Tuberculosis and inflammatory bowel disease

Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, carries an increased risk of tuberculosis (TB), particularly in patients treated with immunosuppressive therapies such as anti-TNF agents. The risk is further elevated when combined with immunomodulators. Other drugs, including anti-integrins, IL-12/23 inhibitors, and JAK inhibitors (JAK-i), present a variable risk of TB reactivation. Given this risk, screening for latent tuberculosis infection (LTBI) is essential in IBD patients before initiating immunosuppressive therapy. Guidelines recommend performing this screening ideally at the time of IBD diagnosis or, alternatively, before advanced therapy. Diagnostic tests include the tuberculin skin test (TST) and interferon-gamma release assays (IGRA). In immunocompromised patients, false negatives may occur; therefore, dual testing is advised. Chest X-rays are reserved for cases with positive tests or clinical suspicion. In the presence of LTBI, chemoprophylaxis with isoniazid or rifampicin is recommended prior to initiating immunosuppression. If active TB is diagnosed, immunosuppressive therapy must be discontinued and standard antituberculous treatment initiated. The reintroduction of immunosuppressive therapy should be assessed on a case-by-case basis, prioritizing agents with lower reactivation risk. Finally, BCG vaccination is not recommended in IBD patients undergoing immunosuppressive treatment due to its nature as a live vaccine.