Latent tuberculosis infection in Korean patients with multiple sclerosis and neuromyelitis optica spectrum disorder

Ki Hoon Kim; Su-Hyun Kim; Na Young Park; Min Jeong Kim; Jae-Won Hyun; Ho Jin Kim

doi:10.1016/j.msard.2023.105145

Latent tuberculosis infection in Korean patients with multiple sclerosis and neuromyelitis optica spectrum disorder

Mult Scler Relat Disord. 2024 Jan:81:105145. doi: 10.1016/j.msard.2023.105145. Epub 2023 Nov 21.

Authors

Ki Hoon Kim¹, Su-Hyun Kim¹, Na Young Park¹, Min Jeong Kim¹, Jae-Won Hyun¹, Ho Jin Kim²

Affiliations

¹ Department of Neurology, Research Institute and Hospital of National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, South Korea.
² Department of Neurology, Research Institute and Hospital of National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, South Korea. Electronic address: hojinkim@ncc.re.kr.

PMID: 38039942
DOI: 10.1016/j.msard.2023.105145

Abstract

Background: Latent tuberculosis infection (LTBI) is defined as an immune response to Mycobacterium tuberculosis infection that does not manifest clinically as active tuberculosis (TB). Since some immunotherapies can alter cellular immunity, LTBI screening has been recommended for patients with multiple sclerosis (pwMS) before initiation of long-term immunotherapies. In this study, we investigated the frequency of LTBI in Korean pwMS and patients with neuromyelitis optica spectrum disorder (pwNMOSD) and reported the long-term observation of untreated LTBI under various immunotherapies.

Methods: We enrolled pwMS or pwNMOSD who visited the Neurology department of the National Cancer Center between 2017 and 2021. LTBI was determined based on positive results of interferon-gamma release assay (IGRA) using QuantiFERON Gold Plus test and no evidence of active TB. Annual chest X-ray and careful monitoring for TB symptoms were performed until April 2023 or the time of follow-up loss.

Results: Among 531 patients who underwent the IGRA test, 25 pwMS (10.5%) and 42 pwNMOSD (14.3%) were diagnosed with LTBI. Of the 67 patients with LTBI, 59 patients (24 pwMS and 35 pwNMOSD) declined to receive preventive anti-TB drugs. None of the 59 with untreated LTBI demonstrated TB reactivation during 74.8 person-years in pwMS and 166.1 person-years in pwNMOSD. In addition, eight patients who completed the treatment for LTBI experienced no TB reactivation for a median of 5.5 years.

Conclusion: The LTBI prevalence in Korean pw MS and pwNMOSD was 10.5% and 14.3%, respectively, which was much higher than that in pwMS from Western countries. Notably, none of the 59 patients with untreated LTBI showed TB reactivation over 240 person-years even under long-term immunotherapies, indicating the need for additional research to stratify the risk of LTBI-reactivation.

Keywords: Interferon-gamma release assay; Latent tuberculosis; Multiple sclerosis; Neuromyelitis optica spectrum disorder; QuantiFERON assay.

MeSH terms

Humans
Latent Tuberculosis* / diagnosis
Latent Tuberculosis* / epidemiology
Multiple Sclerosis* / complications
Multiple Sclerosis* / epidemiology
Neuromyelitis Optica* / epidemiology
Republic of Korea / epidemiology
Tuberculosis*