Research

Tuberculosis in an inflammatory bowel disease cohort from South Africa

E Deetlefs, D Epstein, G A Watermeyer, R M Seggie, S R Thomson

Abstract


Background. Potent immunosuppressive therapy is standard treatment for inflammatory bowel disease (IBD) but carries a risk of reactivating latent tuberculosis (TB). No data exist on the burden of TB in South African patients with IBD.

Objective. To evaluate the burden of TB in IBD patients attending a large tertiary IBD clinic.

Methods. A retrospective analysis was performed on data pertaining to patients attending the Groote Schuur Hospital IBD clinic. Data were extracted from an existing IBD database, patient notes, the National Health Laboratory Services database and chest X-ray analysis.

Results. Of 614 patients, 72 (11.7%) were diagnosed with TB; 40 (55.6%) developed TB prior to the diagnosis of IBD. On regression analysis, coloured IBD patients were at increased risk for TB development (p=0.004, odds ratio (OR) 3.57, 95% confidence interval (CI) 1.49 - 8.56), as were patients with extensive Crohn’s disease (CD) compared with those with less extensive disease (p=0.001,OR 2.84, 95% CI 1.27 - 6.33). No other risk factors, including the use of immunosuppressive agents, were identified for the development of TB.

Conclusions. Of over 600 patients, 12% had TB either before or after IBD diagnosis. The high rate of previous TB and positive association with ethnicity probably reflects the high burden of TB in a socio-economically disadvantaged community. We recommend that IBD patients should be screened actively and monitored for TB when immunosuppressive medications are used.

Authors' affiliations

E Deetlefs,

D Epstein, Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town

G A Watermeyer, Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town

R M Seggie, Department of Radiology, University of Cape Town and Groote Schuur Hospital, Cape Town

S R Thomson, Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town

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Keywords

Tuberculosis, Inflammatory Bowel Disease; Crohn's disease; Ulcerative colitis;

Cite this article

South African Medical Journal 2012;102(10):802-804. DOI:10.7196/SAMJ.5609

Article History

Date submitted: 2012-01-12
Date published: 2012-09-07

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