Screening before prolonged immunosuppressive therapy

• Tuberculosis
  • Screen if planning prednisone ≥15mg daily for 1+ month
  • TB skin test (false positive if BCG and needs a 48h repeat)
    • Still useful to test up after up to two weeks of ≤20mg daily prednisone
  • IGRA (expensive)
• Hepatitis B
  • Screen if planning prednisone >7.5mg daily
  • Treat if HbSag positive or if HbCAb and HBV-DNA positive
  • Prophylaxis with lamivudine for 6 months after the immune suppression is done
• Strongyloides
  • Screen with serology if has ever travelled to an endemic country