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Int J Tuberc Lung Dis. 2012 Oct;16(10):1307-14. doi: 10.5588/ijtld.12.0111. Epub 2012 Aug 3.

Screening for latent tuberculosis in anti-TNF-α candidate patients in a high tuberculosis incidence setting.

Author information

1
Department of Rheumatology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France. nathalie.saidenberg@avc.aphp.fr

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.

PMID:
22863801
DOI:
10.5588/ijtld.12.0111
[Indexed for MEDLINE]

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