Assessment of Latent Tuberculosis Infection Screening in Patients with Immune-Mediated Inflammatory Diseases Undergoing Biologic Therapy

Document Type : New and original researches in the field of Microbiology.

Authors

1 Department of Chest Medicine, Faculty of Medicine, Mansoura University, Egypt

2 Department of Rheumatology and Rehabilitation, Mansoura University, Egypt

Abstract

Background: Patients with immune-mediated inflammatory diseases (IMIDs) on biologic therapy are at increased risk of tuberculosis (TB) reactivation, particularly if infected with latent TB. Screening for latent TB infection (LTBI) is recommended prior to immunosuppressive treatment. Objective: To evaluate the prevalence of LTBI, risk factors for TB reactivation, and the significance of screening in patients with IMIDs receiving biologic agents. Methodology: This prospective, observational cohort study enrolled 80 patients with IMIDs scheduled for biologic therapy at Mansoura University Hospitals. Sixty patients completed follow-up over 2 years. All underwent clinical assessment, laboratory testing, chest imaging, and tuberculin skin testing (TST). Patients with positive TST received LTBI therapy. The incidence of TB reactivation was monitored. Results: The mean age was 38.7 ±11.5 years; 65% were female. LTBI prevalence was 16.7%. Six patients (10%) experienced TB reactivation, including three with LTBI and three without. Risk factors significantly associated with reactivation included diabetes mellitus (p<0.001), SLE (p=0.02), and use of infliximab, adalimumab, etanercept, or baricitinib. TB reactivation was confirmed microbiologically and radiologically. Close monitoring and screening are critical for preventing TB in this population. Conclusion: Routine LTBI screening prior to biologic therapy is essential. Patients with positive LTBI, diabetes, or SLE are at increased risk of reactivation. Careful management and follow-up reduce TB-related morbidity.

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