Active tuberculosis in inflammatory bowel disease patients under treatment from an endemic area in Latin America

Table 1 Clinical and demographic characteristics of 301 inflammatory bowel disease patients from a referral center

Characteristics (total n = 301)	n (%)
Type of IBD
Crohn's disease	115 (38.2)
Ulcerative colitis	186 (61.8)
Age (yr)1	45.8 (15.0)
Duration of the disease (mo)1	104.9 (80.3)
CD Montreal - age at diagnosis
A1 (< 16 yr)	5 (4.35)
A2 (17 to 40 yr)	81 (70.43)
A3 (> 40 yr)	29 (25.22)
CD Montreal - disease location
L1 (terminal ileum)	21 (18.4)
L2 (colon)	49 (43.0)
L3 (ileum colic)	44 (38.6)
L4 associated with L1	4 (3.6)
L4 associated with L2	4 (3.6)
L4 associated with L3	6 (5.4)
CD Montreal-disease behavior
B1 (inflammatory)	59 (53.2)
B2 (stricture)	25 (22.5)
B3 (penetrating)	27 (24.3)
B1 associated with perinal	25 (22.5)
B2 associated with perinal	6 (5.4)
B3 associated with perinal	14 (12.6)
UC location
Proctitis	23 (12.7)
Left colitis	79 (43.6)
Extensive colitis	79 (43.6)

¹data expressed as a mean ± SD. IBD: Inflammatory bowel disease; CD: Crohn's disease; UC: Ulcerative colitis.

Table 2 Ongoing treatment of inflammatory bowel disease patients from a referral center

Medicaments	IBD, n (%)	CD, n (%)	UC, n (%)
Sulfasalazine	63	10 (8.7)	53 (28.5)
Oral Mesalazine	102	7 (6.1)	95 (51.1)
Topic Mesalazine	125		125 (67.2)
Azathioprine	70	42 (36.5)	28 (15.1)
Azathioprine + Anti-TNFα	31	28 (24.3)	3 (1.6)
Methotrexate + Anti-TNFα	3	3 (2.6)
Anti-TNF α	30	29 (25.2)	1 (0.5)
Corticoid	2	2 (1.7)

IBD: Inflammatory bowel disease; CD: Crohn's disease; UC: Ulcerative colitis; Anti-TNFα: Anti-tumor necrosis factor alpha.

Table 3 Clinical and demographic characteristics of patients with inflammatory bowel disease who developed tuberculosis from a referral center

Sex/age	IBD type	IBD duration (months)	Previous TB	Treatment during TB	Anti TNF-α time before TB (months)	Chest X-ray screening LTBI	TST screening LTBI	LTBI treatment	Diagnostic TB	TB location
F/23	CD	26	No	IFX + AZA	9	Normal	Negative	No	Smear	Pulmonary
F/30	CD	180	No	IFX + AZA	45	Normal	Negative	No	Biopsy	Pleural
M/45	CD	144	No	ADA + AZA	3	Normal	Negative	No	Biopsy	Pleural
M/31	CD	132	No	ADA + AZA	24	Normal	Negative	No	Sputum culture	Pulmonary
M/32	UC	36	No	MSL		Changed	Negative	Yes	Sputum culture	Pulmonary
M/38	UC	96	No	MSL		Normal	Positive	Yes	Sputum culture	Pulmonary
M/63	UC	180	No	MSL + AZA		Normal	NR	No	Smear	Pulmonary
M/61	UC	96	No	AZA		Changed	Positive	Yes	Sputum culture	Pulmonary

IBD: Inflammatory bowel disease; CD: Crohn's disease; UC: Ulcerative colitis; TB: Tuberculosis; NR: No registry; LTBI: Latent tuberculosis infection; TST: Tuberculin skin test; IFX: Infliximab; ADA: Adalimumab; AZA: Azathioprine; MSL: Mesalazine.

Table 4 Univariate analysis assessing the relative risk (95%CI) of inflammatory bowel disease patients under treatment who developed active tuberculosis from a referral center

Variable	Total, n (%)	Active tuberculosis, n (%)	RR (95%CI)	P value
Sex				0.027
Female	188 (62.5)	2 (1,1)	1.0
Male	113 (37.5)	6 (5.3)	4.99 (1.02-24.3)
Age (yr)				0.158
18-40	185 (61.5)	3 (1.6)	1.0
41-91	116 (38.5)	5 (4.3)	2.66 (0.65-10.91)
IBD type				0.487
RCU	186 (61.8)	4 (2.2)	1.0
CD	115 (38.2)	4 (3.5)	1.61 (0.41-6.34)
Latent TB				< 0.001
No	276 (93.2)	5 (1.8)	1.0
Yes	20 (6.8)	3 (15.0)	8.28 (2.13-32.18)
Azathioprine				0.013
No	199 (66.1)	2 (1.0)	1.0
Yes	102 (33.0)	6 (5.9)	5.85 (1.20-28.48)
Anti-TNFα				0.034
No	240 (79.7)	4 (1.7)	1.0
Yes	61 (20.3)	4 (6.5)	3.93 (1.01-15.29)
Aza + Anti-TNFα				< 0.001
No	271 (90.0)	4 (1.5)	1.0
Yes	30 (10.0)	4 (13.3)	9.03 (2.38-34.28)

RR: Relative risk; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CD: Crohn's disease; TB: Tuberculosis; Anti-TNFα: Anti-tumor necrosis factor alpha; Aza: Azathioprine.

Table 5 Multivariate analysis of developing active tuberculosis by Poisson regression in patients with inflammatory bowel disease under treatment from a referral center

Model	Anti-TNFα	P value	Azathioprine	P value	Anti-TNFα + azathioprine	P value
	RR (95%CI)		RR (95%CI)		RR (95%CI)
No adjustment	3.93 (1.01-15.32)	0.048	5.85 (1.20-28.56)	0.029	9.03 (2.37-34.35)	0.001
Sex	3.13 (0.69-14.27)	0.14	5.63 (1.15-27.86)	0.033	7.85 (1.88-32.77)	0.005
Sex, type IBD	6.43 (2.33-17.74)	< 0.001	6.91 (1.50-31.80)	0.013	13.53 (4.50-40.78)	< 0.001
Sex, type IBD, latent TB	10.84 (4.26-27.60)	< 0.001	5.57 (0.86-36.06)	0.071	15.81 (6.07-41.23)	< 0.001
Sex, age, type IBD, latent TB	10.34 (4.28-24.96)	< 0.001	6.27 (1.03-38.05)	0.046	17.81 (5.91-53.67)	< 0.001

Anti-TNFα: Anti-tumor necrosis factor alpha; IBD: Inflammatory bowel disease; RR: Relative risk; TB: Tuberculosis.