Tuberculosis in the age of biologic therapy

The introduction of biologic therapies for psoriasis has revolutionized the treatment of plaque psoriasis. These changes in our drug armamentarium have resulted in the need for dermatologists to have a through command of knowledge regarding tuberculosis given the potential for reactivation with this class of medications. The focus of this review is to update dermatologists on pertinent information regarding the microbiology, immunology, screening, and recognition of the clinical presentations of tuberculosis. The current literature regarding the occurrence of tuberculosis with biologics, specifically antitumor necrosis factor therapy, is reviewed. Special emphasis is placed on the different clinical presentations between newly acquired tuberculosis versus reactivation of latent disease while receiving these medications. Given the ever-widening use of biologic therapy in our specialty, we must be capable of rapidly identifying infected patients, including those with asymptomatic latent disease. The failure to screen for tuberculosis before the initiation of biologic therapy may result in adverse outcomes for both the patient and the overall health of our communities.Learning objectivesAfter completing this learning activity, participants should be familiar with the clinical presentation of patients with classic and reactivation patterns of tuberculosis infection, be familiar with current data regarding the occurrence of tuberculosis and biologic therapy—specifically antitumor necrosis factor drugs—and be familiar with the current methods of screening for latent infection, especially Mantoux skin and QuantiFERON-TB Gold testing.