A Study of Optimal Screening for Latent Tuberculosis in Patients with Inflammatory Bowel Disease
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Reactivation of LTBI in patients with IBD on anti-TNF-α agents can lead to serious life-threatening illness. No gold standard exists for the detection of LTBI. We examined whether a dual testing strategy with TST and IGRA would improve the detection of LTBI.
Consecutive IBD patients being considered for anti-TNF-α treatment underwent testing with a TST, IGRA and CXR. All patients completed a self-administered questionnaire. The association of both tests with demographic factors, LTBI risk factors, BCG vaccination, IS therapy and agreement between the TST and IGRA were evaluated.
One-hundred and fifty-five IBD patients were included, 6% were TST positive and 5% were IGRA positive. Concordance between TST and IGRA was fair (κ = 0.21, 95% CI − 0.081–0.498). Neither test was affected by age, gender or BCG vaccination. The presence of risk factors for LTBI was found to be positively associated with TST (OR 19.8, 95% CI 3.9–102.1), but not IGRA. IGRA was negatively associated with IS therapy (OR 0.06, 95% CI 0.007–0.5), but not TST. Four patients who were IGRA positive but TST negative were treated for LTBI by a respirologist.
An IGRA result was negatively associated with IS therapy, while the presence of risk factors for LTBI was found to be positively associated with TST results. There was fair agreement between positive TST and IGRA results. The addition of IGRA to the standard practice of TST and CXR increased the number of cases that were initiated on LTBI therapy.
KeywordsLatent tuberculosis Anti-tumor necrosis alpha Tuberculin skin test Interferon-gamma release assay
Inflammatory bowel disease
Anti-tumor necrosis factor alpha
Latent Tuberculosis infection
Tuberculin skin test
Interferon-gamma release assay
TA and WA conceived the study. TA, TB, AB, ES and WA coordinated data collection at their respective sites. TA and MS collected the data. TA, MM and WA aggregated the data and performed analysis. TA wrote the initial draft of the manuscript. TA and WA coordinated revision of the manuscript as guided by all the authors who approved the final version of the manuscript.
The study was funded by an academic peer-reviewed grant through the Future Leaders in IBD (FLIBD) program, which was administered through Mount Sinai Hospital in Toronto, Canada. Neither FLIBD nor Mount Sinai Hospital had any role in the design or conduct of the study, the interpretation of results, or the development of this manuscript.
Compliance with ethical standards
Conflict of Interest
T Al-Taweel has received travel/accommodation/meeting expenses from Abbvie, Janssen, Newbridge and Novartis, lecture fees from Janssen and Abbvie and consulting fees from Abbvie and Takeda. A. Bitton has received research financial support from Abbvie, lecture fees from Abbvie, Janssen and Shire and consulting fees from Abbvie, Janssen, Shire, Ferring and Takeda. W. Afif has received consulting fees from Abbvie, Janssen, Shire, Ferring and Takeda. T. Bessissow has received research financial support from Abbvie, lecture fees from Abbvie, Janssen, Takeda, Shire, Actavis and Ferring and consultancy fees from Abbvie, Janssen, Takeda, Shire and Actavis. The remaining authors have no conflicts of interest to disclose.
Guarantor of Article
T Al-Taweel MBChB, KMSC, MRCP(UK), MRCPS(Glasg).
- 2.Aberra FN, Stettler N, Brensinger C, et al. Risk for active tuberculosis in inflammatory bowel disease patients. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2007;5:1070–1075.Google Scholar
- 8.Centre for Communicable D, Infection C, Association CL, et al. Canadian Tuberculosis Standards (7th Edition): Public Health Agency of Canada, 2014.Google Scholar
- 15.Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med. 2000;161:S221–S247.Google Scholar
- 16.WHO. Global tuberculosis report 2016: World Health Organization, Geneva, 2016.Google Scholar
- 19.Nguyen D, Menzies D. Diagnosis and treatment of latent TB infection. Can J CME. 2001;1:89–97.Google Scholar