Reversion and Reconversion Rate of Tuberculin Skin Reactions in Correlation with the Use of Prednisone1

Bovornkitti, Somchai; Kangsadal, Prasert; Sathirapat, Poonsri; Oonsombatti, Pairojana

doi:10.1378/chest.38.1.51

Cited by 93 publications

(26 citation statements)

References 11 publications

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“…In adults, Ն15 mg of daily prednisone may cause suppression of previously positive TSTs, but the exact risk is unknown. 2 Bovornkitti et al 68 placed serial TSTs on adults with TB disease (n ϭ 58) or adults with positive TSTs (Ն5 mm) who had other illnesses requiring steroid treatment (40 mg/day of prednisone). The vast majority (97% [68 of 70]) reverted their TSTs to negative (00 mm) a mean of 14 days after starting steroids (treatment duration: 1-4 weeks).…”

Section: Factors Associated With False-negative Tstsmentioning

confidence: 99%

Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents

2004

Pediatrics

110

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ABSTRACT.Comprehensive new guidelines for screening, targeted testing, and treating latent tuberculosis infection (LTBI) in children and adolescents are presented. The recent epidemiology of TB and data on risk factors for LTBI are reviewed. The evidence-based recommendations provided emphasize the paradigm that children and adolescents should be screened for risk factors by using a risk-factor questionnaire for TB and LTBI and tested with the tuberculin skin test only if >1 risk factor is present. The use of administrative or mandated tuberculin skin tests for entry to day care, school, or summer camp is strongly discouraged. Treatment regimens, suggestions to improve adherence, and methods to monitor toxicities are summarized. Children and adolescents with LTBI represent the future reservoir for cases of TB. Thus, detecting and treating LTBI in children and adolescents will contribute to the elimination of TB in the United

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Section: Factors Associated With False-negative Tstsmentioning

confidence: 99%

Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents

2004

Pediatrics

110

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“…A similar reactivation of tuberculosis may occur in persons receiving glucocorticoids, especially in those receiving substantial doses of glucocorticoids for prolonged periods (3). The joint statement of the American Thoracic Society and the Centers for Disease Control and Prevention (CDC) acknowledges that Ͼ15 mg/day of prednisone (or its equivalent) administered for Ն1 month is a risk factor for tuberculosis (3), primarily because this dosage has been shown to suppress tuberculin reactivity (7,8). However, specific thresholds of dose and duration that could increase the risk for tuberculosis remain unknown (3,9).…”

Section: Introductionmentioning

confidence: 99%

Glucocorticoid use, other associated factors, and the risk of tuberculosis

Jick

Lieberman

Rahman³

et al. 2006

Arthritis & Rheumatism

411

257

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Objective. To evaluate the association of glucocorticoids and other purported risk factors with the development of tuberculosis. Methods. We conducted a case-control study of tuberculosis cases identified during 1990 -2001 using the General Practice Research Database in the United Kingdom. Cases were patients with a first time diagnosis of tuberculosis accompanied by at least 6 months of treatment with at least 3 different tuberculosis medications. Up to 4 controls were matched to each case on age, sex, the practice attended by the case, index date, and amount of prior computerized records. Results. The study encompassed 497 new cases of tuberculosis and 1,966 controls derived from 16,629,041 person-years at risk (n ‫؍‬ 2,757,084 persons). The adjusted odds ratio (OR) of tuberculosis for current use of a glucocorticoid compared with no use was 4.9 (95% confidence interval [95% CI] 2.9 -8.3). The adjusted ORs for use of <15 mg and >15 mg of prednisone or its equivalent daily dose were 2.8 (95% CI 1.0 -7.9) and 7.7 (95% CI 2.8 -21.4), respectively. Adjusted ORs of tuberculosis were 2.8 for patients with a body mass index (BMI) <20 compared with normal BMI; 1.6 for current smokers compared with nonsmokers; and 3.8, 3.2, 2.0, and 1.4 for those with history of diabetes, emphysema, bronchitis, and asthma, respectively, compared with those without such history (all P values <0.05). Conclusion. These results indicate that patients treated with glucocorticoids have an increased risk of developing tuberculosis, independent of other risk factors. Low adiposity, diabetes, current smoking, and obstructive pulmonary disorders are also important independent risk factors for tuberculosis.

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“…Despite this, little is known about the precise mechanisms of action of corticosteroids on the immune response in humans (1,2). Several immunosuppressive effects of these agents have been observed to occur in man, including mild lymphocytopenia (3), decreased immunoglobulin production (4), and impaired expression of cutaneous delayed hypersensitivity responses (5). The striking heterogeneity of lymphoid cell populations within different species including man has been the subject of recent intense study (6).…”

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confidence: 99%