Tag Archives: Tuberculosis

Tuberculosis: #1 Infectious Disease Killer

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Followup on previous blog post (Mary Suhr: Coding Update 2025) -there is a new CPT code for the PENFS procedure in 2026: 64567. This procedure has FDA approval for children/adolescents (8-21 years) with functional abdominal pain associated with irritable bowel syndrome; in addition, it has an indication for functional dyspepsia.

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From NPR 9/11/25: TB is the #1 killer among infectious diseases. A new study says its toll could mount

An excerpt:

While it may seem like a disease from the past, this airborne illness kills more people than any other infectious disease worldwide, roughly 1.2 million a year. That number could increase dramatically because of the Trump administration’s cuts to foreign assistance, according to a new study…

As many as 10 million additional people could get TB, and 2.2 million could die by 2030 in high-burden countries under the worst-case funding scenario over the next five years, researchers report in the journal PLOS Global Public Health. 

My take: I recently finished, Everything is Tuberculosis by John Green, which is a good read. So this article caught my attention. Even before the funding cuts, more effort was needed to stop the scourge of TB. Currently TB kills more than a million people per year; in some historic periods, it has killed as many as one in seven people.

Thanks to Anna Kelly for recommending the book to me.

Related blog posts:

Are Kids Different? TB Testing in Patients Receiving Biologics

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SL Lapp et. al. Clin Gastroenterol Hepatol 2024; 22: 420-422. Open Access! Yield of Serial Testing for Tuberculosis Exposure in Patients With Inflammatory Bowel Diseases: One Test is Not Enough

This “retrospective cohort study was conducted using data acquired from SPARC IBD, a component of the Crohn’s & Colitis Foundation’s IBD Plexus research platform. SPARC IBD is a prospective cohort study conducted at 18 US centers and includes more than 4000 patients.” The median patient age was 37 years.

Key findings:

  • Following an initial negative result in 687 patients, 269 patients received a second test (after an initial negative test), of which 5 were positive (1.9%), which was not significantly different from the prevalence with the first test
  • Oral steroids were associated with an increased proportion of indeterminate results, although not achieving statistical significance
  • The authors did not identify any potential risk factors for latent tuberculosis among the covariates investigated

Overall, the authors found “found that there is continued utility for the use of IGRA tests with patients receiving medication for IBD despite the declining incidence of tuberculosis in the United States. In addition to testing before administration of treatment, this study suggests serial testing may still be necessary because of a substantial rate of positive conversions among patients in the cohort.”

After reading this study, I did an informal survey from the physicians/APP in my group. As a group, we take care of approximately 1000 children with inflammatory bowel disease. Over the last 20 years, only one of my partners recollects having a true positive test result after an initial negative result. This particular patient who was asymptomatic received a 9 month course of isoniazid.

My take: There is a low yield of follow-up testing for tuberculosis, especially in pediatric patients with no exposure history or travel history. For our practice, this would be a good summer research project for a premed student, a resident or even a fellow. I would expect the yearly and cumulative costs of screening for latent tuberculosis in our practice to be quite high. A quick web search suggests that a single blood test costs ~$150 which would be $105,000 for 700 tests. However, the costs are much greater due to additional investigations related to indeterminate results.

Related blog post:

PPD (TB Skin Test) or Interferon-Gamma Release Assay (TB Blood Test)?

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A recent editorial (JG Hashash et al. Inflamm Bowel Dis 2020; 26: 1315-1318. Approach to Latent Tuberculosis Infection Screening Before Biologic Therapy in IBD Patients: PPD or IGRA?) provides some guidance on screening for tuberculosis prior to biologic therapy as well as background on how these tests work.

Key points:

  • The authors state that both a PPD or TB Blood Test (aka Quantiferon-TB Gold) are reasonable for most individuals, though they have a preference for the TB Blood Test.
  • For those with history of BCG vaccination, the TB Blood Test is recommended
  • Steroids are associated with negative PPD and indeterminate TB Blood Test.
  • The authors advocate baseline testing prior to biologic therapy for everyone.
  • Annual testing: For  those in high TB endemic areas, “we propose yearly chest x-ray in addition to IGRA [TB Blood Test]…in low endemic areas…we do not perform yearly chest x-rays nor do we check yearly IGRA unless mandated by a patient’s insurance.”

My take: TB blood testing is more convenient but more costly.  The authors indicate that  for patients from low endemic areas, yearly TB testing is mainly to check boxes mandated by insurance companies rather than improving care.

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