GASTROENTEROLOGY ARTICLE OF THE WEEK
May 29, 2008
Viget N, Vernier-Massouille G, Salmon-Ceron D, et al. Opportunistic infections in patients with inflammatory bowel disease: prevention and diagnosis. Gut 2008;57:549-558.
1. Prior to the use of immunosuppressants, the following should be considered
a. serological tests for EBV
b. Varicella titers and possible immunization if non-immune
c. Tests to detect latent tuberculosis
d. Hepatitis serologies
e. CMV PCR testing
True or False
2. The use of azathioprine is mainly associated with viral infections, while the use of TNF antagonists increases risk of granulomatous diseases
3. Patients on TNF-blockers have a reduced response to hepatitis B vaccine but not influenza or pneumococcal vaccines
4. Patients with increased eosinophils should be screened for strongyloides with serologic testing and if positive, treated prior to starting immunosuppressive therapy
5. Febrile patients taking TNF inhibitors who have respiratory symptoms should undergo chest X-ray and O2 saturation measurements
6. Use of immunosuppression in females with IBD may increase the incidence of abnormal PAP smears, possibly due to reactivation of HPV
7. Patients undergoing biologic therapy for IBD with no prior history of varicella should be immunized