Abstract
Background: Increased use of steroids for treatment of autoimmune and other respiratory disorders poses a danger of reactivation of tuberculosis. Patients receiving immunosuppression (non-antiTNF) are generally offered a baseline CXR only. This potential susceptibility was investigated further.
Results: Our TB service treats 250 patients/year. Over 24 months, 4 patients requiring steroid therapy for primary lung pathology developed TB. 24 patients with no lung pathology were matched.
TB/Steroids
Only 2 cases of TB have been detected in patients given steroids for a non-pulmonary cause.
Discussion: A previous meta-analysis had concluded TB occurred more frequently in patients receiving steroids but wasnt statistically significant.[J Intern Med 1994;236:619]. Specifically a prospective study in steroids for lung disease had commented on an incidence of 4.9%. [J Ass Phys Ind 2000;48:881].
In our centre, reactivation was limited to patients with underlying chronic lung pathology, of ethnic origin not born in UK.
Conclusion: The incidence of TB among patients on steroids for lung pathology, born in areas of high incidence is unacceptably high and it seems prudent to investigate and treat them for latent tuberculosis before embarking on steroid therapy. This is particularly relevant for respiratory departments who deal with a high proportion of ethnic population. Further case controlled propective evidence is required to define this relationship.
- © 2011 ERS
