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It is more difficult&#44; however&#44; to determine the prevalence of LTBI&#44; as there are no standardized systems for recording cases&#46; Figures vary according to the level of endemism&#44; with rates ranging from 0&#46;03&#37; in low-burden countries&#44; such as the United States&#44; to 4&#46;2&#37; in high-burden countries&#44; such as South Africa&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> The figures over the past 10 years have varied only minimally&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The risk of a person with LTBI developing active TB is variable and ranges between 0&#46;1&#37; &#40;in healthy individuals without risk factors&#41; to approximately 10&#37; &#40;in patients with HIV coinfection&#41;&#46; Adequate screening for latent infection can therefore reduce the incidence of active TB&#46; As mentioned&#44; patients with inadequately treated active TB are the main source of infection&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> The main factors that favor TB transmission include &#8220;severe disease in the index patient&#44; long periods of exposure to the index patient&#44; and poor ventilation and poor exposure to UV light during proximity to the index patient&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> A detailed description of intrinsic <span class="elsevierStyleItalic">M tuberculosis</span>&#8211; and host-related factors is beyond the scope of this article&#44; but suffice it to say that in dermatology&#44; LTBI prevention and treatment is of interest to dermatologists working with patients with moderate to severe psoriasis under treatment with biologics&#8212;and tumor necrosis factor &#40;TNF&#41; inhibitors in particular&#8212;as these patients are among the high-risk groups for infection &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In this review&#44; we describe the main techniques currently available for diagnosing LTBI&#44; update the existing LTBI screening algorithm&#44; analyze current screening practices in psoriasis patients in low- and high-TB-burden countries&#44; and explore the possibility of extending screening recommendations for psoriasis patients to patients who are being treated with or are candidates for nonbiologic systemic therapy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosing LTBI</span><p id="par0025" class="elsevierStylePara elsevierViewall">Individuals with LTBI at risk of developing active TB must be identified in order to administer appropriate prophylactic treatment&#46; Screening for LTBI&#44; however&#44; should not be applied indiscriminately&#44; but rather reserved for patients in whom it will bring clear benefits&#44; as a positive result mandates treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Tuberculin skin testing &#40;TST&#41; is the traditional method for diagnosing LTBI&#44; although new&#44; immune-based in vitro blood tests&#44; known as interferon-&#947; release assays &#40;IGRAs&#41;&#44; have gained ground in recent years&#46; It should be noted&#44; however&#44; that there is no gold-standard approach for detecting LTBI&#46; Current tests are all immune-based&#44; i&#46;e&#46;&#44; they involve the participation and response of memory T cells to antigens with varying levels of specificity&#46; The main disadvantage of both TST and IGRAs&#44; which are described in the sections below&#44; is that they cannot differentiate between LTBI and active TB&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Tuberculin Skin Testing</span><p id="par0035" class="elsevierStylePara elsevierViewall">TST is performed with an extract obtained from filtrates of sterilized concentrated cultures of the tubercle bacillus&#46; The antigen used is purified protein derivative &#40;PPD&#41;&#44; and in Spain&#44; the RT-23 variant is used&#44; with Tween 80 as a stabilizer&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The most widely used TST technique is the Mantoux technique&#44; which involves injecting 0&#46;1&#160;mL of PPD at a dose of 2 tuberculin units into the inner surface of the forearm&#46; The injection should trigger the appearance of a wheal&#44; which disappears after a short time&#46; Results are read after 48 to 72<span class="elsevierStyleHsp" style=""></span>hours by measuring the diameter of the induration perpendicular to the long axis of the forearm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Another technique is the multipuncture test&#44; which is also performed on the forearm but using tines or pins dipped in tuberculin&#46; This test&#44; however&#44; is considered inadequate&#44; as the amount of tuberculin that actually penetrates the skin is unknown&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">7&#44;8</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The main disadvantage of TST is that the proteins used are not specific to <span class="elsevierStyleItalic">M&#160;tuberculosis</span>&#44; as they are shared by the TB bacillus used in the bacillus Calmette-Gu&#233;rin &#40;BCG&#41; vaccine and by other species of environmental mycobacteria&#46; As a result&#44; the test has reduced specificity&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In Spain&#44; the TST is considered positive when a person who has not received the BCG vaccine develops an induration of 5<span class="elsevierStyleHsp" style=""></span>mm or larger&#46; Interpretation of results in BCG-vaccinated individuals is more complicated due to the need to distinguish between effects attributable to the vaccine and to TB infection&#46; In such cases&#44; an induration larger than 5<span class="elsevierStyleHsp" style=""></span>mm is considered to indicate a positive result if the individual is living with or in frequent contact with a TB patient or if he or she has chest radiograph changes suggesting former or untreated TB infection&#46; All other BCG-vaccinated individuals need to be treated&#44; because&#44; although it is thought that the larger the induration&#44; the greater the chance that the response is due to the presence of TB infection&#44; the effect of the vaccine cannot be proven with certainty&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">An induration of any size in a severely immunocompromised patient &#40;e&#46;g&#46;&#44; an HIV-infected patient&#44; transplant recipient&#44; patient receiving biologic or corticosteroid therapy&#41; is indicative of a positive result&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">TST is known to cause a booster effect that can lead to erroneous interpretation of results&#46; This effect&#44; which corresponds to the induction or re-establishment of waned reactivity in a previously infected patient&#44; can be misinterpreted as a new skin test conversion&#46; The booster effect is typically seen in individuals over 55 years of age and&#47;or in BCG-vaccinated persons&#44; and in such cases&#44; a test with a negative result should be repeated after 7 to 10 days&#59; the result of the second test is considered definitive&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Previous BCG vaccination and use of antigens that are not specific to <span class="elsevierStyleItalic">M tuberculosis</span> &#40;i&#46;e&#46;&#44; antigens shared with nontuberculous mycobacteria&#41; are the main causes of false-positive results in TST&#46; Nontuberculous mycobacteria&#44; however&#44; are only an important cause of false positives in countries with a high prevalence of these bacteria and a low prevalence of <span class="elsevierStyleItalic">M tuberculosis</span> infection<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> The impact of the BCG vaccine depends on time since vaccination and number of doses administered&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Interpretation of results can also be complicated by errors in administering the test&#44; resulting in bruising or injection site infections&#46; Other causes of false-negative results during testing and reading of results include concurrent viral infection&#44; live virus vaccination&#44; immunosuppressed states or use of immunosuppressive drugs&#44; and immune response in very elderly patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In general&#44; although the TST continues to be the method of choice for diagnosing infection&#44; its sensitivity is considerably reduced&#44; particularly in immunodepressed patients&#46; This reduced sensitivity limits the usefulness of the test&#46; Additional problems include the test&#39;s lack of specificity&#44; errors in administration&#44; subjectivity in the interpretation of results&#44; need for a second visit to read the results&#44; and lack of privacy&#46; However&#44; the test does have important advantages&#44; in particular its low cost and ease of administration&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Interferon-&#947; Release Assays</span><p id="par0080" class="elsevierStylePara elsevierViewall">IGRAs are based on the detection of interferon-&#947; in the blood&#46; This cytokine has a fundamental role in the control of TB infection and its release is triggered by the in vitro stimulation of T cells sensitized to <span class="elsevierStyleItalic">M tuberculosis</span>&#8211;specific antigens&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The antigens used in this test are ESAT-6 &#40;early secretory antigenic target-6&#41; and CFP-10 &#40;culture filtrate protein 10&#41;&#44; which are encoded by genes in the RD1 &#40;region of difference 1&#41; of the <span class="elsevierStyleItalic">M tuberculosis</span> genome&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11&#44;12</span></a> These antigens are more specific than PPD&#44; as they are not shared by any of the strains used in the BCG vaccine or by the majority of nontuberculous mycobacteria&#59; exceptions are <span class="elsevierStyleItalic">Mycobacterium marinum</span>&#44; <span class="elsevierStyleItalic">Mycobacterium kansasii&#44; Mycobacterium szulgai</span>&#44; and <span class="elsevierStyleItalic">Mycobacterium flavencens</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">There are 2 commercially available IGRAs&#58; QuantiFERON TB Gold In-Tube &#40;QFT-GIT&#41; &#40;Cellestis&#47;Qiagen&#41;&#44; which is based on the enzyme-linked immunoabsorbent assay &#40;ELISA&#41;&#44; and T-SPOT&#46;<span class="elsevierStyleItalic">TB</span> &#40;T-Spot&#41; &#40;Oxford Immunotec&#41;&#44; which is based on the enzyme-linked immunospot &#40;ELISPOT&#41; technique&#46; Both tests were recently approved for sale in Europe and have also finally received clearance from the US Food and Drug Administration for the diagnosis of LTBI&#46; The QFT-GIT incorporates a third antigen in addition to ESAT-6 and CFP-10&#58; TB 7&#46;7&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Both tests offer procedural advantages over TST&#44; and are significantly more specific in BCG-vaccinated individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">14&#44;15</span></a> In addition&#44; they incorporate controls to test for anergy and rule out false negatives&#46; They can also be repeated immediately and do not cause the booster effect as they do not induce an immune response&#46; Loss of patients is also avoided as patients do not need to return for a second visit&#44; as they do with TST&#46; Finally&#44; IGRAs are easier to standardize and use in the laboratory&#44; and they protect patient privacy&#46; Their main disadvantage compared with TST is their cost&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The QFT-GIT is performed by incubating 1<span class="elsevierStyleHsp" style=""></span>mL of peripheral blood with heparin in 3 tubes&#58; <span class="elsevierStyleItalic">1</span>&#41; a nil control tube containing blood from the patient&#44; <span class="elsevierStyleItalic">2</span>&#41; a positive control tube with phytohemagglutinin to measure the patient&#39;s lymphoproliferative response&#44; and <span class="elsevierStyleItalic">3</span>&#41; a tube containing the specific antigens&#58; ESAT-6&#44; CFP-10&#44; and TB 7&#46;7&#46; The 3 tubes are incubated for 16 to 18<span class="elsevierStyleHsp" style=""></span>hours at a temperature of 37<span class="elsevierStyleHsp" style=""></span>&#176;C and the concentration of interferon &#40;IFN&#41; &#947; is measured in international units &#40;IU&#41; per milliliter by ELISA&#46; Results are interpreted using a standard curve in a software program supplied by the manufacturer&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the T-Spot&#44; unlike the QFT-GIT&#44; peripheral blood mononuclear cells must be separated prior to stimulation&#44; and as mentioned&#44; the presence of interferon-&#947; is determined by ELISPOT not ELISA&#46; The ELISPOT assay involves counting the number of spot-forming cells&#44; whereby each spot corresponds to the footprint of a single IFN-&#947;&#8211;secreting T cell&#46; Technically&#44; the T-Spot requires more blood&#44; has longer preparation times&#44; and is more difficult to conduct&#46; However&#44; it appears to offer greater sensitivity&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Unfortunately&#44; IGRAs may yield indeterminate results due to low IFN-&#947; production in the positive control &#40;mitogen&#41; or high response to the nil control&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">IGRAs have a specificity of over 95&#37; in areas with a low incidence of active TB&#44; and this is not affected by BCG vaccination&#46; According to several studies&#44; T-Spot has higher specificity &#40;90&#37;&#41; than both QFT-GIT and TST &#40;80&#37; in both cases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">16&#44;17</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Biologic Therapy and Screening for LTBI</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this section&#44; we are going to look at the current situation regarding screening for LTBI in patients with moderate to severe psoriasis who are candidates for biologic therapy&#44; the incidence of LTBI in this population in Spain&#44; and the current position of the WHO regarding LTBI screening&#46; We also provide a brief analysis of studies that have analyzed the diagnostic agreement between IGRAs and TST&#44; and conclude with an easy-to-apply algorithm&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The need to screen for LTBI in patients with moderate to severe psoriasis became a key issue in 2005&#44; when biologics were introduced into the therapeutic arsenal for this condition&#46; Drawing on experiences with rheumatological patients&#44; in their first consensus document on the evaluation and treatment of moderate to severe psoriasis&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> the Spanish Psoriasis Group&#44; under the auspices of the Spanish Academy of Dermatology and Venereology&#44; considered 3 situations related to screening for LTBI in this setting &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The current situation regarding LTBI in patients with moderate to severe psoriasis in Spain is quite well known thanks to a study published by S&#225;nchez Moya et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> who reported on statistics from the 2013 BIOBADADERM registry&#46; The study reported a prevalence of 20&#46;5&#37; for LTBI in 1425 patients with moderate to severe psoriasis&#44; 56&#37; of whom were receiving biologics and 44&#37; of whom were receiving conventional systemic treatment&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Screening for LTBI was performed in 83&#37; of these patients&#44; but adherence to screening protocol recommendations was observed in just 51&#37; of cases&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The authors attributed this low adherence to the introduction of IGRAs in many of the participating centers and to the fact that the finding was based only on TST screening&#46; The study highlights the need to modify guidelines for the management of moderate to severe psoriasis and emphasizes the importance of adherence to established protocols&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In its recently published guidelines on the management of LTBI&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> the WHO highlights 3 very interesting points&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">&#8220;Individuals should be asked about symptoms of TB before being tested for LTBI&#46; Chest radiography must be done if efforts are intended also for active TB case finding&#46; Individuals with TB symptoms or any other radiological abnormality should be investigated further for active TB and other conditions &#40;strong recommendation&#44; very low quality of evidence&#41;&#46;&#8221;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">&#8220;Either TST or IGRA can be used to test for LTBI in high-income and upper middle-income countries with estimated TB incidence less than 100 per 100 000 &#40;strong recommendation&#44; very low quality of evidence&#41;&#46;&#8221;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">&#8220;IGRA should not replace TST in low-income and other middle-income countries &#40;strong recommendation&#44; very low quality of evidence&#41;&#46;&#8221;</p></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall">Considering the above&#44; and the relatively recent introduction of new LTBI screening methods&#8212;IGRAs&#8212;now seems an opportune moment to revise the situation&#46; Studies of diagnostic agreement between TST and IGRA have shown clear differences between high- and low-TB-burden countries due to BCG vaccination and reinfection rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">22&#44;23</span></a><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">In countries with a high incidence of TB and BCG vaccination&#44; TST overestimates the diagnosis of LTBI&#44; leading to unnecessary prophylactic treatment and associated adverse effects&#44;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">24&#44;25</span></a> while IGRAs do not offer significant differences with respect to control groups&#44; with similar rates detected in psoriasis patients and the general population&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">In moderately endemic countries with low vaccination rates&#44; TST also overestimates LTBI compared with IGRAs&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Finally&#44; in low-burden countries with low BCG vaccination rates&#44; better diagnostic agreement has been found between the 2 tests&#44; but TST continues to overestimate the prevalence of LTBI compared with IGRAs&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27&#44;28</span></a></p></li></ul></p><p id="par0185" class="elsevierStylePara elsevierViewall">One particularly interesting recent study in this area is that by Gisondi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a> which evaluated the prevalence of LTBI in patients with psoriasis being considered for biologic therapy&#46; The authors compared rates with those observed in health care workers and patients with rheumatoid arthritis or Crohn disease&#46; The findings complemented data from the Italian psoriasis registry &#40;Psocare&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> which had established a prevalence rate of 8&#46;2&#37;&#46; All the patients in the study by Gisondo et al&#46; were screened for LTBI using an IGRA &#40;QFT-GIT&#41;&#44; but 88 of the patients simultaneously underwent screening with TST&#46; The rates detected were 8&#46;2&#37; for patients with psoriasis&#44; 8&#46;8&#37; for health care workers&#44; 9&#37; for patients with rheumatoid arthritis&#44; and 7&#37; for patients with Crohn disease&#46; None of the patients diagnosed with LTBI developed active TB after treatment with appropriate chemoprophylaxis&#46; IGRA testing was repeated after a mean &#40;SD&#41; of 31 &#40;1&#46;7&#41; months&#8212;the authors do not explain why they chose this exact period&#8212;and revealed reversion in 25&#37; of patients diagnosed and treated for LTBI and conversion in 0&#46;8&#37; of cases&#46; Agreement was low between the QFT-GIT and TST &#40;&#954;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#41;&#44; although the authors were clearly in favor of using the IGRA&#44; as it can be repeated as often as the dermatologist considers necessary without inducing a booster effect or sensitization&#46; New studies&#44; however&#44; are required to help explain the fluctuations seen in the serial tests performed&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The reasons for the discrepancies between IGRAs and TST have not been clearly elucidated&#44; but may include variations in psoriasis severity&#44; BCG vaccination status&#44; and use &#40;or not&#41; of concomitant immunosuppressive therapy&#46; Patients with moderate to severe psoriasis exhibit a lower <span class="elsevierStyleItalic">M</span> tuberculosis&#8211;specific immune response and in general greater sensitivity to TST&#46; Finally&#44; immunosuppressive therapy can affect TST but not IGRA results&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Most cost-benefit studies tend to weigh in favor of the use of IGRAs to diagnose LTBI&#44; as these tests minimize false positives &#40;particularly in vaccinated populations&#41; and eliminate the extra costs and adverse effects associated with TB chemoprophylaxis&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">In view of the above&#44; and considering that not all hospitals in Spain have access to IGRAs&#44; we have designed an algorithm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; for screening for LTBI in patients with moderate to severe psoriasis in our setting&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Systemic Treatment and Screening for LTBI&#58; Other Considerations</span><p id="par0205" class="elsevierStylePara elsevierViewall">While the need for LTBI screening in patients who are candidates for biologic therapy is fully acknowledged&#44; there are reasonable doubts regarding the need for such testing in patients transitioning from topical to systemic therapy&#46; Not all systemic drugs or phototherapy have the same mechanism of action&#44; and only methotrexate and ciclosporin&#44; due to their immunosuppressive action&#44; are associated with a notable increased risk of viral&#44; fungal&#44; and bacterial infections&#44; including LTBI of course&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Both Spanish<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> and American<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> guidelines on the diagnostic and therapeutic management of psoriasis recommend screening for LTBI prior to initiating treatment with ciclosporin or methotrexate&#46; However&#44; they do not recommend screening in the case of acitretin or phototherapy&#44; as these have not been found to be associated with an increased risk of TB reactivation&#46; These recommendations are supported by the results of the recent prevalence study of LTBI in patients with psoriasis by Gisondi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> discussed in the previous section&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">In their study based on the latest figures from the BIOBADADERM registry&#44; S&#225;nchez-Moya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> reported no cases of active TB in patients treated with conventional systemic agents&#44; suggesting possibly a lower risk of LTBI in such cases&#46; The findings of such studies and lessons drawn from previous experiences perhaps explain why certain guidelines&#44; such as the European S3-guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> do not consider it necessary to screen for LTBI before initiating treatment with any of the 4 classical treatments used in the management of moderate to severe psoriasis&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">While beyond the scope of our study&#44; we believe it important to draw attention to one aspect highlighted by several authors&#58; the inclusion of oral corticosteroids in treatment regimens that require screening for LTBI prior to initiation&#44; particularly when doses of over 20<span class="elsevierStyleHsp" style=""></span>mg&#47;d are to be used for longer than 2 weeks in areas with a high prevalence of TB&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">34&#8211;36</span></a> In a review on the evidence regarding screening for infectious diseases before initiation of systemic immunosuppressive treatment in patients with autoimmune bullous diseases&#44; Keith et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a> recommended assessing individual risk in order to choose the most appropriate method&#46; The authors also stressed the fact that patients with autoimmune bullous diseases may require multiple immunosuppressive therapies over time&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Patients with moderate to severe psoriasis also typically need multiple treatments over time&#44; and it would therefore seem reasonable to screen for LTBI in all patients about to start systemic therapy&#44; although&#44; as we have mentioned&#44; there is no consensus on this matter&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">We have provided an update of the methods currently used to screen for LTBI and their application in routine dermatology practice&#46; IGRAs are now widely used in the diagnosis of TB due to the absence of cross-reactions with the BCG vaccine and other nontuberculous mycobacteria&#46; Compared with TST&#44; they are influenced less by immunosuppression&#44; although not all authors would agree&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> and can be repeated over time without causing a booster effect&#46; Accordingly&#44; they are ideal for monitoring for LTBI in patients with moderate to severe psoriasis who are candidates for biologic therapy&#46; Their cost&#44; however&#44; continues to be their main disadvantage&#46; Although consensus is lacking regarding the need for LTBI screening before the initiation of conventional systemic treatments in patients with moderate to severe psoriasis&#44; the fact that these patients also need multiple treatments&#44; including biologics&#44; throughout the course of their disease&#44; makes screening highly recommendable&#46; LTBI screening should also be considered for other systemic or autoimmune diseases that require treatments such as systemic corticosteroids&#44; as these are also associated with higher rates of LTBI reactivation&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of Interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Diagnosing LTBI"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Tuberculin Skin Testing"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Interferon-&#947; Release Assays"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Biologic Therapy and Screening for LTBI"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Systemic Treatment and Screening for LTBI&#58; Other Considerations"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conclusions"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflicts of Interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-07-24"
    "fechaAceptado" => "2015-10-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec819966"
          "palabras" => array:4 [
            0 => "Screening"
            1 => "Latent tuberculosis"
            2 => "Psoriasis"
            3 => "Biologic therapy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec819965"
          "palabras" => array:4 [
            0 => "Despistaje"
            1 => "Tuberculosis latente"
            2 => "Psoriasis"
            3 => "Terapia biol&#243;gica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Screening to detect latent tuberculosis infection &#40;LTBI&#41; is essential before patients with moderate to severe psoriasis start treatment with biologics and vigilance will continue to be needed during and after such treatment&#46; The most recently analyzed statistics from the BIOBADADERM registry show a 20&#46;5&#37; prevalence of LTBI in psoriasis patients treated with biologics in Spain&#46; Various screening protocols are in effect in different countries according to their levels of endemic TB and bacillus Calmette-Gu&#233;rin &#40;BCG&#41; vaccination&#44; and there is no consensus on a gold-standard approach to the diagnosis of LTBI&#46; Tuberculin skin testing &#40;TST&#41; continues to be the diagnostic method of choice in spite of its limited sensitivity&#44; mainly in immunocompromised patients&#46; Additional problems include the TST&#39;s well-established lack of specificity&#44; errors in application&#44; subjectivity in the interpretation of results &#40;which must be read during a second visit&#41;&#44; and lack of privacy&#59; the main advantages of this test are its low cost and ease of application&#46; Most cost-benefit studies are therefore inclined to favor using interferon-&#947; release assays to detect LTBI because they minimize false positives &#40;especially in BCG-vaccinated individuals&#41;&#44; thereby eliminating the extra costs and side effects of unnecessary chemoprophylaxis&#46; We review the methods used for LTBI screening in psoriasis patients who are candidates for biologic therapy&#46; Additionally&#44; given the fact that most guidelines do not currently consider it necessary to screen patients about to start conventional systemic therapy&#44; we discuss the reasons underlying the need for such screening&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con psoriasis moderada-grave que van a iniciar tratamiento con agentes biol&#243;gicos deben ser monitorizados para la detecci&#243;n de infecci&#243;n tuberculosa latente antes&#44; durante y despu&#233;s del tratamiento&#46; En el &#250;ltimo informe publicado de BIOBADADERM la prevalencia de infecci&#243;n latente por M&#46;tuberculosis &#40;ILMT&#41; alcanzaba el 20&#44;5&#37; de los pacientes psori&#225;sicos tratados con agentes biol&#243;gicos en nuestro pa&#237;s&#46; En la actualidad no existe un m&#233;todo diagn&#243;stico <span class="elsevierStyleItalic">gold standard</span> que permita una aplicaci&#243;n sistem&#225;tica y consensuada&#44; con variaciones en los diferentes pa&#237;ses seg&#250;n el grado de endemicidad y vacunaci&#243;n con BCG&#46; La prueba de tuberculina &#40;PT&#41; contin&#250;a siendo el m&#233;todo de elecci&#243;n para el diagn&#243;stico de infecci&#243;n&#44; pero presenta importantes limitaciones en su sensibilidad &#40;principalmente en pacientes inmunodeprimidos&#41;&#46; Esta situaci&#243;n&#44; junto a su falta de especificidad conocida&#44; errores en su administraci&#243;n&#44; la subjetividad en la interpretaci&#243;n de los resultados&#44; la necesidad de una segunda visita para la lectura y la ausencia de privacidad hacen de ella una prueba limitada&#44; cuyas principales ventajas resultar&#237;an su bajo coste y f&#225;cil realizaci&#243;n&#46; Por eso la mayor&#237;a de los estudios de coste beneficio se inclinan por el m&#233;todo IGRA para el diagn&#243;stico de la ILMT&#44; ya que minimiza los falsos positivos &#40;especialmente en poblaci&#243;n vacunada&#41;&#44; eliminando costes extra y efectos secundarios de la quimioprofilaxis antituberculosa&#46; Valoramos la aplicabilidad en pacientes psori&#225;sicos candidatos a terapia biol&#243;gica y discutimos la necesidad de su realizaci&#243;n previamente a terapia sist&#233;mica convencional&#44; puesto que la mayor&#237;a de las gu&#237;as actuales no consideran imprescindible su realizaci&#243;n&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez-L&#243;pez A&#44; Rodriguez-Granger J&#44; Ruiz-Villaverde R&#46; Despistaje de tuberculosis latente en el paciente con psoriasis moderada grave candidato a terapia sist&#233;mica y&#47;o biol&#243;gica&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;207&#8211;214&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Reading of the tuberculin skin test&#46;</p>"
        ]
      ]
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Proposed LTBI screening algorithm for patients with moderate to severe psoriasis before initiation of biologic therapy&#46; BCG indicates bacillus Calmette-Gu&#233;rin&#59; TST&#44; tuberculin skin test&#59; IGRA&#44; interferon &#947; release assay&#59; LTBI&#44; latent tuberculosis infection&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; TB&#44; tuberculosis&#59; TNF&#44; tumor necrosis factor&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acquired immunodeficiency syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Human immunodeficiency virus infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transplant recipients on immunosuppressive treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Silicosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic kidney disease under treatment with hemodialysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Head and neck cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recent TB infection &#40;in last 2 years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chest radiograph findings consistent with TB&#44; i&#46;e&#46;&#44; apical fibronodular changes not granulomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Health care workers in contact with patients with active TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Casual contact with patients with highly contagious active TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients being treated with TNF inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1384148.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">High-Risk Groups for Active TB&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">TST was repeated yearly in patients with a negative result&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">After thorough history taking with relevant search for history and risk factors&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Adapted from the 2009 Consensus Document on the Evaluation and Treatment of Moderate to Severe Psoriasis of the Spanish Academy of Dermatology and Venereology&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative TST<br>Negative booster effect<br>Normal chest radiograph findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><br>Start biologic therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive TST and&#47;or positive booster effect<br>Normal chest radiograph findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diagnose LTBI<br>Start chemoprophylaxis<br>Delay initiation of biologic therapy for 1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive TST and&#47;or booster effect &#40;and BCG vaccination &#62;<span class="elsevierStyleHsp" style=""></span>10 years ago in vaccinated individuals&#41;<br>Abnormal chest radiograph findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diagnose active TB<br>Start TB treatment<br>Delay initiation of biologic therapy for 6 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1384149.png"
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            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Screening Algorithm for LTBI<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a></p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Informe mundial sobre la tuberculosis 2014 &#91;cited 23 Jul 2015&#93;&#46; Available from&#58; <a href="http://www.who.int/tb/publications/global_report/es/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;tb&#47;publications&#47;global&#95;report&#47;es&#47;</a>"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Annual risk of tuberculous infection using different methods in communities with a high prevalence of TB and HIV in Zambia and South Africa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Shanaube"
                            1 => "C&#46; Sismanidis"
                            2 => "H&#46; Ayles"
                            3 => "N&#46; Beyers"
                            4 => "A&#46; Schaap"
                            5 => "K&#46;A&#46; Lawrence"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2009"
                        "volumen" => "13"
                        "paginaInicial" => "e7749"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estimation of the annual risk of tuberculosis infection for white men in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;M&#46; Daniel"
                            1 => "S&#46;M&#46; Debanne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1997"
                        "volumen" => "175"
                        "paginaInicial" => "1535"
                        "paginaFinal" => "1537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9180202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latent Mycobacterium tuberculosis infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Getahun"
                            1 => "A&#46; Matteelli"
                            2 => "R&#46;E&#46; Chaisson"
                            3 => "M&#46; Raviglione"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "28"
                        "paginaInicial" => "2127"
                        "paginaFinal" => "2135"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Grupo de trabajo del &#225;rea TIR de SEPAR&#46; Recomendaciones SEPAR&#59; normativa sobre la prevenci&#243;n de la tuberculosis&#46; Arch Bronconeumol&#46; 2002&#59;38&#58;441-451&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativa SEPAR sobre diagn&#243;stico y tratamiento de la tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Ruiz-Manzano"
                            1 => "R&#46; Blanquer"
                            2 => "J&#46;L&#46; Calpe"
                            3 => "J&#46;A&#46; Caminero"
                            4 => "J&#46; Cayl&#224;"
                            5 => "J&#46;A&#46; Dom&#237;nguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2008"
                        "volumen" => "44"
                        "paginaInicial" => "551"
                        "paginaFinal" => "556"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19006636"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic standard and classification of tuberculosis in adults and children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "ATS"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.161.4.16141"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "161"
                        "paginaInicial" => "1376"
                        "paginaFinal" => "1395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10764337"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ATS&#46; Targeted tuberculin testing and treatment of latent tuberculosis infection&#46; Am J Respir Crit Care Med 2000&#59;161&#58;S221-S247&#46;"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of BCG vaccination on tuberculin reactivity and the booster effect among hospital employees"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Moreno"
                            1 => "R&#46; Bl&#225;zquez"
                            2 => "A&#46; Novoa"
                            3 => "I&#46; Carpena"
                            4 => "A&#46; Menasalvas"
                            5 => "C&#46; Ramirez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2001"
                        "volumen" => "161"
                        "paginaInicial" => "1760"
                        "paginaFinal" => "1765"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11485509"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "False-positive tuberculin skin test&#58; What is the absolute effect of BCG and non-tuberculous mycobacteria&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Farhat"
                            1 => "C&#46; Greenaway"
                            2 => "M&#46; Pai"
                            3 => "D&#46; Menzies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J tuber Lung Dis"
                        "fecha" => "2006"
                        "volumen" => "10"
                        "paginaInicial" => "1192"
                        "paginaFinal" => "1204"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular analysis of genetic differences between Mycobacterium bovis BCG and virulent M&#46; bovis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;C&#46; Maharias"
                            1 => "P&#46;J&#46; Sabo"
                            2 => "M&#46;J&#46; Hickey"
                            3 => "D&#46;C&#46; Singh"
                            4 => "C&#46;K&#46; Stover"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bacteriol"
                        "fecha" => "1996"
                        "volumen" => "178"
                        "paginaInicial" => "1274"
                        "paginaFinal" => "1282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8631702"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Purification and characterization of a low-molecular-mass T-cell antigen secreted by Mycobacterium tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;L&#46; Sorensen"
                            1 => "S&#46; Nagai"
                            2 => "G&#46; Houen"
                            3 => "P&#46; Andersen"
                            4 => "A&#46;B&#46; Andersen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Infect Inmmun"
                        "fecha" => "1995"
                        "volumen" => "63"
                        "paginaInicial" => "1710"
                        "paginaFinal" => "1717"
                      ]
                    ]
                  ]
                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Specific immune-based diagnosis of tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Andersen"
                            1 => "M&#46;E&#46; Munck"
                            2 => "J&#46;M&#46; Pollock"
                            3 => "T&#46;M&#46; Doherty"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2000"
                        "volumen" => "356"
                        "paginaInicial" => "1099"
                        "paginaFinal" => "1104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11009160"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0255"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review&#58; T-cell-based assays for the diagnosis of latent tuberculosis infection&#58; An update"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Pai"
                            1 => "A&#46; Zwerling"
                            2 => "D&#46; Menzies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2008"
                        "volumen" => "149"
                        "paginaInicial" => "177"
                        "paginaFinal" => "184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18593687"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915015300411"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of two commercially available gamma-interferon blood tests for immunodiagnosis of tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Dominguez"
                            1 => "J&#46; Ruiz Manzano"
                            2 => "M&#46; de Souza Galvao"
                            3 => "I&#46; Latorre"
                            4 => "C&#46; Mila"
                            5 => "S&#46; Blanco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CVI.00364-07"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Vaccine Immunol"
                        "fecha" => "2008"
                        "volumen" => "15"
                        "paginaInicial" => "168"
                        "paginaFinal" => "171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17978008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The typically atypical radiographic presentation of tuberculosis in advanced HIV disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Daley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tuber Lung Dis"
                        "fecha" => "1995"
                        "volumen" => "76"
                        "paginaInicial" => "475"
                        "paginaFinal" => "476"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8593365"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Narita"
                            1 => "D&#46; Ashkin"
                            2 => "E&#46; Hollender"
                            3 => "A&#46; Pitchenick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.158.1.9712001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "158"
                        "paginaInicial" => "157"
                        "paginaFinal" => "161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9655723"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0275"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus document on the evaluation and treatment of moderate-to-severe psoriasis Spanish psoriasis group of the Spanish Academy of Dermatology and Venereology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Puig"
                            1 => "X&#46; Bordas"
                            2 => "J&#46;M&#46; Carrascosa"
                            3 => "E&#46; Daud&#233;n"
                            4 => "C&#46; Ferr&#225;ndiz"
                            5 => "J&#46;M&#46; Hernanz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2009"
                        "volumen" => "100"
                        "paginaInicial" => "277"
                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19463230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0280"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latent tuberculosis infection and active tuberculosis in patients with psoriasis&#58; A study on the incidence of tuberculosis and the prevalence of latent tuberculosis disease in patients with moderate-severe psoriasis in Spain BIOBADADERM registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;I&#46; S&#225;nchez-Moya"
                            1 => "I&#46; Garc&#237;a-Doval"
                            2 => "G&#46; Carretero"
                            3 => "J&#46; S&#225;nchez-Carazo"
                            4 => "C&#46; Ferrandiz"
                            5 => "E&#46; Herrera Ceballos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2013"
                        "volumen" => "27"
                        "paginaInicial" => "1366"
                        "paginaFinal" => "1374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23134268"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish evidence-based guidelines on the treatment of moderate-to-severe psoriasis with biologic agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Puig"
                            1 => "J&#46;M&#46; Carrascosa"
                            2 => "E&#46; Daud&#233;n"
                            3 => "J&#46;L&#46; S&#225;nchez-Carazo"
                            4 => "C&#46; Ferr&#225;ndiz"
                            5 => "M&#46; S&#225;nchez-Rega&#241;a"
                          ]
                        ]
                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2009"
                        "volumen" => "100"
                        "paginaInicial" => "386"
                        "paginaFinal" => "413"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19558918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Guidelines on the management of latent tuberculosis infection&#46; Geneva&#58; World Health Organization&#59; 2015 &#91;cited 23 Jul 2015&#93;&#46; Available from&#58; <a href="http://www.who.int/tb/publications/latent-tuberculosis-infection/en/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;tb&#47;publications&#47;latent-tuberculosis-infection&#47;en&#47;</a>"
                ]
              ]
            ]
            21 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma interferon release assays for detection of Mycobacterium tuberculosis infection"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Pai"
                            1 => "C&#46;M&#46; Denkinger"
                            2 => "S&#46;V&#46; Kik"
                            3 => "M&#46;X&#46; Rangaka"
                            4 => "A&#46; Zwerling"
                            5 => "O&#46; Oxlade"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR.00034-13"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "3"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24396134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive value of interferon-&#947; release assays for incident active tuberculosis&#58; A systematic review and meta-analysis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "K&#46;A&#46; Wilkinson"
                            2 => "J&#46;R&#46; Glynn"
                            3 => "D&#46; Ling"
                            4 => "D&#46; Menzies"
                            5 => "J&#46; Mwansa-Kambafwile"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1473-3099(11)70210-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Infect Dis"
                        "fecha" => "2012"
                        "volumen" => "12"
                        "paginaInicial" => "45"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21846592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0305"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Screening for latent tuberculosis infection in psoriasis and psoriatic arthritis patients in a tuberculosis-endemic country&#58; a comparison of the QuantiFERON<span class="elsevierStyleSup">&#174;</span>-TBGold In-Tube test and tuberculin skin test"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "S&#46; Ersoy-Evans"
                            2 => "O&#46; Karada&#287;"
                            3 => "S&#46; A&#351;&#231;&#305;o&#287;lu"
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                            5 => "S&#46; Kiraz"
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.12522"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2014"
                        "volumen" => "53"
                        "paginaInicial" => "1286"
                        "paginaFinal" => "1292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25039468"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            24 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of an IFN-gamma assay in the diagnosis of latent tuberculosis in patients with psoriasis in a highly endemic setting"
                      "autores" => array:1 [
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                          "etal" => false
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                            2 => "V&#46;M&#46; de Lorena"
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                            5 => "G&#46; Benard"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-1151"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol"
                        "fecha" => "2011"
                        "volumen" => "91"
                        "paginaInicial" => "694"
                        "paginaFinal" => "697"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21629971"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0315"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical experience of QuantiFERON&#40;<span class="elsevierStyleSup">&#174;</span>&#41;-TB Gold testing in patients with psoriasis treated with tumour necrosis factor blockers in Taiwan"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:3 [
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                            1 => "P&#46;R&#46; Hsueh"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2010.10137.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2011"
                        "volumen" => "164"
                        "paginaInicial" => "553"
                        "paginaFinal" => "559"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21083541"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
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              "identificador" => "bib0320"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluating the use of the interferon-&#947; response to Mycobacterium tuberculosis-specific antigens in patients with psoriasis prior to antitumour necrosis factor-&#945; therapy&#58; A prospective head-to-head cross-sectional study"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
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                            2 => "B&#46;W&#46; Kirkham"
                            3 => "R&#46;W&#46; Groves"
                            4 => "H&#46;J&#46; Milburn"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.12176"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "1012"
                        "paginaFinal" => "1018"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23278714"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0325"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical applicability of quantiferon-TB-Gold testing in psoriasis patients during long-term anti-TNF-alpha treatment&#58; A prospective&#44; observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "A&#46; Ruggeri"
                            2 => "M&#46; D&#8217;Agostino"
                            3 => "F&#46; Ardito"
                            4 => "C&#46; de Simone"
                            5 => "G&#46; Delogu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2011.04220.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2012"
                        "volumen" => "26"
                        "paginaInicial" => "1572"
                        "paginaFinal" => "1576"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21923840"
                            "web" => "Medline"
                          ]
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                ]
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                        "link" => array:1 [
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                        "paginaInicial" => "381929"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22666260"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Guidelines of care for the management of psoriasis and psoriatic arthritis&#46; Section 4&#46; Guidelines of care for the management of psoriasis with traditional systemic agents"
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                            3 => "S&#46;R&#46; Feldman"
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                      ]
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                    0 => array:2 [
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                        "tituloSerie" => "J Am Acad Dermatol"
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                        "volumen" => "65"
                        "paginaInicial" => "137"
                        "paginaFinal" => "174"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21306785"
                            "web" => "Medline"
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                  ]
                ]
              ]
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              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European S3-guidelines on the systemic treatment of psoriasis vulgaris"
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                          "etal" => true
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                            2 => "P&#46; Saiag"
                            3 => "C&#46; Smith"
                            4 => "P&#46;J&#46; Spulis"
                            5 => "A&#46; Nast"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2009.03389.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2009"
                        "volumen" => "23"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "1"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19712190"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prednisolone treatment affects the performance of QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection"
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                            1 => "S&#46; Semb"
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                            3 => "A&#46;M&#46; Werlinrud"
                            4 => "B&#46; Soborg"
                            5 => "F&#46;K&#46; Jensen"
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                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Inflamm Bowel Dis"
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                        "volumen" => "17"
                        "paginaInicial" => "2340"
                        "paginaFinal" => "2349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21319275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between traditional systemic antipsoriatic drugs and tuberculosis risk in patients with psoriasis with or without psoriatic arthritis&#58; Results of a nationwide cohort study from Taiwan"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "J&#46;L&#46; Shen"
                            3 => "T&#46;T&#46; Chen"
                            4 => "Y&#46;T&#46; Chang"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2013"
                        "volumen" => "69"
                        "paginaInicial" => "25"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23375515"
                            "web" => "Medline"
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                  ]
                ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based guidelines for laboratory screening for infectious diseases before initiation systemic immunosuppressive agents in patients with autoimmune bullous diseases"
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                          "etal" => false
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                    ]
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                  "host" => array:1 [
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                        "paginaInicial" => "1307"
                        "paginaFinal" => "1317"
                        "link" => array:1 [
                          0 => array:2 [
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Practical Dermatology
Screening for Latent Tuberculosis in the Patient With Moderate to Severe Psoriasis Who Is a Candidate for Systemic and/or Biologic Therapy
Despistaje de tuberculosis latente en el paciente con psoriasis moderada grave candidato a terapia sistémica y/o biológica
A. Martínez-Lópeza,
Autor para correspondencia
ismenios@hotmail.com

Corresponding anutho.
, J. Rodriguez-Grangerb, R. Ruiz-Villaverdea
a Unidad de Gestión Clínica Dermatología Médico Quirúrgica y Venereología , Granada, Spain
b Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis &#40;TB&#41; infection occurs when a person comes into contact with airborne pathogens that originate from &#8220;open&#8221; lung lesions&#44; i&#46;e&#46;&#44; lesions connected to the exterior via a bronchus draining a tuberculous cavity&#46; Other routes of contagion are possible but are no longer of epidemiological importance&#46; Infected humans are thus the only important reservoir of the <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> bacterium responsible for the persistence of the TB pandemic&#46; Primary TB infection generates an immune response&#44; which in most cases halts the multiplication of the bacillus&#44; enabling control of the infection and subsequent cure&#46; However&#44; when the immune system fails to destroy all the bacteria&#44; some of these remain in a latent state in the host&#39;s cells and the host develops what is known as latent tuberculosis infection &#40;LTBI&#41;&#46; Affected individuals normally have no clinical manifestations or objective findings on examination&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the latest epidemiological data from the World Health Organization &#40;WHO&#41;&#44; which includes information up to 2014&#44; 6&#46;1 million TB cases were reported in 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> Of these&#44; 5&#46;7 million cases were newly diagnosed&#44; while the remaining 0&#46;4 million were cases under treatment&#46; In Spain&#44; the reported prevalence of TB is 16 cases per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants &#40;including human immunodeficiency virus &#91;HIV&#93; coinfection cases&#41;&#44; and the estimated incidence for 2013 was 13 cases per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#46; These data correspond to cases of active TB and illustrate the magnitude of the problem&#46; It is more difficult&#44; however&#44; to determine the prevalence of LTBI&#44; as there are no standardized systems for recording cases&#46; Figures vary according to the level of endemism&#44; with rates ranging from 0&#46;03&#37; in low-burden countries&#44; such as the United States&#44; to 4&#46;2&#37; in high-burden countries&#44; such as South Africa&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> The figures over the past 10 years have varied only minimally&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The risk of a person with LTBI developing active TB is variable and ranges between 0&#46;1&#37; &#40;in healthy individuals without risk factors&#41; to approximately 10&#37; &#40;in patients with HIV coinfection&#41;&#46; Adequate screening for latent infection can therefore reduce the incidence of active TB&#46; As mentioned&#44; patients with inadequately treated active TB are the main source of infection&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> The main factors that favor TB transmission include &#8220;severe disease in the index patient&#44; long periods of exposure to the index patient&#44; and poor ventilation and poor exposure to UV light during proximity to the index patient&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> A detailed description of intrinsic <span class="elsevierStyleItalic">M tuberculosis</span>&#8211; and host-related factors is beyond the scope of this article&#44; but suffice it to say that in dermatology&#44; LTBI prevention and treatment is of interest to dermatologists working with patients with moderate to severe psoriasis under treatment with biologics&#8212;and tumor necrosis factor &#40;TNF&#41; inhibitors in particular&#8212;as these patients are among the high-risk groups for infection &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In this review&#44; we describe the main techniques currently available for diagnosing LTBI&#44; update the existing LTBI screening algorithm&#44; analyze current screening practices in psoriasis patients in low- and high-TB-burden countries&#44; and explore the possibility of extending screening recommendations for psoriasis patients to patients who are being treated with or are candidates for nonbiologic systemic therapy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosing LTBI</span><p id="par0025" class="elsevierStylePara elsevierViewall">Individuals with LTBI at risk of developing active TB must be identified in order to administer appropriate prophylactic treatment&#46; Screening for LTBI&#44; however&#44; should not be applied indiscriminately&#44; but rather reserved for patients in whom it will bring clear benefits&#44; as a positive result mandates treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Tuberculin skin testing &#40;TST&#41; is the traditional method for diagnosing LTBI&#44; although new&#44; immune-based in vitro blood tests&#44; known as interferon-&#947; release assays &#40;IGRAs&#41;&#44; have gained ground in recent years&#46; It should be noted&#44; however&#44; that there is no gold-standard approach for detecting LTBI&#46; Current tests are all immune-based&#44; i&#46;e&#46;&#44; they involve the participation and response of memory T cells to antigens with varying levels of specificity&#46; The main disadvantage of both TST and IGRAs&#44; which are described in the sections below&#44; is that they cannot differentiate between LTBI and active TB&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Tuberculin Skin Testing</span><p id="par0035" class="elsevierStylePara elsevierViewall">TST is performed with an extract obtained from filtrates of sterilized concentrated cultures of the tubercle bacillus&#46; The antigen used is purified protein derivative &#40;PPD&#41;&#44; and in Spain&#44; the RT-23 variant is used&#44; with Tween 80 as a stabilizer&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The most widely used TST technique is the Mantoux technique&#44; which involves injecting 0&#46;1&#160;mL of PPD at a dose of 2 tuberculin units into the inner surface of the forearm&#46; The injection should trigger the appearance of a wheal&#44; which disappears after a short time&#46; Results are read after 48 to 72<span class="elsevierStyleHsp" style=""></span>hours by measuring the diameter of the induration perpendicular to the long axis of the forearm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Another technique is the multipuncture test&#44; which is also performed on the forearm but using tines or pins dipped in tuberculin&#46; This test&#44; however&#44; is considered inadequate&#44; as the amount of tuberculin that actually penetrates the skin is unknown&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">7&#44;8</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The main disadvantage of TST is that the proteins used are not specific to <span class="elsevierStyleItalic">M&#160;tuberculosis</span>&#44; as they are shared by the TB bacillus used in the bacillus Calmette-Gu&#233;rin &#40;BCG&#41; vaccine and by other species of environmental mycobacteria&#46; As a result&#44; the test has reduced specificity&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In Spain&#44; the TST is considered positive when a person who has not received the BCG vaccine develops an induration of 5<span class="elsevierStyleHsp" style=""></span>mm or larger&#46; Interpretation of results in BCG-vaccinated individuals is more complicated due to the need to distinguish between effects attributable to the vaccine and to TB infection&#46; In such cases&#44; an induration larger than 5<span class="elsevierStyleHsp" style=""></span>mm is considered to indicate a positive result if the individual is living with or in frequent contact with a TB patient or if he or she has chest radiograph changes suggesting former or untreated TB infection&#46; All other BCG-vaccinated individuals need to be treated&#44; because&#44; although it is thought that the larger the induration&#44; the greater the chance that the response is due to the presence of TB infection&#44; the effect of the vaccine cannot be proven with certainty&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">An induration of any size in a severely immunocompromised patient &#40;e&#46;g&#46;&#44; an HIV-infected patient&#44; transplant recipient&#44; patient receiving biologic or corticosteroid therapy&#41; is indicative of a positive result&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">TST is known to cause a booster effect that can lead to erroneous interpretation of results&#46; This effect&#44; which corresponds to the induction or re-establishment of waned reactivity in a previously infected patient&#44; can be misinterpreted as a new skin test conversion&#46; The booster effect is typically seen in individuals over 55 years of age and&#47;or in BCG-vaccinated persons&#44; and in such cases&#44; a test with a negative result should be repeated after 7 to 10 days&#59; the result of the second test is considered definitive&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Previous BCG vaccination and use of antigens that are not specific to <span class="elsevierStyleItalic">M tuberculosis</span> &#40;i&#46;e&#46;&#44; antigens shared with nontuberculous mycobacteria&#41; are the main causes of false-positive results in TST&#46; Nontuberculous mycobacteria&#44; however&#44; are only an important cause of false positives in countries with a high prevalence of these bacteria and a low prevalence of <span class="elsevierStyleItalic">M tuberculosis</span> infection<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> The impact of the BCG vaccine depends on time since vaccination and number of doses administered&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Interpretation of results can also be complicated by errors in administering the test&#44; resulting in bruising or injection site infections&#46; Other causes of false-negative results during testing and reading of results include concurrent viral infection&#44; live virus vaccination&#44; immunosuppressed states or use of immunosuppressive drugs&#44; and immune response in very elderly patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In general&#44; although the TST continues to be the method of choice for diagnosing infection&#44; its sensitivity is considerably reduced&#44; particularly in immunodepressed patients&#46; This reduced sensitivity limits the usefulness of the test&#46; Additional problems include the test&#39;s lack of specificity&#44; errors in administration&#44; subjectivity in the interpretation of results&#44; need for a second visit to read the results&#44; and lack of privacy&#46; However&#44; the test does have important advantages&#44; in particular its low cost and ease of administration&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Interferon-&#947; Release Assays</span><p id="par0080" class="elsevierStylePara elsevierViewall">IGRAs are based on the detection of interferon-&#947; in the blood&#46; This cytokine has a fundamental role in the control of TB infection and its release is triggered by the in vitro stimulation of T cells sensitized to <span class="elsevierStyleItalic">M tuberculosis</span>&#8211;specific antigens&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The antigens used in this test are ESAT-6 &#40;early secretory antigenic target-6&#41; and CFP-10 &#40;culture filtrate protein 10&#41;&#44; which are encoded by genes in the RD1 &#40;region of difference 1&#41; of the <span class="elsevierStyleItalic">M tuberculosis</span> genome&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11&#44;12</span></a> These antigens are more specific than PPD&#44; as they are not shared by any of the strains used in the BCG vaccine or by the majority of nontuberculous mycobacteria&#59; exceptions are <span class="elsevierStyleItalic">Mycobacterium marinum</span>&#44; <span class="elsevierStyleItalic">Mycobacterium kansasii&#44; Mycobacterium szulgai</span>&#44; and <span class="elsevierStyleItalic">Mycobacterium flavencens</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">There are 2 commercially available IGRAs&#58; QuantiFERON TB Gold In-Tube &#40;QFT-GIT&#41; &#40;Cellestis&#47;Qiagen&#41;&#44; which is based on the enzyme-linked immunoabsorbent assay &#40;ELISA&#41;&#44; and T-SPOT&#46;<span class="elsevierStyleItalic">TB</span> &#40;T-Spot&#41; &#40;Oxford Immunotec&#41;&#44; which is based on the enzyme-linked immunospot &#40;ELISPOT&#41; technique&#46; Both tests were recently approved for sale in Europe and have also finally received clearance from the US Food and Drug Administration for the diagnosis of LTBI&#46; The QFT-GIT incorporates a third antigen in addition to ESAT-6 and CFP-10&#58; TB 7&#46;7&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Both tests offer procedural advantages over TST&#44; and are significantly more specific in BCG-vaccinated individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">14&#44;15</span></a> In addition&#44; they incorporate controls to test for anergy and rule out false negatives&#46; They can also be repeated immediately and do not cause the booster effect as they do not induce an immune response&#46; Loss of patients is also avoided as patients do not need to return for a second visit&#44; as they do with TST&#46; Finally&#44; IGRAs are easier to standardize and use in the laboratory&#44; and they protect patient privacy&#46; Their main disadvantage compared with TST is their cost&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The QFT-GIT is performed by incubating 1<span class="elsevierStyleHsp" style=""></span>mL of peripheral blood with heparin in 3 tubes&#58; <span class="elsevierStyleItalic">1</span>&#41; a nil control tube containing blood from the patient&#44; <span class="elsevierStyleItalic">2</span>&#41; a positive control tube with phytohemagglutinin to measure the patient&#39;s lymphoproliferative response&#44; and <span class="elsevierStyleItalic">3</span>&#41; a tube containing the specific antigens&#58; ESAT-6&#44; CFP-10&#44; and TB 7&#46;7&#46; The 3 tubes are incubated for 16 to 18<span class="elsevierStyleHsp" style=""></span>hours at a temperature of 37<span class="elsevierStyleHsp" style=""></span>&#176;C and the concentration of interferon &#40;IFN&#41; &#947; is measured in international units &#40;IU&#41; per milliliter by ELISA&#46; Results are interpreted using a standard curve in a software program supplied by the manufacturer&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the T-Spot&#44; unlike the QFT-GIT&#44; peripheral blood mononuclear cells must be separated prior to stimulation&#44; and as mentioned&#44; the presence of interferon-&#947; is determined by ELISPOT not ELISA&#46; The ELISPOT assay involves counting the number of spot-forming cells&#44; whereby each spot corresponds to the footprint of a single IFN-&#947;&#8211;secreting T cell&#46; Technically&#44; the T-Spot requires more blood&#44; has longer preparation times&#44; and is more difficult to conduct&#46; However&#44; it appears to offer greater sensitivity&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Unfortunately&#44; IGRAs may yield indeterminate results due to low IFN-&#947; production in the positive control &#40;mitogen&#41; or high response to the nil control&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">IGRAs have a specificity of over 95&#37; in areas with a low incidence of active TB&#44; and this is not affected by BCG vaccination&#46; According to several studies&#44; T-Spot has higher specificity &#40;90&#37;&#41; than both QFT-GIT and TST &#40;80&#37; in both cases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">16&#44;17</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Biologic Therapy and Screening for LTBI</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this section&#44; we are going to look at the current situation regarding screening for LTBI in patients with moderate to severe psoriasis who are candidates for biologic therapy&#44; the incidence of LTBI in this population in Spain&#44; and the current position of the WHO regarding LTBI screening&#46; We also provide a brief analysis of studies that have analyzed the diagnostic agreement between IGRAs and TST&#44; and conclude with an easy-to-apply algorithm&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The need to screen for LTBI in patients with moderate to severe psoriasis became a key issue in 2005&#44; when biologics were introduced into the therapeutic arsenal for this condition&#46; Drawing on experiences with rheumatological patients&#44; in their first consensus document on the evaluation and treatment of moderate to severe psoriasis&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> the Spanish Psoriasis Group&#44; under the auspices of the Spanish Academy of Dermatology and Venereology&#44; considered 3 situations related to screening for LTBI in this setting &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The current situation regarding LTBI in patients with moderate to severe psoriasis in Spain is quite well known thanks to a study published by S&#225;nchez Moya et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> who reported on statistics from the 2013 BIOBADADERM registry&#46; The study reported a prevalence of 20&#46;5&#37; for LTBI in 1425 patients with moderate to severe psoriasis&#44; 56&#37; of whom were receiving biologics and 44&#37; of whom were receiving conventional systemic treatment&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Screening for LTBI was performed in 83&#37; of these patients&#44; but adherence to screening protocol recommendations was observed in just 51&#37; of cases&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The authors attributed this low adherence to the introduction of IGRAs in many of the participating centers and to the fact that the finding was based only on TST screening&#46; The study highlights the need to modify guidelines for the management of moderate to severe psoriasis and emphasizes the importance of adherence to established protocols&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In its recently published guidelines on the management of LTBI&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> the WHO highlights 3 very interesting points&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">&#8220;Individuals should be asked about symptoms of TB before being tested for LTBI&#46; Chest radiography must be done if efforts are intended also for active TB case finding&#46; Individuals with TB symptoms or any other radiological abnormality should be investigated further for active TB and other conditions &#40;strong recommendation&#44; very low quality of evidence&#41;&#46;&#8221;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">&#8220;Either TST or IGRA can be used to test for LTBI in high-income and upper middle-income countries with estimated TB incidence less than 100 per 100 000 &#40;strong recommendation&#44; very low quality of evidence&#41;&#46;&#8221;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">&#8220;IGRA should not replace TST in low-income and other middle-income countries &#40;strong recommendation&#44; very low quality of evidence&#41;&#46;&#8221;</p></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall">Considering the above&#44; and the relatively recent introduction of new LTBI screening methods&#8212;IGRAs&#8212;now seems an opportune moment to revise the situation&#46; Studies of diagnostic agreement between TST and IGRA have shown clear differences between high- and low-TB-burden countries due to BCG vaccination and reinfection rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">22&#44;23</span></a><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">In countries with a high incidence of TB and BCG vaccination&#44; TST overestimates the diagnosis of LTBI&#44; leading to unnecessary prophylactic treatment and associated adverse effects&#44;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">24&#44;25</span></a> while IGRAs do not offer significant differences with respect to control groups&#44; with similar rates detected in psoriasis patients and the general population&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">In moderately endemic countries with low vaccination rates&#44; TST also overestimates LTBI compared with IGRAs&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Finally&#44; in low-burden countries with low BCG vaccination rates&#44; better diagnostic agreement has been found between the 2 tests&#44; but TST continues to overestimate the prevalence of LTBI compared with IGRAs&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27&#44;28</span></a></p></li></ul></p><p id="par0185" class="elsevierStylePara elsevierViewall">One particularly interesting recent study in this area is that by Gisondi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a> which evaluated the prevalence of LTBI in patients with psoriasis being considered for biologic therapy&#46; The authors compared rates with those observed in health care workers and patients with rheumatoid arthritis or Crohn disease&#46; The findings complemented data from the Italian psoriasis registry &#40;Psocare&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> which had established a prevalence rate of 8&#46;2&#37;&#46; All the patients in the study by Gisondo et al&#46; were screened for LTBI using an IGRA &#40;QFT-GIT&#41;&#44; but 88 of the patients simultaneously underwent screening with TST&#46; The rates detected were 8&#46;2&#37; for patients with psoriasis&#44; 8&#46;8&#37; for health care workers&#44; 9&#37; for patients with rheumatoid arthritis&#44; and 7&#37; for patients with Crohn disease&#46; None of the patients diagnosed with LTBI developed active TB after treatment with appropriate chemoprophylaxis&#46; IGRA testing was repeated after a mean &#40;SD&#41; of 31 &#40;1&#46;7&#41; months&#8212;the authors do not explain why they chose this exact period&#8212;and revealed reversion in 25&#37; of patients diagnosed and treated for LTBI and conversion in 0&#46;8&#37; of cases&#46; Agreement was low between the QFT-GIT and TST &#40;&#954;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#41;&#44; although the authors were clearly in favor of using the IGRA&#44; as it can be repeated as often as the dermatologist considers necessary without inducing a booster effect or sensitization&#46; New studies&#44; however&#44; are required to help explain the fluctuations seen in the serial tests performed&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The reasons for the discrepancies between IGRAs and TST have not been clearly elucidated&#44; but may include variations in psoriasis severity&#44; BCG vaccination status&#44; and use &#40;or not&#41; of concomitant immunosuppressive therapy&#46; Patients with moderate to severe psoriasis exhibit a lower <span class="elsevierStyleItalic">M</span> tuberculosis&#8211;specific immune response and in general greater sensitivity to TST&#46; Finally&#44; immunosuppressive therapy can affect TST but not IGRA results&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Most cost-benefit studies tend to weigh in favor of the use of IGRAs to diagnose LTBI&#44; as these tests minimize false positives &#40;particularly in vaccinated populations&#41; and eliminate the extra costs and adverse effects associated with TB chemoprophylaxis&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">In view of the above&#44; and considering that not all hospitals in Spain have access to IGRAs&#44; we have designed an algorithm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; for screening for LTBI in patients with moderate to severe psoriasis in our setting&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Systemic Treatment and Screening for LTBI&#58; Other Considerations</span><p id="par0205" class="elsevierStylePara elsevierViewall">While the need for LTBI screening in patients who are candidates for biologic therapy is fully acknowledged&#44; there are reasonable doubts regarding the need for such testing in patients transitioning from topical to systemic therapy&#46; Not all systemic drugs or phototherapy have the same mechanism of action&#44; and only methotrexate and ciclosporin&#44; due to their immunosuppressive action&#44; are associated with a notable increased risk of viral&#44; fungal&#44; and bacterial infections&#44; including LTBI of course&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Both Spanish<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> and American<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> guidelines on the diagnostic and therapeutic management of psoriasis recommend screening for LTBI prior to initiating treatment with ciclosporin or methotrexate&#46; However&#44; they do not recommend screening in the case of acitretin or phototherapy&#44; as these have not been found to be associated with an increased risk of TB reactivation&#46; These recommendations are supported by the results of the recent prevalence study of LTBI in patients with psoriasis by Gisondi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> discussed in the previous section&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">In their study based on the latest figures from the BIOBADADERM registry&#44; S&#225;nchez-Moya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> reported no cases of active TB in patients treated with conventional systemic agents&#44; suggesting possibly a lower risk of LTBI in such cases&#46; The findings of such studies and lessons drawn from previous experiences perhaps explain why certain guidelines&#44; such as the European S3-guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> do not consider it necessary to screen for LTBI before initiating treatment with any of the 4 classical treatments used in the management of moderate to severe psoriasis&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">While beyond the scope of our study&#44; we believe it important to draw attention to one aspect highlighted by several authors&#58; the inclusion of oral corticosteroids in treatment regimens that require screening for LTBI prior to initiation&#44; particularly when doses of over 20<span class="elsevierStyleHsp" style=""></span>mg&#47;d are to be used for longer than 2 weeks in areas with a high prevalence of TB&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">34&#8211;36</span></a> In a review on the evidence regarding screening for infectious diseases before initiation of systemic immunosuppressive treatment in patients with autoimmune bullous diseases&#44; Keith et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a> recommended assessing individual risk in order to choose the most appropriate method&#46; The authors also stressed the fact that patients with autoimmune bullous diseases may require multiple immunosuppressive therapies over time&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Patients with moderate to severe psoriasis also typically need multiple treatments over time&#44; and it would therefore seem reasonable to screen for LTBI in all patients about to start systemic therapy&#44; although&#44; as we have mentioned&#44; there is no consensus on this matter&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">We have provided an update of the methods currently used to screen for LTBI and their application in routine dermatology practice&#46; IGRAs are now widely used in the diagnosis of TB due to the absence of cross-reactions with the BCG vaccine and other nontuberculous mycobacteria&#46; Compared with TST&#44; they are influenced less by immunosuppression&#44; although not all authors would agree&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> and can be repeated over time without causing a booster effect&#46; Accordingly&#44; they are ideal for monitoring for LTBI in patients with moderate to severe psoriasis who are candidates for biologic therapy&#46; Their cost&#44; however&#44; continues to be their main disadvantage&#46; Although consensus is lacking regarding the need for LTBI screening before the initiation of conventional systemic treatments in patients with moderate to severe psoriasis&#44; the fact that these patients also need multiple treatments&#44; including biologics&#44; throughout the course of their disease&#44; makes screening highly recommendable&#46; LTBI screening should also be considered for other systemic or autoimmune diseases that require treatments such as systemic corticosteroids&#44; as these are also associated with higher rates of LTBI reactivation&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of Interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Screening to detect latent tuberculosis infection &#40;LTBI&#41; is essential before patients with moderate to severe psoriasis start treatment with biologics and vigilance will continue to be needed during and after such treatment&#46; The most recently analyzed statistics from the BIOBADADERM registry show a 20&#46;5&#37; prevalence of LTBI in psoriasis patients treated with biologics in Spain&#46; Various screening protocols are in effect in different countries according to their levels of endemic TB and bacillus Calmette-Gu&#233;rin &#40;BCG&#41; vaccination&#44; and there is no consensus on a gold-standard approach to the diagnosis of LTBI&#46; Tuberculin skin testing &#40;TST&#41; continues to be the diagnostic method of choice in spite of its limited sensitivity&#44; mainly in immunocompromised patients&#46; Additional problems include the TST&#39;s well-established lack of specificity&#44; errors in application&#44; subjectivity in the interpretation of results &#40;which must be read during a second visit&#41;&#44; and lack of privacy&#59; the main advantages of this test are its low cost and ease of application&#46; Most cost-benefit studies are therefore inclined to favor using interferon-&#947; release assays to detect LTBI because they minimize false positives &#40;especially in BCG-vaccinated individuals&#41;&#44; thereby eliminating the extra costs and side effects of unnecessary chemoprophylaxis&#46; We review the methods used for LTBI screening in psoriasis patients who are candidates for biologic therapy&#46; Additionally&#44; given the fact that most guidelines do not currently consider it necessary to screen patients about to start conventional systemic therapy&#44; we discuss the reasons underlying the need for such screening&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con psoriasis moderada-grave que van a iniciar tratamiento con agentes biol&#243;gicos deben ser monitorizados para la detecci&#243;n de infecci&#243;n tuberculosa latente antes&#44; durante y despu&#233;s del tratamiento&#46; En el &#250;ltimo informe publicado de BIOBADADERM la prevalencia de infecci&#243;n latente por M&#46;tuberculosis &#40;ILMT&#41; alcanzaba el 20&#44;5&#37; de los pacientes psori&#225;sicos tratados con agentes biol&#243;gicos en nuestro pa&#237;s&#46; En la actualidad no existe un m&#233;todo diagn&#243;stico <span class="elsevierStyleItalic">gold standard</span> que permita una aplicaci&#243;n sistem&#225;tica y consensuada&#44; con variaciones en los diferentes pa&#237;ses seg&#250;n el grado de endemicidad y vacunaci&#243;n con BCG&#46; La prueba de tuberculina &#40;PT&#41; contin&#250;a siendo el m&#233;todo de elecci&#243;n para el diagn&#243;stico de infecci&#243;n&#44; pero presenta importantes limitaciones en su sensibilidad &#40;principalmente en pacientes inmunodeprimidos&#41;&#46; Esta situaci&#243;n&#44; junto a su falta de especificidad conocida&#44; errores en su administraci&#243;n&#44; la subjetividad en la interpretaci&#243;n de los resultados&#44; la necesidad de una segunda visita para la lectura y la ausencia de privacidad hacen de ella una prueba limitada&#44; cuyas principales ventajas resultar&#237;an su bajo coste y f&#225;cil realizaci&#243;n&#46; Por eso la mayor&#237;a de los estudios de coste beneficio se inclinan por el m&#233;todo IGRA para el diagn&#243;stico de la ILMT&#44; ya que minimiza los falsos positivos &#40;especialmente en poblaci&#243;n vacunada&#41;&#44; eliminando costes extra y efectos secundarios de la quimioprofilaxis antituberculosa&#46; Valoramos la aplicabilidad en pacientes psori&#225;sicos candidatos a terapia biol&#243;gica y discutimos la necesidad de su realizaci&#243;n previamente a terapia sist&#233;mica convencional&#44; puesto que la mayor&#237;a de las gu&#237;as actuales no consideran imprescindible su realizaci&#243;n&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez-L&#243;pez A&#44; Rodriguez-Granger J&#44; Ruiz-Villaverde R&#46; Despistaje de tuberculosis latente en el paciente con psoriasis moderada grave candidato a terapia sist&#233;mica y&#47;o biol&#243;gica&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;207&#8211;214&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Proposed LTBI screening algorithm for patients with moderate to severe psoriasis before initiation of biologic therapy&#46; BCG indicates bacillus Calmette-Gu&#233;rin&#59; TST&#44; tuberculin skin test&#59; IGRA&#44; interferon &#947; release assay&#59; LTBI&#44; latent tuberculosis infection&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; TB&#44; tuberculosis&#59; TNF&#44; tumor necrosis factor&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acquired immunodeficiency syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Human immunodeficiency virus infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transplant recipients on immunosuppressive treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Silicosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic kidney disease under treatment with hemodialysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Head and neck cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recent TB infection &#40;in last 2 years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chest radiograph findings consistent with TB&#44; i&#46;e&#46;&#44; apical fibronodular changes not granulomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Health care workers in contact with patients with active TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Casual contact with patients with highly contagious active TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients being treated with TNF inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">TST was repeated yearly in patients with a negative result&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">After thorough history taking with relevant search for history and risk factors&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Adapted from the 2009 Consensus Document on the Evaluation and Treatment of Moderate to Severe Psoriasis of the Spanish Academy of Dermatology and Venereology&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a></p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative TST<br>Negative booster effect<br>Normal chest radiograph findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><br>Start biologic therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive TST and&#47;or positive booster effect<br>Normal chest radiograph findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diagnose LTBI<br>Start chemoprophylaxis<br>Delay initiation of biologic therapy for 1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive TST and&#47;or booster effect &#40;and BCG vaccination &#62;<span class="elsevierStyleHsp" style=""></span>10 years ago in vaccinated individuals&#41;<br>Abnormal chest radiograph findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diagnose active TB<br>Start TB treatment<br>Delay initiation of biologic therapy for 6 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Screening Algorithm for LTBI<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a></p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Informe mundial sobre la tuberculosis 2014 &#91;cited 23 Jul 2015&#93;&#46; Available from&#58; <a href="http://www.who.int/tb/publications/global_report/es/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;tb&#47;publications&#47;global&#95;report&#47;es&#47;</a>"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Annual risk of tuberculous infection using different methods in communities with a high prevalence of TB and HIV in Zambia and South Africa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Shanaube"
                            1 => "C&#46; Sismanidis"
                            2 => "H&#46; Ayles"
                            3 => "N&#46; Beyers"
                            4 => "A&#46; Schaap"
                            5 => "K&#46;A&#46; Lawrence"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2009"
                        "volumen" => "13"
                        "paginaInicial" => "e7749"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estimation of the annual risk of tuberculosis infection for white men in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;M&#46; Daniel"
                            1 => "S&#46;M&#46; Debanne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1997"
                        "volumen" => "175"
                        "paginaInicial" => "1535"
                        "paginaFinal" => "1537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9180202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latent Mycobacterium tuberculosis infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Getahun"
                            1 => "A&#46; Matteelli"
                            2 => "R&#46;E&#46; Chaisson"
                            3 => "M&#46; Raviglione"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "28"
                        "paginaInicial" => "2127"
                        "paginaFinal" => "2135"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Grupo de trabajo del &#225;rea TIR de SEPAR&#46; Recomendaciones SEPAR&#59; normativa sobre la prevenci&#243;n de la tuberculosis&#46; Arch Bronconeumol&#46; 2002&#59;38&#58;441-451&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativa SEPAR sobre diagn&#243;stico y tratamiento de la tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Ruiz-Manzano"
                            1 => "R&#46; Blanquer"
                            2 => "J&#46;L&#46; Calpe"
                            3 => "J&#46;A&#46; Caminero"
                            4 => "J&#46; Cayl&#224;"
                            5 => "J&#46;A&#46; Dom&#237;nguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2008"
                        "volumen" => "44"
                        "paginaInicial" => "551"
                        "paginaFinal" => "556"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19006636"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic standard and classification of tuberculosis in adults and children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "ATS"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.161.4.16141"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "161"
                        "paginaInicial" => "1376"
                        "paginaFinal" => "1395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10764337"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ATS&#46; Targeted tuberculin testing and treatment of latent tuberculosis infection&#46; Am J Respir Crit Care Med 2000&#59;161&#58;S221-S247&#46;"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of BCG vaccination on tuberculin reactivity and the booster effect among hospital employees"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Moreno"
                            1 => "R&#46; Bl&#225;zquez"
                            2 => "A&#46; Novoa"
                            3 => "I&#46; Carpena"
                            4 => "A&#46; Menasalvas"
                            5 => "C&#46; Ramirez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2001"
                        "volumen" => "161"
                        "paginaInicial" => "1760"
                        "paginaFinal" => "1765"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11485509"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "False-positive tuberculin skin test&#58; What is the absolute effect of BCG and non-tuberculous mycobacteria&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Farhat"
                            1 => "C&#46; Greenaway"
                            2 => "M&#46; Pai"
                            3 => "D&#46; Menzies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J tuber Lung Dis"
                        "fecha" => "2006"
                        "volumen" => "10"
                        "paginaInicial" => "1192"
                        "paginaFinal" => "1204"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular analysis of genetic differences between Mycobacterium bovis BCG and virulent M&#46; bovis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;C&#46; Maharias"
                            1 => "P&#46;J&#46; Sabo"
                            2 => "M&#46;J&#46; Hickey"
                            3 => "D&#46;C&#46; Singh"
                            4 => "C&#46;K&#46; Stover"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bacteriol"
                        "fecha" => "1996"
                        "volumen" => "178"
                        "paginaInicial" => "1274"
                        "paginaFinal" => "1282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8631702"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Purification and characterization of a low-molecular-mass T-cell antigen secreted by Mycobacterium tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;L&#46; Sorensen"
                            1 => "S&#46; Nagai"
                            2 => "G&#46; Houen"
                            3 => "P&#46; Andersen"
                            4 => "A&#46;B&#46; Andersen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Infect Inmmun"
                        "fecha" => "1995"
                        "volumen" => "63"
                        "paginaInicial" => "1710"
                        "paginaFinal" => "1717"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Specific immune-based diagnosis of tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Andersen"
                            1 => "M&#46;E&#46; Munck"
                            2 => "J&#46;M&#46; Pollock"
                            3 => "T&#46;M&#46; Doherty"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2000"
                        "volumen" => "356"
                        "paginaInicial" => "1099"
                        "paginaFinal" => "1104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11009160"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review&#58; T-cell-based assays for the diagnosis of latent tuberculosis infection&#58; An update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Pai"
                            1 => "A&#46; Zwerling"
                            2 => "D&#46; Menzies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2008"
                        "volumen" => "149"
                        "paginaInicial" => "177"
                        "paginaFinal" => "184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18593687"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915015300411"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of two commercially available gamma-interferon blood tests for immunodiagnosis of tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Dominguez"
                            1 => "J&#46; Ruiz Manzano"
                            2 => "M&#46; de Souza Galvao"
                            3 => "I&#46; Latorre"
                            4 => "C&#46; Mila"
                            5 => "S&#46; Blanco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CVI.00364-07"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Vaccine Immunol"
                        "fecha" => "2008"
                        "volumen" => "15"
                        "paginaInicial" => "168"
                        "paginaFinal" => "171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17978008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The typically atypical radiographic presentation of tuberculosis in advanced HIV disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Daley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tuber Lung Dis"
                        "fecha" => "1995"
                        "volumen" => "76"
                        "paginaInicial" => "475"
                        "paginaFinal" => "476"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8593365"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Narita"
                            1 => "D&#46; Ashkin"
                            2 => "E&#46; Hollender"
                            3 => "A&#46; Pitchenick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.158.1.9712001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "158"
                        "paginaInicial" => "157"
                        "paginaFinal" => "161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9655723"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus document on the evaluation and treatment of moderate-to-severe psoriasis Spanish psoriasis group of the Spanish Academy of Dermatology and Venereology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Puig"
                            1 => "X&#46; Bordas"
                            2 => "J&#46;M&#46; Carrascosa"
                            3 => "E&#46; Daud&#233;n"
                            4 => "C&#46; Ferr&#225;ndiz"
                            5 => "J&#46;M&#46; Hernanz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2009"
                        "volumen" => "100"
                        "paginaInicial" => "277"
                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19463230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0280"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latent tuberculosis infection and active tuberculosis in patients with psoriasis&#58; A study on the incidence of tuberculosis and the prevalence of latent tuberculosis disease in patients with moderate-severe psoriasis in Spain BIOBADADERM registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;I&#46; S&#225;nchez-Moya"
                            1 => "I&#46; Garc&#237;a-Doval"
                            2 => "G&#46; Carretero"
                            3 => "J&#46; S&#225;nchez-Carazo"
                            4 => "C&#46; Ferrandiz"
                            5 => "E&#46; Herrera Ceballos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2013"
                        "volumen" => "27"
                        "paginaInicial" => "1366"
                        "paginaFinal" => "1374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23134268"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish evidence-based guidelines on the treatment of moderate-to-severe psoriasis with biologic agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Puig"
                            1 => "J&#46;M&#46; Carrascosa"
                            2 => "E&#46; Daud&#233;n"
                            3 => "J&#46;L&#46; S&#225;nchez-Carazo"
                            4 => "C&#46; Ferr&#225;ndiz"
                            5 => "M&#46; S&#225;nchez-Rega&#241;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2009"
                        "volumen" => "100"
                        "paginaInicial" => "386"
                        "paginaFinal" => "413"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19558918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Guidelines on the management of latent tuberculosis infection&#46; Geneva&#58; World Health Organization&#59; 2015 &#91;cited 23 Jul 2015&#93;&#46; Available from&#58; <a href="http://www.who.int/tb/publications/latent-tuberculosis-infection/en/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;tb&#47;publications&#47;latent-tuberculosis-infection&#47;en&#47;</a>"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma interferon release assays for detection of Mycobacterium tuberculosis infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Pai"
                            1 => "C&#46;M&#46; Denkinger"
                            2 => "S&#46;V&#46; Kik"
                            3 => "M&#46;X&#46; Rangaka"
                            4 => "A&#46; Zwerling"
                            5 => "O&#46; Oxlade"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR.00034-13"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "3"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24396134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive value of interferon-&#947; release assays for incident active tuberculosis&#58; A systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;X&#46; Rangaka"
                            1 => "K&#46;A&#46; Wilkinson"
                            2 => "J&#46;R&#46; Glynn"
                            3 => "D&#46; Ling"
                            4 => "D&#46; Menzies"
                            5 => "J&#46; Mwansa-Kambafwile"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1473-3099(11)70210-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Infect Dis"
                        "fecha" => "2012"
                        "volumen" => "12"
                        "paginaInicial" => "45"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21846592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0305"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Screening for latent tuberculosis infection in psoriasis and psoriatic arthritis patients in a tuberculosis-endemic country&#58; a comparison of the QuantiFERON<span class="elsevierStyleSup">&#174;</span>-TBGold In-Tube test and tuberculin skin test"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Duman"
                            1 => "S&#46; Ersoy-Evans"
                            2 => "O&#46; Karada&#287;"
                            3 => "S&#46; A&#351;&#231;&#305;o&#287;lu"
                            4 => "B&#46; Sener"
                            5 => "S&#46; Kiraz"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.12522"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2014"
                        "volumen" => "53"
                        "paginaInicial" => "1286"
                        "paginaFinal" => "1292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25039468"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of an IFN-gamma assay in the diagnosis of latent tuberculosis in patients with psoriasis in a highly endemic setting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; De Andrade Lima"
                            1 => "M&#46; de Andrade Lima"
                            2 => "V&#46;M&#46; de Lorena"
                            3 => "Y&#46; de Miranda Gomes"
                            4 => "O&#46; Lupi"
                            5 => "G&#46; Benard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-1151"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol"
                        "fecha" => "2011"
                        "volumen" => "91"
                        "paginaInicial" => "694"
                        "paginaFinal" => "697"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21629971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical experience of QuantiFERON&#40;<span class="elsevierStyleSup">&#174;</span>&#41;-TB Gold testing in patients with psoriasis treated with tumour necrosis factor blockers in Taiwan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;Y&#46; Chiu"
                            1 => "P&#46;R&#46; Hsueh"
                            2 => "T&#46;F&#46; Tsai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2010.10137.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2011"
                        "volumen" => "164"
                        "paginaInicial" => "553"
                        "paginaFinal" => "559"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21083541"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluating the use of the interferon-&#947; response to Mycobacterium tuberculosis-specific antigens in patients with psoriasis prior to antitumour necrosis factor-&#945; therapy&#58; A prospective head-to-head cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;L&#46; Martyn-Simmons"
                            1 => "J&#46;B&#46; Mee"
                            2 => "B&#46;W&#46; Kirkham"
                            3 => "R&#46;W&#46; Groves"
                            4 => "H&#46;J&#46; Milburn"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.12176"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "1012"
                        "paginaFinal" => "1018"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23278714"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
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              "identificador" => "bib0325"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical applicability of quantiferon-TB-Gold testing in psoriasis patients during long-term anti-TNF-alpha treatment&#58; A prospective&#44; observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "A&#46; Ruggeri"
                            2 => "M&#46; D&#8217;Agostino"
                            3 => "F&#46; Ardito"
                            4 => "C&#46; de Simone"
                            5 => "G&#46; Delogu"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2011.04220.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
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                        "volumen" => "26"
                        "paginaInicial" => "1572"
                        "paginaFinal" => "1576"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21923840"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0330"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latent tuberculosis infection in patients with chronic plaque psoriasis who are candidates for biological therapy"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Gisondi"
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                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2014"
                        "volumen" => "171"
                        "paginaInicial" => "884"
                        "paginaFinal" => "890"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24863903"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latent tuberculosis infection in patients with chronic plaque psoriasis&#58; evidence from the Italian Psocare Registry"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
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                            2 => "S&#46; Chimenti"
                            3 => "M&#46; Maccarone"
                            4 => "M&#46; Picardo"
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                      "doi" => "10.1111/bjd.13539"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2015"
                        "volumen" => "172"
                        "paginaInicial" => "1613"
                        "paginaFinal" => "1620"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25401733"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            30 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunosuppression adversely affects TST but not IGRAs in patients with psoriasis or inflammatory musculoskeletal diseases"
                      "autores" => array:1 [
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                          "etal" => true
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                            4 => "A&#46; Kantele"
                            5 => "A&#46; J&#228;rvinen"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Rheumatol"
                        "fecha" => "2012"
                        "volumen" => "2012"
                        "paginaInicial" => "381929"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22666260"
                            "web" => "Medline"
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                  ]
                ]
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            31 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines of care for the management of psoriasis and psoriatic arthritis&#46; Section 4&#46; Guidelines of care for the management of psoriasis with traditional systemic agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "A&#46; Menter"
                            1 => "N&#46;J&#46; Korman"
                            2 => "C&#46;A&#46; Elmets"
                            3 => "S&#46;R&#46; Feldman"
                            4 => "J&#46;M&#46; Gelfand"
                            5 => "K&#46;B&#46; Gordon"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2010.11.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2011"
                        "volumen" => "65"
                        "paginaInicial" => "137"
                        "paginaFinal" => "174"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21306785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            32 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European S3-guidelines on the systemic treatment of psoriasis vulgaris"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            3 => "C&#46; Smith"
                            4 => "P&#46;J&#46; Spulis"
                            5 => "A&#46; Nast"
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2009.03389.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2009"
                        "volumen" => "23"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "1"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19712190"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0355"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prednisolone treatment affects the performance of QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "S&#46; Semb"
                            2 => "M&#46; Ruhwald"
                            3 => "A&#46;M&#46; Werlinrud"
                            4 => "B&#46; Soborg"
                            5 => "F&#46;K&#46; Jensen"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.21605"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "2340"
                        "paginaFinal" => "2349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21319275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
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ISSN: 15782190
Idioma original: Inglés
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