Latent tuberculosis infection in psoriasis patients

Abstract

Aims: Psoriasis is a chronic, inflammatory, and life-long skin disease. Patients may need to change the treatment regimen by time due to the course of the disease. According to the guidelines, patients should be screened for latent tuberculosis infection (LTBI) before starting treatment with biological agents. We aimed to evaluate the associations between positive interferon-gamma release assay (IGRA) tests, the chest CT findings and inflammatory blood markers of the psoriasis patients who have undergone screening for LTBI before starting systemic treatment with biological agents or conventional options. Methods: The electronic medical records, Chest CT reports and blood tests of 123 consecutive patients with a diagnosis of psoriasis who were candidates for systemic treatment (methotrexate, cyclosporin and biological agents) and screened for LTBI were examined. Results: The mean age of the patients was 49.24 and 64 (52%) of them were males. 37(30%) had a family history of tuberculosis 103(83%) of them had BCG vaccination scars. 59% had radiological features on their Chest CT scans. 28% of the patients had positive Quantiferon test results. When compared to the Quantiferon negative group, there was no difference between the two groups according to demographic characteristics, comorbidities, family history of tuberculosis, BCG vaccination status, smoking habits, occupation, and qualification details (p>0.05). The values of WBC, neutrophils, lymphocyte, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, systemic inflammation index and erythrocyte sedimentation rates were found statistically higher in the patients with positive Quantiferon test (p<0.05). Conclusion: The patients with psoriasis requiring systemic treatment and having positive IGRA test results have increased levels of inflammation. Psoriasis and LTBI might have a synergistic action in the inflammatory response which necessitates further studies to find out the associations between these two entities.

Keywords

• latent TB
• psoriasis
• quantiferon
• lung
• chest CT

References

1. Rendón A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20(6):1475. doi.org/10.3390/ijms20061475
2. Brajac I, Gruber F. History of psoriasis. In InTech eBooks. 2012. doi.org/10.5772/27640
3. Smith C, Jabbar‐Lopez ZK, Yiu ZZN, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017. Br J Dermatol. 2017;177(3):628-636. doi.org/10.1111/bjd.15665
4. Herzog H. History of tuberculosis. Respiration, 1998;65(1):5-15. doi.org/10.1159/000029220
5. Programme, G. T. Global tuberculosis report 2021. 2021. https://www.who.int/publications/i/item/9789240037021
6. Türkiye’de Verem Savaşı 2020 Raporu. https://hsgm.saglik.gov.tr/tr/tuberkuloz-haberler/turkiye-deverem-savasi.html. Access date:10.03.21
7. Salgame P, Geadas C, Collins LF, Jones-López EC, Ellner JJ. Latent tuberculosis infection - revisiting and revising concepts. Tuberculosis. 2015;95(4):373-384. doi.org/10.1016/j.tube.2015.04.003
8. Stop TB Field guide 6: Using Contact Investigation to Improve TB Case Detection, (2018). https://stoptbstrategicinitiative.org/elearning/wpcontent/uploads/2019/04/STBFG_06.pdf Access date: 25.10.2019

9. Tuberculosis. (2023, April 21). Available at: https://www.who.int/features/qa/08/en/
10. Barcellini L, Borroni E, Brown J, et al. First independent evaluation of QuantiFERON-TB Plus performance. Eur Respir J. 2016;47(5);1587-1590. doi.org/10.1183/13993003.02033-2015
11. Kodali N, Blanchard I, Kunamneni S, Lebwohl M. Current management of generalized pustular psoriasis. Experim Dermatol. 2023;32(8):1204-1218. https://doi.org/10.1111/exd.14765
12. Jonas DE, Riley S, Lee LC, et al. Screening for latent tuberculosis infection in adults. JAMA. 2023;329(17):1495. doi.org/10.1001/jama.2023.3954
13. Feng P, Horne D, Wortham JM, Katz D. Trends in tuberculosis clinicians’ adoption of short-course regimens for latent tuberculosis infection. J Clin Tuberc Other Mycobact Dis. 2023;33:100382. doi.org/10.1016/j.jctube.2023.100382
14. Mangione CM, Barry MJ, Nicholson WK, et al. Screening for latent tuberculosis infection in adults. JAMA. 2023:329(17):1487. doi.org/10.1001/jama.2023.4899
15. Ghesani N, Patrawalla A, Lardizabal A, Salgame P, Fennelly KP. Increased cellular activity in thoracic lymph nodes in early human latent tuberculosis infection. Am J Respir Crit Care Med. 2014;189(6):748-750. doi.org/10.1164/rccm.201311-1976le
16. Wallis RS, Kim P, Cole ST, et al. (2013). Tuberculosis biomarkers discovery: developments, needs, and challenges. Lancet Infect Dis. 2013;13(4):362-372. doi.org/10.1016/s1473-3099(13)70034-3
17. Akinshipe BO, Yusuf EO, Ehiaghe FA, Egunjobi TO, Yusuf OA. Elevated high-sensitivity C-reactive protein among apparently healthy adults with concomitant prediabetes and latent tuberculosis infection in Nigeria. Int J Res Med Sci. 2021;9(2):338. doi.org/10.18203/2320-6012.ijrms20210407
18. Katakura S, Kobayashi N, Hashimoto H, et al. Identification of a novel biomarker based on lymphocyte count, albumin level, and TBAg/PHA ratio for differentiation between active and latent tuberculosis infection in Japan. Tuberculosis. 2020;125:101992. doi.org/10.1016/j.tube.2020.101992
19. Moore N, Maher M, Murphy G, Maher MC, O’Connor OJ, McEntee MF. CT in the detection of latent tuberculosis: a systematic review. Clin Radiol. 2023;78(8);p568-575.
20. Polat M, Buğdaycı G, Kaya H, Oğuzman H. Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in Turkish patients with chronic plaque psoriasis. Acta Dermatovenerologica Alpina, Pannonica Et Adriatica. 2017;26(4):97-101. doi.org/10.15570/actaapa.2017.28
21. Lagunas-Alvarado M, Mijangos-Huesca FJ, Terán-González JÓ, et al. Systemic immune inflammatory index in sepsis. índice de inmunidad-inflamación sistémica en sepsis. Med Interna México, 2017;33(3):303-309.
22. Yorulmaz A, Hayran Y, Akpınar Ü, Yalçın B. Systemic Immune-Inflammation Index (SII) predicts increased severity in psoriasis and psoriatic arthritis. Curr Health Sci J. 2020;46(4):352-357. doi.org/10.12865/chsj.46.04.05
23. Rota DD, Tanacan E. The utility of systemic‐immune inflammation index for predicting the disease activation in patients with psoriasis. Int J Clin Pract. 2021;75(6):e14101 doi.org/10.1111/ijcp.14101