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TB Screening Before Biologics — RACP Adult Medicine MCQ

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HardInfectious DiseasesTB Screening Before BiologicsRACP Adult Medicine

Before adalimumab is started, a 45-year-old born in a country with high tuberculosis prevalence has no current respiratory symptom. Which assessment is appropriate?

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Correct answer: D — Assess epidemiological risk and symptoms, perform an IGRA or tuberculin test and chest imaging, and treat latent infection before anti-TNF therapy when indicated

The best answer is “Assess epidemiological risk and symptoms, perform an IGRA or tuberculin test and chest imaging, and treat latent infection before anti-TNF therapy when indicated”. Anti-TNF therapy substantially increases tuberculosis reactivation risk. Screening combines history, immune-based testing and chest imaging, with evaluation for active disease before latent-treatment decisions. No single test is perfect in immunosuppression, but symptom absence cannot exclude latency; sputum testing assesses suspected active pulmonary disease rather than latent infection.

Reference: Australian National Tuberculosis Advisory Committee: Management of latent tuberculosis infection: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdi4103-d