Intest Res.  2014 Jan;12(1):12-19. 10.5217/ir.2014.12.1.12.

Diagnosis and Treatment of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Diseases due to Initiation of Anti-Tumor Necrosis Factor Therapy

• Shim TS

• KMID: 2174333
• DOI: http://doi.org/10.5217/ir.2014.12.1.12

Abstract

Patients with intractable inflammatory bowel diseases (IBD) are increasingly being treated with anti-tumor necrosis factor (TNF) agents and are at increased risk of developing tuberculosis (TB). Therefore, diagnosis and treatment of latent TB infection (LTBI) is recommended in patients due to the initiation of anti-TNF therapy. Traditionally, LTBI has been diagnosed on the basis of clinical factors and a tuberculin skin test. Recently, interferon-gamma releasing assays (IGRAs) that can detect TB infection have become available. Considering the high-risk of developing TB in patients on anti-TNF therapy, the use of both a tuberculin skin test and an IGRA should be considered to detect and treat LTBI in patients with IBD due to the initiation of anti-TNF therapy. The traditional LTBI treatment regimen has consisted of isoniazid monotherapy for 9 months. However, shorter regimens such as 4 months of rifampicin or 3 months of isoniazid/rifampicin have been used increasingly to improve treatment completion rates. In this review, the incidence of TB and the prevalence of LTBI in patients with IBD will be briefly described, as well as methods for diagnosing latent and active TB before anti-TNF therapy, current LTBI treatment regimens, recommendations for managing TB that develops during anti-TNF therapy, the necessity of regular monitoring to detect new TB infection, and the re-initiation of anti-TNF therapy in patients who develop TB.

Keyword

Tuberculosis; Latent tuberculosis infection; Tumor necrosis factor; Treatment; Infliximab

MeSH Terms

Diagnosis*
Humans
Incidence
Infliximab
Inflammatory Bowel Diseases*
Interferon-gamma
Isoniazid
Latent Tuberculosis*
Methods
Necrosis*
Prevalence
Rifampin
Skin Tests
Tuberculin
Tuberculosis
Tumor Necrosis Factor-alpha
Interferon-gamma
Isoniazid
Rifampin
Tuberculin
Tumor Necrosis Factor-alpha

Figure

• 

  Fig. 1 Algorithm for the selection of candidates requiring latent tuberculosis infection (LTBI) treatment. TB, tuberculosis; CXR, chest radiography; CT, computed tomography.

• 

  Fig. 2 Diagnosis of latent tuberculosis infection (LTBI) in immunocompromised adults. The appropriate method, either a combination of tuberculin skin test/interferon-gamma releasing assay (TST/IGRA) (A) or IGRA alone (B), should be chosen based on individual patient circumstances. The negative LTBI test is not recommended with TST alone, but a positive TST alone can be diagnosed as LTBI. TB, tuberculosis.

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