Evidence-Based Commentary: Testing and Treating Latent Tuberculosis Before Starting Biologics and Small Molecules in Patients with Inflammatory Bowel Disease

Simplistically speaking, latent tuberculosis infection (LTBI) represents a stage in tuberculosis infection where persistent immune responsiveness to tubercular antigens is detectable in the absence of active disease. In LTBI, bacterial replication is absent or below some threshold due to a persistent immune response, which prevents the progression to the stage of active tuberculosis. The concept is useful in identifying individuals who harbor dormant tubercular bacilli and therefore potentially could develop tubercular re-activation in the future. The re-activation could be driven by defective or deteriorating host immune responses consequent to nutritional deficits, co-morbidities, or immune-suppressing therapies.[1] [2]