Abstract
Introduction: Detecion of latent tuberculosis (LTB) is important before stating immunosupression or biological agents in patients with inflammatory bowel disease (IBD). The purified protein derivative (PPD) skin test is the most widely used method which detect LTB. Since the introduction immunosupression and biological treatment in IBD many cases of tuberculosis (TBC) have been observed. Especially in populations with high prevalence. Most of these cases occur in the first months of treatment suggesting reactivation of LTB. Objective: To evaluate the response to PPD in patients with IBD and to compare it with that of control subjects. Methods: We evaluated a total 44 IBD patients (25 patients with Crohn’s disease, 16 patients with ulcerative colitis and 2 patients with indeterminate colitis), 14 men and 30 women. None of the patients were using immunosuppressives nor biological agents. Forty-six healthy controls (10 men and 36 women) were included. PPD 5 U was applied using the Mantoux method, and skin reaction was measured at 72 hours. The reaction was considered positive if induration was 5mm. Results: There were no signifant differences in age, sex, history of Bacille Camette-Guerin vaccination between two groups. The median size of the PPD induration in patients with IBD was significantly less than that in the control group (7.5 vs 12.3mm, p 0.05). There were significantly more anergic tests in pateints with IBD than in control (29.5% vs 13%, p < 0.05). Conclusion: In Turkey where tuberculosis is relatively frequent, we observed a lower frequency of PPD positivity and high incidence of anergy in IBD patients compared to controls. T-lymphocyte mediated immunity defects in IBD patients, especially in Crohn’s disease may explain the lower frequency of PPD positivity in these patients. In IBD patients, other than PPD test, new screening methods needed to evaluate latent TBC before starting immunosupressive or biological treatments.
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