Early Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease.
OBJECTIVE
Sensitivity of tuberculin skin test [TST] during screening for latent tuberculosis infection [LTBI] is affected by steroid and/or immunosuppressant therapy. The aim of this study was to compare performance of the two-step TST in inflammatory bowel disease patients immediately before anti-tumour necrosis factor [TNF] therapy as part of routine screening for LTBI vs control patients when the TST was carried out at an early stage.


METHODS
In this multicentre prospective controlled study, we evaluated the performance of two-step TST with 5-mm threshold. Factors associated with TST results were determined by logistic regression.


RESULTS
We evaluated 243 candidates for anti-TNF therapy and 337 control patients. Overall, 105 patients [18.1%] had an induration ≥ 5 mm in the first TST or in TST retest. LTBI was diagnosed in 25% of patients by TST retest. Twenty-eight [11.5%] anti-TNF group patients vs 77 [22.8%] control patients had a positive TST (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28-0.70; P < 0.001]. In multivariate analysis, positive TST was associated with higher age [OR 2.63, 95% CI 1.21-5.72; P < 0.001] and 5-aminosalicylate therapy [OR 1.86, 95% CI 1.14-3.05; P = 0.013]. Negative TST was associated with steroid therapy [OR 0.36, 95% CI 0.16-0.83; P = 0.016], immunosuppressant therapy [OR 0.36, 95% CI 0.21-0.62; P < 0.001], or steroids + immunosuppressant therapy [OR 0.20, 95% CI 0.07-0.59; P = 0.004].


CONCLUSIONS
The sensitivity of routine TST performed just before starting anti-TNF therapy is low. TST performed at an early stage enables screening in the absence of immunosuppressive treatment and thus maximises the diagnostic yield of TST for detecting LTBI.
Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain.
Carlos
C
Taxonera
Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain.
Ángel
Á
Ponferrada
Department of Gastroenterology, Hospital de Fuenlabrada, Madrid, Spain.
Fernando
F
Bermejo
Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain.
Sabino
S
Riestra
Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain.
Cristina
C
Saro
Department of Gastroenterology, Hospital La Paz, Madrid, Spain.
María Dolores
MD
Martín-Arranz
Department of Gastroenterology, Hospital de Galdakao, Galdakao, Spain.
José Luis
JL
Cabriada
Department of Gastroenterology, Hospital Clínico de Santiago, Santiago de Compostela, Spain.
Manuel
M
Barreiro-de Acosta
Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.
María Luisa
ML
de Castro
Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
Pilar
P
López-Serrano
Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
Jesús
J
Barrio
Department of Gastroenterology, Hospital Puerta de Hierro, Madrid, Spain.
Cristina
C
Suarez
Department of Gastroenterology, Hospital Reina Sofía, Córdoba, Spain.
Eva
E
Iglesias
Department of Gastroenterology, Hospitales Virgen Macarena-Rocío, Sevilla, Spain.
Federico
F
Argüelles-Arias
Department of Gastroenterology, Hospital de Manises, Manises, Spain.
Isabel
I
Ferrer
Department of Gastroenterology, Hospital Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM], Madrid, Spain.
Ignacio
I
Marín-Jiménez
Department of Gastroenterology, Hospital Universitario de Canarias, La Laguna, Spain.
Alejandro
A
Hernández-Camba
Department of Gastroenterology, Hospital La Fe, Valencia, Spain.
Guillermo
G
Bastida
Department of Gastroenterology, Hospital de Torrejón, Madrid, Spain.
Manuel
M
Van Domselaar
Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain.
Pilar
P
Martínez-Montiel
Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain.
David
D
Olivares
Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain.
Cristina
C
Alba
Department of Gastroenterology, Hospital de la Princesa, CIBEREHD, Madrid, Spain.
Javier P
JP
Gisbert
D000328:Adult; D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D014374:Tuberculin Test / Q000379:methods*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha; D019804:Mesalamine
Crohn′s disease; Tuberculosis; anti-TNF; immunosuppressant; inflammatory bowel disease; steroid; tuberculin skin test; ulcerative colitis