Time to update guidelines on screening for latent tuberculosis infection in dermatologic patients being treated with tumor necrosis factor-alfa inhibitors

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Time to update guidelines on screening for latent tuberculosis infection in dermatologic patients being treated with tumor necrosis factor-alfa inhibitors Karynne O. Duncan, MD Journal of the American Academy of Dermatology Volume 72, Issue 4, Pages 741-743 (April 2015) DOI: 10.1016/j.jaad.2014.07.065 Copyright © 2014 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 2012 American College of Rheumatology's updated recommendations for tuberculosis (TB) screening in patients receiving biologic agents. Copyright 2012 by the American College of Rheumatology. Reprinted with permission. All rights reserved.4 Depending on a patient's current therapy, the management may begin at an appropriate rectangle in the figure, rather than only at the top of the figure. ∗Anergy panel testing is not recommended. †Interferon-γ–release assay (IGRA) is preferred if the patient has a history of BCG vaccination. ‡Risk factors for TB exposure (see Table I). §If the patient is immunosuppressed and false-negative results are more likely, consider repeating screening test(s) with tuberculin skin test (TST) or IGRA. ¶Chest radiograph may also be considered when clinically indicated in patients with risk factors, even with a negative repeated TST or IGRA. #Obtain respiratory (eg, sputum, bronchoalveolar lavage fluid) or other samples as clinically appropriate for acid-fast bacilli (AFB) smear and culture and consider referral to a TB specialist for further evaluation and treatment. ∗∗In a patient given a diagnosis of latent or active TB, consider referral to a specialist for the recommended treatment. ††Patients who test positive for TST or IGRA at baseline often remain positive for these tests even after successful treatment of TB. These patients need monitoring for clinical signs and symptoms of recurrent TB disease, because repeating tests will not allow help in diagnosis of recurrent TB. Journal of the American Academy of Dermatology 2015 72, 741-743DOI: (10.1016/j.jaad.2014.07.065) Copyright © 2014 American Academy of Dermatology, Inc. Terms and Conditions