Brito Carlos, de Brito Rita Moraes
Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Federal University of Pernambuco, Recife, Brazil.
Department of Internal Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, Pernambuco, 50740-600, Brazil.
Adv Rheumatol. 2025 Jul 1;65(1):29. doi: 10.1186/s42358-025-00462-7.
The article "Brazilian Recommendations for the Management of Tuberculosis Infection in Immune-Mediated Inflammatory Diseases" by Viviane de Souza et al. presents important discussions on the subject; however, the recommendation for annual repetition of the TST/IGRA test for three years and after medication changes raises considerable concerns. This approach may lead to overdiagnosis and overtreatment of latent tuberculosis infection (LTBI). Frequent false-positive results in retests can result in unnecessary antibiotic use, contributing to bacterial resistance, a problem of global significance. The recommendation, considered to have a moderate level of evidence, is subject to criticism. Arguments used to support retesting, such as high conversion rates of tests after one year, reports of tuberculosis cases despite negative screenings being attributed to false negatives, and reliance on other sources with lower levels of evidence, do not constitute sufficient evidence to confirm tuberculosis infection or justify the recommendation. On the other hand, there is evidence that has not been considered in the discussion against the recommendation for retesting, indicating that this practice may increase the risk of diagnosing false-positive infections, leading to overtreatment without clinically proven benefits. Potentially harmful interventions should not be implemented without solid evidence to support them. In this letter to the editor, we briefly discuss this recommendation and the arguments against its implementation, highlighting its associated risks.
维维安妮·德·索萨等人撰写的《巴西免疫介导性炎症疾病中结核感染管理建议》一文对该主题进行了重要讨论；然而，关于结核菌素皮肤试验（TST）/干扰素-γ释放试验（IGRA）连续三年每年重复进行以及在药物变更后重复进行的建议引发了诸多担忧。这种方法可能导致潜伏性结核感染（LTBI）的过度诊断和过度治疗。复查中频繁出现的假阳性结果可能导致不必要的抗生素使用，进而促成细菌耐药性，这是一个具有全球意义的问题。该建议被认为证据水平中等，受到了批评。用于支持复查的论据，如一年后检测的高转化率、尽管筛查为阴性但仍有结核病病例报告被归因于假阴性，以及依赖其他证据水平较低的来源，并不构成确认结核感染或证明该建议合理的充分证据。另一方面，在反对复查建议的讨论中未被考虑的证据表明，这种做法可能增加诊断假阳性感染的风险，导致在没有临床证实益处的情况下进行过度治疗。在没有确凿证据支持的情况下，不应实施潜在有害的干预措施。在这封给编辑的信中，我们简要讨论了这一建议及其反对实施的论据，强调了其相关风险。
