Latent Tuberculosis In Patients Research Articles

Screening and treatment of latent tuberculosis in patients with solid tumors and systemic cancer therapy.

Tuberculosis is one of the infectious diseases with greater morbidity and mortality worldwide. Cancer causes an important immunosuppression with increased risk of infections. There is an enlarged bidirectional incidence between tuberculosis and cancer, mainly due to latent tuberculosis. There is great discrepancy between recommendations for screening and prophylaxis of latent tuberculosis in patients with solid tumors and systemic cancer therapy among different medical societies and guidelines. Most infectious diseases guidelines recommend it, while most oncology guidelines do not. Patients with solid tumours generally have a limited life expectancy and a state of intermittent immunosuppression, resulting in a lower risk of tuberculosis reactivation than other riskypopulations. There is a lack of prospective and retrospective studies analysing the benefit of screening and prophylaxis in this population. The first step is to study the incidence of active tuberculosis in this population to estimate the real magnitude of the problem.

Adverse events of biological agents in pediatric rheumatologic diseases

ABSTRACT Objectives To evaluate adverse events (AEs) in pediatric patients with rheumatologic diseases being treated with approved or off-label biologic agents (BAs). Methods This observational, retrospective, multicenter study was conducted from 2010 to 2022 in patients under 18 years of age with rheumatic diseases who were receiving interleukin-1 antibodies (Anti-IL1), interleukin-6 antibodies (Anti-IL6), and tumor necrosis factor alpha inhibitors (anti-TNF). Efficacy, AEs, and timing of AEs were collected from electronic medical records. Results Three hundred and fifteen BAs were prescribed to 237 patients. Fifty AEs occurred in 44 patients (18.6%). Anti-TNF exposure was present in 8 (72.2%) of 11 patients with latent tuberculosis (TB) and in all 7 patients with herpes infections. Four of 6 patients (66.7%) with recurrent upper respiratory tract infections and 7 of 8 patients (87.5%) with local skin reactions were on Anti-IL1. The cutoff value for latent TB development was determined as 23.5 months by ROC analysis (AUC: 0.684 ± 0.072, p = 0.038, 95% CI: 0.54–0.82). In patients who used BA for 23.5 months or more, the risk of latent TB was 5.94-fold (p = 0.024, 95% CI: 1.26–27.97). Drug rash with eosinophilia and systemic symptoms (DRESS) occurred in 2 patients on anakinra, and anaphylaxis occurred in 1 patient on anti-IL6. There were no cases of malignancy or death in any patient. Conclusion The physician should be vigilant for latent TB in patients exposed to BA for more than 2 years. While local skin reactions are more prevalent in patients receiving anti-IL1, severe skin reactions such as DRESS may also occur.

Latent tuberculosis in children and youth with type 1 diabetes mellitus in Dar es Salaam, Tanzania: a cross section survey

BackgroundData for latent tuberculosis in patients with type 1 Diabetes in Africa is limited. We assessed the prevalence of latent tuberculosis in youth and children with type 1 Diabetes in Dar es Salaam –Tanzania.MethodsOur cross-sectional study recruited children and youth with T1DM by stage of puberty, glycaemic control, and age at diagnosis from January to December 2021 in Dar es Salaam. Participants were screened for the presence of latent Tuberculosis using the QuantiFERON test. A positive test was considered to have latent TB.ResultsOf the 281 participants, the mean age was 19 (± 6) years, 51.2% were female, and 80.8% had either a primary or secondary level of education at baseline. The prevalence of latent TB was 14.9% and was slightly higher in females (52.4%) than in males. This difference, however, was insignificant (p > 0.05). On the other hand, the proportion of latent TB was significantly higher in uncontrolled HbA1c levels (76.2%) than in those with controlled HbA1c (23.8%) [p = 0.046]. Duration of diabetes and age at diagnosis did not affect the occurrence of latent Tuberculosis [p > 0.05]. Meanwhile, in the regression model, participants with latent TB were more likely to have uncontrolled HbA1c. [p = 0.045]ConclusionsDespite the methodological limitations, this survey highlights the high prevalence of latent TB among children and youth with diabetes; shouting for better control. These results clearly show the need to screen for Tuberculosis in children and youth with diabetes and start them on prevention as per protocol, especially in tuberculosis-endemic areas like Tanzania.

Frequency of latent tuberculosis in patients receiving Anti-TNF-Alpha therapy.

In this study, it was aimed to reveal the incidence of tuberculosis development in patients receiving tumor necrosis factor-alpha (TNF-α) blocker therapy, despite tuberculosis chemoprophylaxis. 520 patients who were receiving anti TNF-α treatment in the last 3 years were evaluated retrospectively. Radiological imaging tuberculin skin test (TST), history of tuberculosis, BCG vaccine, chemoprophylaxis administration, used anti TNF-α drugs were recorded. There were 265(51.0%) of the patients with ankylosing spondylitis (AS), 175(33.7%) with rheumatoid arthritis, 35(6.7%) with Crohn's, 10(1.9%) with ulcerative colitis (UC), 21(4.0%) with psoriatic arthritis, 14(2.7%) with psoriasis vulgaris. In total, 455 (79.6%) patients were given INH prophylaxis. Active tuberculosis development was observed in five patients (4: pulmonary,1: extrapulmonary; 3: UC, 2:AS) who all received anti TNF-α treatment (0.96%), infliximab. Three patients had tuberculosis disease in the 6th month, and the other 2 patients in the 5th and 24th month of their anti TNF-α treatments, and two had 9-month, and 1 had 6-month chemoprophylaxis history. The incidence of tuberculosis development in patients treated with anti TNF-α was found to be higher than the general population. In our country, where tuberculosis is still prevalent, patients receiving Anti TNF-α treatment (especially infliximab) should be carefully questioned and examined about tuberculosis.

Disseminated Tuberculosis in Patients on Biotherapy for Inflammatory Bowel Disease About 2 Cases

No one can deny that biological therapy using TNF-a inhibitors has revolutionized not only the management and outcomes of inflammatory bowel disease, but many dermatological and rheumatological diseases as well. Unfortunately, this biological therapy is also associated with an increased risk of opportunistic infections, including active tuberculosis. A risk that cannot be ignored, especially in countries with a high incidence of tuberculosis like Morocco. Here, two cases are presented of patients with crohn's disease on biological therapy who developed a very aggressive form of disseminated tuberculosis. It is therefore imperative to screen for latent tuberculosis in patients who are candidates for biotherapy, and also to ensure close monitoring throughout the treatment period.

Miliary Tuberculosis in a Patient With Ulcerative Colitis Treated With Tofacitinib

ABSTRACT Immunosuppression with tumor necrosis factor-alpha inhibitors and tofacitinib is a risk factor for reactivation of latent tuberculosis (TB) and the development of active TB. We report a case of miliary TB in a patient on treatment with tofacitinib for active ulcerative colitis. By week 4 of therapy, a clinical response was achieved. Subsequently, although being on treatment, the patient started having fever with night sweats and myalgias. The investigative workup revealed pulmonary miliary TB. Tofacitinib was withdrawn, and antitubercular therapy was initiated. The patient responded, both clinically and radiologically, to the antitubercular therapy. This case report highlights the importance of screening for latent TB in patients receiving tofacitinib.

Latent tuberculosis in adult hematopoietic stem cell transplantation recipients: Clinical experience from a previously endemic population.

Hematopoietic stem cell transplantation (HSCT) recipients may be at an elevated risk of developing active tuberculosis infection due to suppression in the cellular immune system. Herein, we aimed to evaluate the prevalence of latent tuberculosis and active tuberculosis in patients with allogeneic and autologous HSCT. In this cohort, data were obtained retrospectively from patients' records. The patients who were followed up in the bone marrow transplantation unit of the University of Health Sciences Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital between January 2016 and December 2019 were screened for the study. And the HSCT recipients who had tuberculin skin test and/or QuantiFERON-TB gold (QFT-GIT) test results were included in the study. A total of 361 patients were included in the study, 227 patients had autologous HSCT, and 134 patients had allogeneic HSCT. QFT-GIT was performed in 10 patients with allogeneic HSCT, and it was found positive in only 1 patient. Tuberculin skin test ≥5 mm was accepted as positive and was accepted to have latent tuberculosis, and it was positive in 18.2% (41) of the patients with autologous HSCT and was positive in 21.6% (29) of the patients with allogeneic HSCT. There was no significant difference between the 2 groups (P = .429). Isoniazid (INH) prophylaxis was started in 16.7% of patients with autologous HSCT and 22.4% of patients with allogeneic HSCT. During follow-up, active tuberculosis did not develop in any patients in both groups. There was no statistically significant difference found between allogeneic and autologous HSCT recipients regarding the prevalence of latent tuberculosis. Active tuberculosis infection did not develop in any of the patients who started INH prophylaxis. INH prophylaxis seems to be very efficient in preventing the reactivation of latent tuberculosis in patients going through allogeneic HSCT and/or autologous HSCT.

Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management.

SummaryBackgroundOne quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune‐based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence.AimTo review the screening, diagnostic practices and medical management of LTBI in patients with IBD.MethodsPublished literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD.ResultsScreening for LTBI should be performed proactively and includes assessment of risk factors, an interferon‐gamma releasing assay or tuberculin skin test and chest X‐ray. LTBI treatment in patients with IBD is scenario‐dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD.ConclusionsProactive screening for LTBI is essential in patients with IBD undergoing immune‐suppressing therapy and several therapeutic strategies are available. Reporting of real‐world experience is essential to refining current management recommendations.

P242 Latent Tuberculosis: frequency of occurrence and effect on clinical, laboratory, endoscopic and morphological activity of the course Inflammatory Bowel Diseases

Abstract Background Early diagnosis of tuberculosis remains challenging due to the nonspecific clinical manifestations that can mimic other gastrointestinal diseases and range from acute to chronic abdominal disease. In recent decades, latent tuberculosis (LTI) has been of particular interest. Patients with inflammatory bowel disease (IBD) are at risk of contracting tuberculosis. Aim to identify the incidence of LTI in patients with IBD and its effect on the clinical, laboratory, endoscopic and morphological activity of IBD. Methods The study included 350 patients with IBD, who were monitored and a group of patients (188 people (UC = 80, CD = 101, MC = 7) who did not respond / or poorly respond to basic IBD therapy were identified. In this group, the determination of the quantiferon test was carried out. To achieve this goal, two main hypotheses were considered: assessment of IBD-associated and systemic vascular lesions (h/s CRP, platelet count, homocysteine, vit D, urine albumin, fecal calprotectin and lactoferrin; α-TNF, IL-1,IL-2,IL-4,IL-6,IL-8,IL-10,IL-18; endoscopic examination with pathomorphological assessment), assessment of changes in the thickness of the vascular intima and blood flow velocity (based on the doppler determination of the pulse wave velocity (PWV) and the thickness of the intima media (CIMT) on the common carotid, vertebral and subclavian arteries). Results The number of positive responses to the quantiferon test was found in 37 patients (19.7%) / 10.6%) out of 188 patients (53.7%); positive skin tests (Mantoux reaction) ≥5 mm in 78 (22.3%) patients; altered peritoneal lymph nodes in 28 (8%), pulmonary and pleural TB in 9 (2.57%) patients. There were no patients with intestinal TB / “+” TB PCR in the gastrointestinal tract tissue. The prevalence of positive cases according to the quantiferon test was: in the general group of patients - 10.6%. Laboratory indicators for both IBD and systemic vascular lesions were higher in the group of patients with latent tuberculosis (Table 1, Table 2). Damage to the vascular bed (based on doppler determination of pulse wave velocity (PWV) and intimal thickness (CIMT) on the common carotid, vertebral and subclavian arteries) was more pronounced in the group of patients with latent tuberculosis (CIMT (mm) 0.68 ± 0, 1 / 0.67 ± 0.2; PWV (sm / s) 93.3 ± 2.2 / 97.2 ± 1.4). Conclusion Conclusion. Comparing the results of the data before and after the treatment of latent TB in patients with IBD, certain dependences of the influence of infection on the course of IBD (h/s CRP, platelet levels, homocysteine, fecal calprotetin and lactoferrin, IL-8 and a decreased vit. D; changes, associated with damage to the vascular bed), endoscopic and morphological activity.

Prevalence of latent tuberculosis in patients with hematological neoplasms in a cancer referral hospital in Mexico City

ObjectiveTo determine the prevalence of Latent Tuberculosis in patients with hematological neoplasms at the Instituto Nacional de Cancerología in Mexico City using the Tuberculin skin test (TST).MethodsThis retrospective study included all patients with a recent diagnosis of hematological neoplasms who were admitted for treatment from 2017 to 2018 and who were screened for latent tuberculosis with the TST. The prevalence of latent tuberculosis in this group, tolerance and therapeutic adherence in treated patients are described.ResultsThe files of 446 patients with hematological malignancy who had a TST were reviewed. The prevalence of latent tuberculosis was 31.2% (n = 139). Ninety-three patients received isoniazid, 15.1% had some adverse reactions, but only 4 (4.3%) had to discontinue treatment. Two patients with latent tuberculosis under treatment with Isoniazid reactivated tuberculosis infection.ConclusionsThe prevalence in our study was within the range of other similar Mexican populations. Isoniazid treatment had an adequate tolerance and adherence. Longer follow-up could offer more information on the risk of reactivation in both groups.

A prospective cohort study comparing the performance of interferon gamma release assays in autoimmune skin diseases

A prospective cohort study comparing the performance of interferon gamma release assays in autoimmune skin diseases

Interferon-gamma assay and tuberculin skin test for screening of latent tuberculosis in patients with inflammatory bowel disease: a summarization study

Background Latent tuberculosis is an important clinical problem. This problem might be significant in some specific groups of patients. The screening for latent tuberculosis is recommended for management of those patients at risk. An important group to be screened is patients with inflammatory bowel disease. Materials and methods This work is a retrospective study. The summarization on the available data from published articles on the comparative study between interferon-gamma assay and tuberculin skin test for screening for latent tuberculosis in inflammatory bowel disease patients was done. The pooled detection rate was calculated for using interferon-gamma assay and tuberculin skin test in screening for latent tuberculosis in patients with inflammatory bowel disease. Results The pooled detection rates for using tuberculin skin test and interferon-gamma assay in screening for latent tuberculosis in patients with inflammatory bowel disease are equal to 11.67% (95% confidence interval=10.33–13.19%) and 14.64% (95% confidence interval=13.16–16.30%), respectively. Conclusion It can be shown that interferon-gamma assay has a better efficacy in detection of latent tuberculosis among the patients with inflammatory bowel disease.

Prevalence of latent tuberculosis and associated factors in patients with chronic kidney disease on hemodialysis.

Objective:to identify the prevalence of latent tuberculosis in patients with chronic kidney disease on hemodialysis and associated factors.Method:a cross-sectional study conducted with 176 patients with chronic kidney disease on hemodialysis. The tuberculin test was performed with the standardized antigen, distributed by the Brazilian Ministry of Health, and the reading occurred after 72 to 96 hours of the application. An association test (Chi-square, Fisher’s exact), prevalence ratio, and multivariate regression tests were performed.Results:the prevalence of latent tuberculosis diagnosed through Tuberculosis Skin Test was 8.5% (15/176). The “has/has had diabetes” (aOR: 0.117; 95%CI: 0.015-0.92) and “having regular garbage collection (aOR: 0.076; 95%CI: 0.008-0.702) factors were associated with a lower probability of having a Positive skin test.Conclusion:the low prevalence of latent tuberculosis identified and the factors associated with it reinforce the need for screening for latent tuberculosis infection for diabetics combined with an analysis of previous risk factors and comorbidities.

Increasing screening for latent tuberculosis in patients with hematologic malignancy: A quality improvement project.

264 Background: Latent tuberculosis infection (LBTI) affects about one quarter of the world population. Treating LTBI is the most effective way of preventing active TB. Patients with hematologic malignancy (HM) and LTBI are at heightened risk (2-40 times baseline) of progressing to active TB. Universal TB screening is recommended for this population. In 2016, a patient receiving chemotherapy for myeloma at our center developed active TB. This triggered an intensive contact tracing investigation involving local public health units, infection control, and specialists. Over 800 patients had one or more exposures to the index case. No cases of secondary TB were identified; however, the contact tracing was resource intensive and stressful for patients and staff. This project aims to prevent future incidents by developing a standardized process for completing and documenting TBSTs, ensuring LTBIs are identified and managed prior to systemic therapy for HM. We aimed to complete and document TBSTs in ≥85% of patients starting systemic therapy for HM by Feb 2018. Methods: Baseline data was determined via retrospective review of 25 patients receiving chemotherapy for HM Jul-Nov 2017. An order set, work flow process map and standard operating procedure were created over a series of plan-do-study act cycles. TBST was added to a pre-existing “ready for treatment” checklist employed by pharmacists at our site. When pharmacists could find no record of a TBST result prior to treatment, the treating physician was notified. The go-live date was Aug 15, 2018. The impact of change was evaluated via chart review of patients who started chemotherapy for HM between Aug 27, 2018-Feb 27, 2019. Results: Prior to implementation of the standardized process, 3/25 patients (12%) had documentation of prior TBST. Following implementation of the standardized process, 14/30 patients (47%) had documentation of TBST prior to starting systemic therapy for HM. All 14 patients had negative TBSTs. Conclusions: Developing a standardized process for ordering, completing, and documenting TBST for patients starting systemic therapy for HM is feasible and effective. Additional revisions of the process are required to meet our target.

Screening for latent tuberculosis in patients with inflammatory bowel disease under antitumor necrosis factor: data from a Portuguese center

Portugal is one of the countries with the highest tuberculosis (TB) burden in the European Union. Patients who are receiving antitumor necrosis factor (TNF) treatment should be screened and treated for latent tuberculosis infection (LTBI). This study aimed to evaluate the prevalence of LTBI and the number of active TB cases in patients with inflammatory bowel disease (IBD) treated with anti-TNF agents. This was a retrospective study from a Portuguese center that included patients with IBD who started anti-TNF treatment between 2013 and 2017. LTBI screening was considered positive in case of positive tuberculin skin test, positive/indeterminate interferon gamma release test, or history of exposure to TB irrespective of the results of the screening. One hundred and seventeen patients were included, 56% female, mean age 40 years; 91% had Crohn's disease; infliximab was initiated in 79%, adalimumab in 21%, and golimumab in 1%. Of these, 37 (32%) presented LTBI - tuberculin skin test was positive in 18 (49%) patients; interferon gamma release test was positive in 14 (38%) patients and undetermined in seven (19%); and there was a history of exposure in 12 (32%) patients. All patients screened with LTBI were on isoniazid for 9 months. During follow-up (mean 21.6 months), one patient under infliximab developed pleural TB 5 years after receiving treatment with isoniazid. None of the patients with negative LTBI screening developed active TB. In this sample of patients with IBD, the prevalence of LTBI before starting anti-TNF treatment was significant (32%), but only one patient had active TB after LTBI treatment.

Prevalence of Latent Tuberculosis in Patients Undergoing Hematopoietic Stem Cell Transplantation and Risk of Disease Activation in an Endemic Population

Introduction Latent tuberculosis infection (LTBI) affects one third of the worldOs population. It is well known that patients with immunodeficiency are at a higher risk of developing active tuberculosis (ATBI). Hematopoietic stem cell transplant (HSCT) recipients have and incidence of ATBI 10 to 40 times higher when compared to general population, related to high morbidity and mortality. Objectives Our aim was to determine prevalence of LTBI and incidence of ATBI in recipients and donors of HSCT living in an endemic country. Methods We retrospectively analyzed clinical data of patients that underwent HSCT between January 2010 and December 2016 at our Institution. Results We included 200 patients, 63 allogeneic-HSCT (allo-HSCT) recipients, 74 autologous-HSCT (auto-HSCT) recipients, and 63 HSCT donors. Median age was 36 years (11-68) and 57.5% were male (n=115). Main baseline diagnosis that led to HSCT were: acute leukemia in 27.7%, lymphoma in 23.4%, and monoclonal gammopathy in 20.4% (figure 2). The source of HSCT was peripheral blood (PB) in 83 patients, bone marrow (BM) in 21, and primed-BM in 21 patients. Allo-HSCT donors were matched-related (MRD) in 85.7%, matched unrelated (MUD) in 6.3%, and haploidentical in 9%. All patients were evaluated pre-HSCT with tuberculin skin test (TST) and chest x-ray. Patients with positive TST (n=54) were further evaluated to rule out ATBI with chest-CT (n=54) and smear and culture in either sputum (n=28), gastric fluid (n=16), and urine (n=27), with no positive results. Rates of LTBI were 17% in all-HSCT recipients, 24% in auto-HSCT, and 39% in donors. All patients diagnosed with latent tuberculosis received treatment with isoniazid 300mg for at least 6 months. Interestingly, any patient developed ATBI after transplantation. According to state of residence, most cases were detected in states were lower socioeconomic status and related to migration corridors (Figure 1). Conclusions To our knowledge, this is the first study that evaluates the prevalence of LTBI among HSCT recipients in a Latin American country where TB is endemic. We identified a prevalence of LTBI similar to the estimations of the WHO, however, unlike other published reports from developed and developing countries we have no incidence of active tuberculosis in our population despite Mexico is an endemic country. Figure 1 Cases distribution according patients state of residence.

Evaluating results of an interferon-γ release assay in patients with autoimmune disease who are taking hydroxychloroquine

Evaluating results of an interferon-γ release assay in patients with autoimmune disease who are taking hydroxychloroquine

A Study of Optimal Screening for Latent Tuberculosis in Patients with Inflammatory Bowel Disease

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.

Diagnosis and treatment of latent tuberculosis in patients with multiple sclerosis, expert consensus. On behalf of the Colombian Association of Neurology, Committee of Multiple Sclerosis.

BackgroundMultiple sclerosis is an inflammatory and neurodegenerative demyelinating disease. Current treatment of multiple sclerosis focuses on the use of immunomodulatory, immunosuppressant, and selective immunosuppressant agents. Some of these medications may result in high risk of opportunistic infections including tuberculosis.ObjectiveThe purpose of this study was to obtain consensus from a panel of neurologists, pulmonologists, infectious disease specialists, and epidemiology experts regarding the diagnosis, treatment, and monitoring of latent tuberculosis in patients with multiple sclerosis.MethodsA panel of experts in multiple sclerosis and tuberculosis was established. The methodological process was performed in three phases: definition of questions, answer using Delphi methodology, and the discussion of questions not agreed.ResultsTuberculosis screening is suggested when multiple sclerosis drugs are prescribed. The recommended tests for latent tuberculosis are tuberculin and interferon gamma release test. When an anti-tuberculosis treatment is indicated, monitoring should be performed to determine liver enzyme values with consideration of age as well as comorbid conditions such as a history of alcoholism, age, obesity, concomitant hepatotoxic drugs, and history of liver disease.ConclusionLatent tuberculosis should be considered in patients with multiple sclerosis who are going to be treated with immunomodulatory and immunosuppressant medications. Transaminase level monitoring is required on a periodic basis depending on clinical and laboratory characteristics. In addition to the liver impairment, other side effects should be considered when Isoniazid is prescribed.

Latent tuberculosis in patients with hepatitis C infection before receiving antiretroviral drugs

Aim of the work Studying the prevalence of latent TB infection among people infected with hepatitis C virus for preventing emergence of active tuberclous disease during treatment of hepatitis C virus with antiviral drugs that cause immunosuppression. Patients and method The study was performed on 75 patients who were divided into two groups ; group A (hepatitis C group) which was 45 patients and group B (control group) which was 30 patients. A written consent was taken from patents who underwent the study. Patients underwent: 1. History taking. 2. Examination: general and local chest examination. 3. Radiology: chest x-ray. 4. tuberculin skin test with (PPD) 5. QuantiFERON TB testing (interferon gamma release assay {IGRA}). Results The mean age of (54.9±10.23) in group A (hepatitis C group) and (61.1±9.2) in group B (control group). In group A there are 30 males (66.7%) and 15 females (33.3%) while in group B there are 16 males (53.3%) and 14 females (46.7%) with no significance difference between the two groups. In group A there are 9 patients (20%) with positive tuberculin test and 36 patients with negative test while in group B there are 4 patients (13.3%) with positive test and 26 patients (86.7%) with negative test . there is no significant difference between the two groups regarding tuberculin test. Regarding QuantiFERON TB Gold test, In group A there are 15 patients (33.3%) with positive test and 30 patients (66,7%) with negative test while in group B there is 4 patients (13.3%) with positive test and 26 patients (86.7%) with negative test. There is significant difference between the studied groups regarding QuantiFERON TB gold test. Summary and conclusion People infected with hepatitis C virus should undergo testing for latent TB for preventing emergence of active tuberculous disease during treatment of hepatitis C virus with antiviral drugs that cause immunosuppression. QuantiFERON test is preferred more than tuberculin test in detecting latent TB in patient with hepatitis C because tuberculin test may be falsely negative in patient with immunosuppression and hepatic patients which may give unreliable results.