Review

. 2022 Jul;56(1):6-27.

doi: 10.1111/apt.16952. Epub 2022 May 20.

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

Sasha R Fehily^{1

2}, Aysha H Al-Ani^{2

3}, Jonathan Abdelmalak⁴, Clarissa Rentch³, Eva Zhang³, Justin T Denholm^{2

5

6

7}, Douglas Johnson^{2

5}, Siew C Ng⁸, Vishal Sharma⁹, David T Rubin¹⁰, Peter R Gibson¹¹, Britt Christensen^{2

3}

Affiliations

¹ Gastroenterology Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
² Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
³ Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁴ Gastroenterology Department, Alfred Hospital, Melbourne, Victoria, Australia.
⁵ Infectious Diseases Department, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁶ Victorian Tuberculosis Program, Melbourne, Victoria, Australia.
⁷ Department of Infectious Diseases, Doherty Institute, Parkville, Victoria, Australia.
⁸ Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁹ Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹⁰ University of Chicago Medicine Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
¹¹ Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia.

PMID: 35596242
PMCID: PMC9325436
DOI: 10.1111/apt.16952

Review

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

Sasha R Fehily et al. Aliment Pharmacol Ther. 2022 Jul.

. 2022 Jul;56(1):6-27.

doi: 10.1111/apt.16952. Epub 2022 May 20.

Authors

Affiliations

¹ Gastroenterology Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
² Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
³ Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁴ Gastroenterology Department, Alfred Hospital, Melbourne, Victoria, Australia.
⁵ Infectious Diseases Department, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁶ Victorian Tuberculosis Program, Melbourne, Victoria, Australia.
⁷ Department of Infectious Diseases, Doherty Institute, Parkville, Victoria, Australia.
⁸ Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁹ Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹⁰ University of Chicago Medicine Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
¹¹ Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia.

PMID: 35596242
PMCID: PMC9325436
DOI: 10.1111/apt.16952

Abstract

Background: One 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.

Aim: To review the screening, diagnostic practices and medical management of LTBI in patients with IBD.

Methods: Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD.

Results: Screening 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.

Conclusions: Proactive 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.

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Figures

**FIGURE 1**
Estimated incidence rates of TB. Adapted from https://www.who.int/publications/digital/global‐tuberculosis‐report‐2021/tb‐disease‐burden/incidence Figure 2.1.5. World Health Organisation; 2021. License: CC BY‐NC‐SA 3.0 IGO

**FIGURE 2**
Detection of LTBI in IBD patients. (a) Detection of LTBI in non‐endemic areas. (b) Detection of LTBI in endemic areas

**FIGURE 3**
Initiation of immunosuppressive treatment with LTBI in IBD

See this image and copyright information in PMC

Comment in

Letter: Ozanimod and latent tuberculosis.
Alaskar D, AlMusa Z, AlAmeel T. Alaskar D, et al. Aliment Pharmacol Ther. 2023 Feb;57(3):353-354. doi: 10.1111/apt.17311. Aliment Pharmacol Ther. 2023. PMID: 36641788 No abstract available.

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

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

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