Screening for Parasitic Infection and Tuberculosis in Immunosuppressed and Pre-Immunosuppressed Patients: An Observational Study

oleh: Luisa Carnino, Jean-Marc Schwob, Dionysios Neofytos, Maria Lazo-Porras, François Chappuis, Gilles Eperon

Format: Article
Diterbitkan: MDPI AG 2021-09-01

Deskripsi

Reactivation of latent tuberculosis infection (LTBI) or latent parasitic infection (LPI) during drug-induced immunosuppression can have serious consequences. The Division of tropical and humanitarian medicine of the Geneva University Hospitals runs a specific consultation for parasitic screening of immunosuppressed or pre-immunosuppressed patients. We sought to determine the seroprevalence of LTBI and LPI in such patients and explore its relationship with country of origin or previous travel in a retrospective, single-centre observational study from 2016 to 2019. Demographic data, travel history, ongoing treatments and results of the parasitological (<i>Strongyloides stercoralis</i>, <i>Trypanosoma cruzi</i>, <i>Echinococcus multilocularis</i>, <i>Entamoeba histolytica</i> and <i>Leishmania</i> spp.) and TB screening were collected to calculate LPI or LTBI prevalence. Risk factors for LTBI and strongyloidiasis were analysed using Poisson regression with robust variance. Among 406 eligible patients, 24/353 (6.8%) had LTBI, 8/368 (2.2%) were positive for <i>Strongyloides stercoralis</i> infection, 1/32 (3.1%) was positive for <i>Entamoeba histolytica</i> and 1/299 (0.3%) was positive for Leishmaniasis. No cases of <i>Trypanosoma cruzi</i> (0/274) or <i>Echinococcus multilocularis</i> (0/56) infection were detected. Previous travel to or originating from high-prevalence countries was a risk factor for LTBI (PR = 3.4, CI 95%: 1.4–8.2 and 4.0, CI 95%: 1.8–8.9, respectively). The prevalence of serological Strongyloidiasis in immunosuppressed patients is lower in comparison to those without immunosuppression (PR = 0.1, CI 95%: 0.01–0.8). In conclusion, screening before immunosuppression needs to be individualized, and LTBI and LPI need to be ruled out in patients who originate from or have travelled to high-prevalence countries. The sensitivity of strongyloidiasis serology is reduced following immunosuppression, so an algorithm combining different tests or presumptive treatment should be considered.