Abstract
Background and Aim
Despite the increasing use of biologic therapies, there is no consensus on screening for latent TB infection (LTBI) in the UK. Given the significant threat that reactivated TB poses to immunosuppressed individuals, the risk of LTBI must be accurately assessed before immunosuppression. Currently, risk assessments are performed by non-TB specialists, with consequent variability. We aimed to review LTBI screening practices linked to a regional TB service in south-west England.
Methods
From January 2023 we retrospectively reviewed clinical notes for 77 patients commencing biologics under four specialties. Having mapped national specialty guidance on pre-biologic TB screening, we evaluated LTBI risk assessments against these, alongside 2005 British Thoracic Society guidance and current best practice in screening, considering clinical, radiological and laboratory parameters.
Results
We found widespread variability between guidance, particularly advice on symptom screening and immunological testing. In practice, risk assessments were poorly evidenced, including demographic risk factors and symptoms, with 15 patients having symptoms which would be consistent with active TB disease prior to biologics. 75 patients (97%) had chest imaging, with 69 (90%) undergoing immunological testing regardless of risk factors. One patient was referred to TB services and received LTBI therapy, however eight (10%) further patients had findings warranting referral.
Conclusion
LTBI screening practices were widely variable, directed by discrepant specialty guidance. Without consensus, current screening practices risk missing opportunities to treat patients at a critical phase before immunosuppression.
Despite the increasing use of biologic therapies, there is no consensus on screening for latent TB infection (LTBI) in the UK. Given the significant threat that reactivated TB poses to immunosuppressed individuals, the risk of LTBI must be accurately assessed before immunosuppression. Currently, risk assessments are performed by non-TB specialists, with consequent variability. We aimed to review LTBI screening practices linked to a regional TB service in south-west England.
Methods
From January 2023 we retrospectively reviewed clinical notes for 77 patients commencing biologics under four specialties. Having mapped national specialty guidance on pre-biologic TB screening, we evaluated LTBI risk assessments against these, alongside 2005 British Thoracic Society guidance and current best practice in screening, considering clinical, radiological and laboratory parameters.
Results
We found widespread variability between guidance, particularly advice on symptom screening and immunological testing. In practice, risk assessments were poorly evidenced, including demographic risk factors and symptoms, with 15 patients having symptoms which would be consistent with active TB disease prior to biologics. 75 patients (97%) had chest imaging, with 69 (90%) undergoing immunological testing regardless of risk factors. One patient was referred to TB services and received LTBI therapy, however eight (10%) further patients had findings warranting referral.
Conclusion
LTBI screening practices were widely variable, directed by discrepant specialty guidance. Without consensus, current screening practices risk missing opportunities to treat patients at a critical phase before immunosuppression.
Original language | English |
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Publication status | Accepted/In press - 2024 |
Event | European Respiratory Congress 2024 - Vienna, Austria, Vienna, Austria Duration: 7 Sept 2024 → 11 Sept 2024 |
Conference
Conference | European Respiratory Congress 2024 |
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Abbreviated title | ERS Congress 2024 |
Country/Territory | Austria |
City | Vienna |
Period | 7/09/24 → 11/09/24 |
Keywords
- Tuberculosis
- Screening
- Infection
- latent tuberculosis