Screening before prolonged immunosuppressive therapy

• Tuberculosis
  • Screen if pred 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 >7.5mg prednisone daily
  • Treat if HbSag positive or if HbCAb and HBV-DNA positive
  • Prophylaxis with lemivudine for 6 months after the immune suppression is done
• Strongyloides
  • Screen with serology if has ever travelled to an endemic country