Most people infected by Mycobacterium tuberculosis (Mtb) do not have any signs or disease symptoms, a condition known as latent tuberculosis infection (LTBI). The introduction of biological agents, mainly tumor necrosis factor (TNF) inhibitors, for the treatment of immune-mediated diseases such as Rheumatoid Arthritis (RA) and other rheumatic diseases, increased the risk of reactivation of LTBI, leading to development of active TB. Thus, this review will approach the aspects related to LTBI in patients with rheumatologic diseases, especially those using iTNF drugs. For this purpose it will be considered the definition and prevalence of LTBI, mechanisms associated with diseases and medications in use, criteria for screening, diagnosis and treatment. Considering that reactivation of LTBI accounts for a large proportion of the incidence of active TB, adequate diagnosis and treatment are crucial, especially in high-risk groups such as patients with rheumatologic diseases.

Background: Most studies that have evaluated the impact of infection-control measures (ICM) reported a decrease in latent tuberculosis (TB) and not in TB. The objective of this study was to evaluate the impact of ICM on TB incidence among Health Care Workers (HCW’s). Methods: We conducted a retrospective record review study in a general, tertiary care, university-affiliated hospital. All TB case reports among HCWs in the hospital from 2005 to 2018 were reviewed. The TB incidence was measured before and after 2012 to evaluate the impact of ICM implemented. Findings: In total, there were 53 TB cases. The number of TB cases before and after the implementation of ICM was 42 (incidence: 100.0 cases/100,000 HCWs/year) and 11 (incidence: 26.2 cases/100,000 HCWs/year), respectively ( p < .0001). Conclusions/Application to Practice: TB incidence among HCWs reduced significantly after the implementation of ICM. The establishment of ICM, such as written TB infection control plan, monitoring, screening, training, and education, can reduce TB incidence.

A significant portion of tuberculosis (TB) patients, especially severe cases, are still being hospitalized, with estimates ranging from 2 to 12%. In addition, patients required mechanical ventilation (MV) in many cases 1,2 . In a study conducted in Brazil, ICU admission was necessary in 8.5% of cases 3 . In another study at a university hospital, 16.7% of the 311 cases of TB were admitted to the ICU and 15.4% required MV 4 . Besides, in-hospital mortality of patients with TB remains high, particularly among patients requiring MV. TB associated with acute respiratory failure has been associated with mortality rates of up to 81.0% [5][6][7][8][9] .Several factors have been identified as predictive of mortality among TB patients, such as delay in diagnosis, irregular treatment, human immunodeficiency virus infection, malnutrition, and multidrug-resistant TB 4,[10][11][12][13] . In a study 10 that evaluated 311 patients with TB, MV and negative sputum smear were predictors of in-hospital death in multivariate analysis. In another retrospective cohort study 4 with 67 patients requiring intensive care, ventilator-associated pneumonia and early intensive care unit admission were risk factors for in-hospital mortality. In addition, serum levels of albumin, reflecting the nutritional status, were associated with higher mortality in ICU patients with TB and respiratory failure 14,15 .In the treatment of TB, corticosteroids are used as adjuvants, especially in meningeal and pericardial TB. Corticosteroids can allow anti-TB drugs to penetrate granulomas, undoing their formation. Moreover, they inhibit the release of cytokines and lymphokines 16,17 . In other forms of the disease, especially in severe TB, its use is controversial 16,[18][19][20][21][22] . Therefore, the aim of the present study is to assess whether the use of corticosteroids in the treatment of pulmonary TB patients in MV is associated with in-hospital mortality.