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J Crohns Colitis. 2017 Jul 1;11(7):792-800. doi: 10.1093/ecco-jcc/jjx022.

Early Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease.

Author information

1
Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain.
2
Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain.
3
Department of Gastroenterology, Hospital de Fuenlabrada, Madrid, Spain.
4
Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain.
5
Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain.
6
Department of Gastroenterology, Hospital La Paz, Madrid, Spain.
7
Department of Gastroenterology, Hospital de Galdakao, Galdakao, Spain.
8
Department of Gastroenterology, Hospital Clínico de Santiago, Santiago de Compostela, Spain.
9
Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.
10
Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
11
Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
12
Department of Gastroenterology, Hospital Puerta de Hierro, Madrid, Spain.
13
Department of Gastroenterology, Hospital Reina Sofía, Córdoba, Spain.
14
Department of Gastroenterology, Hospitales Virgen Macarena-Rocío, Sevilla, Spain.
15
Department of Gastroenterology, Hospital de Manises, Manises, Spain.
16
Department of Gastroenterology, Hospital Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM], Madrid, Spain.
17
Department of Gastroenterology, Hospital Universitario de Canarias, La Laguna, Spain.
18
Department of Gastroenterology, Hospital La Fe, Valencia, Spain.
19
Department of Gastroenterology, Hospital de Torrejón, Madrid, Spain.
20
Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain.
21
Department of Gastroenterology, Hospital de la Princesa, CIBEREHD, Madrid, Spain.

Abstract

Background and Aim:

Sensitivity of tuberculin skin test [TST] during screening for latent tuberculosis infection [LTBI] is affected by steroid and/or immunosuppressant therapy. The aim of this study was to compare performance of the two-step TST in inflammatory bowel disease patients immediately before anti-tumour necrosis factor [TNF] therapy as part of routine screening for LTBI vs control patients when the TST was carried out at an early stage.

Methods:

In this multicentre prospective controlled study, we evaluated the performance of two-step TST with 5-mm threshold. Factors associated with TST results were determined by logistic regression.

Results:

We evaluated 243 candidates for anti-TNF therapy and 337 control patients. Overall, 105 patients [18.1%] had an induration ≥ 5 mm in the first TST or in TST retest. LTBI was diagnosed in 25% of patients by TST retest. Twenty-eight [11.5%] anti-TNF group patients vs 77 [22.8%] control patients had a positive TST (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28-0.70; P < 0.001]. In multivariate analysis, positive TST was associated with higher age [OR 2.63, 95% CI 1.21-5.72; P < 0.001] and 5-aminosalicylate therapy [OR 1.86, 95% CI 1.14-3.05; P = 0.013]. Negative TST was associated with steroid therapy [OR 0.36, 95% CI 0.16-0.83; P = 0.016], immunosuppressant therapy [OR 0.36, 95% CI 0.21-0.62; P < 0.001], or steroids + immunosuppressant therapy [OR 0.20, 95% CI 0.07-0.59; P = 0.004].

Conclusions:

The sensitivity of routine TST performed just before starting anti-TNF therapy is low. TST performed at an early stage enables screening in the absence of immunosuppressive treatment and thus maximises the diagnostic yield of TST for detecting LTBI.

KEYWORDS:

Crohn′s disease; Tuberculosis; anti-TNF; immunosuppressant; inflammatory bowel disease; steroid; tuberculin skin test; ulcerative colitis

PMID:
28333182
DOI:
10.1093/ecco-jcc/jjx022
[Indexed for MEDLINE]

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