Frequency of pulmonary tuberculosis in patients with skin diseases requiring high dose long-term systemic steroid therapy
Keywords:
Frequency, tuberculosis, steroidsAbstract
Objective To determine the frequency of pulmonary tuberculosis in patients with skin diseases requiring high dose long-term systemic steroid therapy. Patients and methods This cross-sectional study was conducted in the Department of Dermatology Unit-II, Mayo Hospital, Lahore. Newly diagnosed patients of skin disease were screened for tuberculosis and then followed up after 6 weeks, 3 months and 6 months to evaluate pulmonary tuberculosis while patients were on high dose systemic steroids. At each visit, history, examination and screening tests for tuberculosis were performed which included sputum smear for acid-fast bacilli (AFB), chest radiograph and sputum culture for AFB. Results Out of fifty patients, who were on high dose long-term systemic steroid therapy, four patients (8%) developed pulmonary tuberculosis after a period of three months (P=0.0001). Conclusion Patients on high dose long-term systemic steroid therapy can develop pulmonary tuberculosis.References
Raviglione MC, O'Brien RJ. Tuberculosis. In: Kasper DL, Braunwald E, Fauci AS, et al., eds. Harrison's Principles of Internal Medicine, 16th ed. New York: McGraw-Hill; 2005. P.953-66.
World Health Organization. Tuberculosis Fact sheet N 104 - Global and regional incidence. Revised November 2010. Cited online on 10.12.2010. URL:http://www.who.int/mediacentre/ factsheets/fs104/en/index.html
Global tuberculosis control WHO report 2010. World Health Organization WHO/HTM/TB/2010.7. Cited online on 10.12.2010. URL:http://www.who.int/entity/tb/publications/global_report/ 2007/pdf/full.pdf
Crompton GK, Haslett C, Chilvers ER. Immunological factors in disease. In: Haslett C, Chilvers ER, John A et al., eds. Davidson’s Principles and Practice of Medicine, 20th ed. London: Churchill Livingstone; 2006. P. 75.
Kumar P, Clark M. Immunology. In: Kumar P, Clark M, eds. Clinical Medicine, 6th ed, W.B. Saunders 2005: 177.
Chan YC, Yosipovitch G. Suggested guidelines for screening and management of tuberculosis in patients taking oral glucocortoids -- an important but often neglected issue. J Am Acad Dermatol. 2003; 49: 91-5.
Sayarlioglu M, Inanc M, Kamali S et al. Tuberculosis in Turkish patients with systemic lupus erythematosus: increased frequency of extrapulmonary localization. Lupus. 2004;13:274-8.
Pal D, Behera D, Gupta D, Agarwal A. Tuberculosis in patients receiving prolonged treatment with oral corticosteroids for respiratory disorders. Indian J Tuberc. 2002;49: 83.
Kim H, Yoo C, Baek J et al. Mycobacterium tuberculosis infection in a corticosteroid-treated rheumatic disease patient population. Clin Exp Rheumatol. 1998;16:9-13.
Sasaki Y, Yamagishi F, Yagi T et al. A clinical study in the collagen disease patients developed pulmonary tuberculosis during corticosteroid administration. Kekkaku. 2000;75:569-73.
Kobashi Y, Yoneyama H, Okimoto N et al. Clinical analysis of pulmonary tuberculosis in association with corticosteroid therapy. Kekkaku 1999;74:789-95.
Dryga P, Nesterovskiĭ I, Kovalenko L, Elovskikh P. Clinical-morphological characteristics and prevention of steroid tuberculosis. Probl Tuberk Bolezn Leg. 1995;4:22-4.
Jick SS, Lieberman ES, Rahman MU, Choi HK. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum. 2006;55:19-26.
Gajalakshmi V, Peto R, Kanaka TS, Jha P. Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43000 adult male deaths and 35000 controls. Lancet. 2003;362:507-15.
Davies PDO. Risk factors for tuberculosis. Monaldi Arch Chest Dis. 2005;63:37-46.
