Tuberculose pulmonar e latente em pacientes com doença inflamatória intestinal na América Latina: revisão sistemática dos fatores associados

Abstract

Tuberculosis (TB) remains a significant public health problem in Latin America, especially in immunocompromised individuals. Patients with Inflammatory Bowel Disease (IBD), including Crohn's disease and ulcerative colitis, frequently require immunosuppressive and immunobiological therapies, particularly anti-TNF agents, which can increase the risk of reactivation of latent Mycobacterium tuberculosis infection and the development of active tuberculosis. The aim of this study was to analyze the occurrence of active and latent pulmonary tuberculosis in IBD patients undergoing these therapies, as well as to identify the main factors associated with its development in Latin America. This is a systematic literature review conducted in the PubMed/MEDLINE, SciELO, and LILACS databases, including studies published between 2015 and 2025. Six studies were selected, encompassing cohorts, observational studies, case-control studies, and case reports. The results showed a consistent association between the use of anti-TNF agents, especially infliximab and adalimumab, and a higher risk of tuberculosis. Concomitant use of immunosuppressants, longer exposure time to biological therapies, male sex, occupational exposure, and residence in endemic regions were also identified as relevant risk factors. Furthermore, limitations in screening methods were observed, which may contribute to cases of active tuberculosis even after an initial negative screening. It is concluded that rigorous screening for latent tuberculosis and continuous monitoring during immunobiological treatment are fundamental to reducing the risk of infection in this population.