Chest roentgenography is complementary to interferon-gamma release assay in latent tuberculosis infection screening of rheumatic patients

Abstract

Background: A study of latent tuberculosis infection (LTBI) burden by chest roentgenography (CXR) with reference to interferon-gamma release assay (IGRA) is still lacking in rheumatic patients of an intermediate tuberculosis burden area. Methods: We retrospectively reviewed clinical data of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) receiving LTBI screening for biologics from Jan 2013 to April 2014. Results: A total of 238 rheumatic patients who underwent LTBI screening were included in this study, of whom 46 (19.3%) had positive IGRA tests, 178 (74.8%) had negative results, and 14 (5.9%) had indeterminate results. Radiological findings suggesting healed tuberculosis (CXR-old-TB) were found in 18.1% of all patients, 23.9% in the IGRA-positive patients vs 16.9% in the IGRA-negative patients (OR 1.55 95% CI: 0.71-3.39, p = 0.27). Forty (40/46, 87.0%) IGRA-positive patients received isoniazid prophylaxis and 77.5% of them finished treatment. Six patients developed adverse effects of isoniazid treatment, resulting in an overall number needed to harm (NNH) of 6.7 (40/ 6). IGRA-non-positive patients with old TB-suggestive CXR comprised 13.4% (32/238) of all our rheumatic patients, and one of them developed pulmonary tuberculosis within one year after screening. Conclusions: LTBI disease burden in rheumatic patients is substantial according to the estimation of CXR and IGRA screening. Correlation between CXR and IGRA is not significant in rheumatic patients, which implies their complementary roles. IGRA-non-positive patients with old TB-suggestive CXR comprise a significant portion in rheumatic patients and merit cautious follow-up by rheumatologists, tuberculosis specialists, and pulmonologists.

Patterns of T and B cell responses to Mycobacterium tuberculosis membrane-associated antigens and their relationship with disease activity in rheumatoid arthritis patients with latent tuberculosis infection

“…The fact that 16% of our enrolled patients had a history of TB also points to Mtb as a possible ‘environmental’ factor for RA. A recent study from Taiwan has found evidence of past TB, detected by chest x-ray, in a similar proportion of IMID patients, mostly of RA [ 48 ]. In another large Taiwanese cohort, 2.38% RA patients presented a history of TB whereas TB prevalence in the control population was 1.36% [ 5 ].…”

“…In an earlier study, also from India, comparable proportions of TB cases emerged from TB contacts who were either positive or negative for TST or IGRA [ 49 ]. Sensitivity of these assays is also being debated on a wider scale [ 3 , 48 ] and the need for more sensitive assays for a reliable detection of LTBI cannot be overemphasised [ 28 , 31 ].…”

Pulmonary Tuberculosis Following Immune Checkpoint Inhibitor Treatment for Recurrent Maxillary Squamous Cell Carcinoma

“…While guidelines have been disseminated for the screening of TB before the initiation of biological agents, such as anti-tumor necrosis factor-α (TNFα), in the context of various chronic inflammatory ailments such as rheumatoid arthritis [5,32], it is noteworthy that a consensus regarding the routine screening for TB before the administration of ICIs in cancer patients remains conspicuously absent, especially in low endemic areas. Recent retrospective investigations have unveiled that TB infection has been observed in a mere 0.1 to 1.67 % of patients following PD-1/PD-L1 therapy [33][34][35][36].…”

The burden and predictors of latent tuberculosis infection among elder adults in high epidemic rural area of tuberculosis in Zhejiang, China

“…Similar results were also reported that lesions on chest radiographs suggestive of previous infection with Mtb were significantly associated with positive tests for LTBI ( Uzorka et al., 2019 ). The complementary roles between chest radiograph and immunological testing methods were also reported ( Wang et al., 2020 ). Thus, people with abnormal chest radiographs should also be the focus of screening for TB infection.…”