title: Screening for latent tuberculosis in anti-TNF-α candidate patients in a high tuberculosis incidence setting.
abstract: BACKGROUND
  Screening for latent tuberculosis infection (LTBI) using a protocol comprising chest X-ray and tuberculin skin test (TST) interpreted with medical history, Sc1, reduces LTBI reactivation on treatment with anti-tumour necrosis factor-alpha (anti-TNF-α). In the district of Seine-Saint-Denis, France, where tuberculosis (TB) incidence ranges from 30 to >100/100 000 person-years, however, Sc1 might be insensitive as a screening tool. We adopted another protocol, Sc2, comprising Sc1 plus two additional tests: the QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) and chest computed tomography (CT).
  
  
  METHODS
  We screened 123 consecutive patients with inflammatory rheumatic diseases (IRDs), candidates for anti-TNF-α treatment, and evaluated the impact of Sc2 vs. Sc1 on the prescription of prophylactic anti-tuberculosis treatment.
  
  
  RESULTS
  Sc2 led to a diagnosis of LTBI in 69 patients vs. 59 when using Sc1: eight were QFT-GIT-positive. Diagnosis was based on CT findings in two patients. QFT-GIT had higher diagnostic accuracy than TST, but no single diagnostic test could detect all patients at high risk for LTBI reactivation (respectively 30.2% and 37.5% of patients positive with only TST or QFT-GIT). CT detected TB sequelae in 3/46 rheumatoid arthritis patients who were negative to all tests.
  
  
  CONCLUSIONS
  Testing with both TST and QFT-GIT seems the safest strategy for detecting LTBI in patients with IRD from populations with high incidence of TB. Systematic screening with CT warrants further evaluation.
authors.affiliation: Department of Rheumatology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France. nathalie.saidenberg@avc.aphp.fr
authors.forename: N
authors.initials: N
authors.lastname: Saidenberg-Kermanac'h
authors.forename: L
authors.initials: L
authors.lastname: Semerano
authors.forename: J M
authors.initials: JM
authors.lastname: Naccache
authors.forename: M
authors.initials: M
authors.lastname: Brauner
authors.forename: G
authors.initials: G
authors.lastname: Falgarone
authors.forename: D
authors.initials: D
authors.lastname: Dumont-Fischer
authors.forename: X
authors.initials: X
authors.lastname: Guillot
authors.forename: D
authors.initials: D
authors.lastname: Valeyre
authors.forename: M-C
authors.initials: MC
authors.lastname: Boissier
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D015994:Incidence; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha