protocol comprising chest X-ray and tuberculin skin test (TST) interpreted with medical history, Sc1, reduces LTBI reactivation on treatment with anti-tumour necrosis factor-alpha (anti-TNF-α). In the district of Seine-Saint-Denis, France, where tuberculosis (TB) incidence ranges from 30 to >100/100 000 person-years, however, Sc1 might be insensitive as a screening tool. We adopted another protocol, Sc2, comprising Sc1 plus two additional tests: the QuantiFERON®-TB Gold In-Tube (QFT-GIT) and chest computed tomography (CT).
METHODS: We screened 123 consecutive patients with inflammatory rheumatic diseases (IRDs), candidates for anti-TNF-α treatment, and evaluated the impact of Sc2 vs. Sc1 on the prescription of prophylactic anti-tuberculosis treatment.
RESULTS: Sc2 led to a diagnosis of LTBI in 69 patients vs. 59 when using Sc1: eight were QFT-GIT-positive. Diagnosis was based on CT findings in two patients. QFT-GIT had higher diagnostic accuracy than TST, but no single diagnostic test could detect all patients at high risk for LTBI reactivation (respectively 30.2% and 37.5% of patients positive with only TST or QFT-GIT). CT detected TB sequelae in 3/46 rheumatoid arthritis patients who were negative to all tests.
CONCLUSIONS: Testing with both TST and QFT-GIT seems the safest strategy for detecting LTBI in patients with IRD from populations with high incidence of TB. Systematic screening with CT warrants further evaluation.
Document Type: Research Article
Affiliations: 1: Department of Rheumatology, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Bobigny, France; and Sorbonne Paris Cité–Université Paris 13, Bobigny, France 2: Department of Rheumatology, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Bobigny, France; Sorbonne Paris Cité–Université Paris 13, Bobigny, France 3: Department of Pneumology, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Bobigny, France 4: Department of Radiology, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Bobigny, France 5: Department of Rheumatology, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Bobigny, France
Publication date: October 1, 2012
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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