{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:15:26Z","timestamp":1755216926187,"version":"3.43.0"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Tuberculosis (TB), a chronic infection caused by the Mycobacterium tuberculosis complex, has an increased risk of reactivation in conditions that affect the immune system, such as MS, and its treatment with disease-modifying drugs (DMDs). The present is a retrospective study of 2,036 patients diagnosed with MS followed at the Department of Neurology and Neurosurgery of Escola Paulista de Medicina, Universidade Federal de S\u00e3o Paulo, from February 1994 to September 2023. Of that total, 6 were included in this case series, taking different DMDs: fingolimod (n\u2009=\u20092), interferon beta 1a (n\u2009=\u20092), glatiramer acetate (n\u2009=\u20091) and cyclophosphamide (n\u2009=\u20091). In our study, two patients experienced worsening disability during tuberculosis treatment, while three others had increased disability after completing treatment. We reinforce the importance of screening all patients eligible for DMD treatment, especially the highly effective modern ones, and the importance of developing research-based guidelines for screening infectious diseases among patients with MS.<\/jats:p>","DOI":"10.1055\/s-0045-1810406","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T23:35:26Z","timestamp":1754350526000},"page":"001-006","source":"Crossref","is-referenced-by-count":0,"title":["Active tuberculosis and multiple sclerosis: the importance of screening before treatment"],"prefix":"10.1055","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6545-0163","authenticated-orcid":false,"given":"Leizian de Souza","family":"Amorim","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4011-2918","authenticated-orcid":false,"given":"Paloma Peter Travassos","family":"Zaidan","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7332-2658","authenticated-orcid":false,"given":"Felipe Toscano Lins de","family":"Menezes","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4939-7200","authenticated-orcid":false,"given":"Enedina Maria Lobato de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1038\/nrmicro1065","article-title":"Tuberculosis \u2013 metabolism and respiration in the absence of growth","volume":"3","author":"H IM Boshoff","year":"2005","journal-title":"Nat Rev Microbiol"},{"issue":"06","key":"ref2","doi-asserted-by":"publisher","first-page":"e2375","DOI":"10.1371\/journal.pone.0002375","article-title":"Genetic basis of virulence attenuation revealed by comparative genomic analysis of Mycobacterium tuberculosis strain H37Ra versus H37Rv","volume":"3","author":"H Zheng","year":"2008","journal-title":"PLoS One"},{"issue":"04","key":"ref3","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.tube.2010.05.003","article-title":"Regulatory T cell frequency and modulation of IFN-gamma and IL-17 in active and latent tuberculosis","volume":"90","author":"N D Marin","year":"2010","journal-title":"Tuberculosis (Edinb)"},{"issue":"03","key":"ref4","doi-asserted-by":"publisher","first-page":"e005639","DOI":"10.1136\/bmjgh-2021-005639","article-title":"Increasing tuberculosis burden in Latin America: an alarming trend for global control efforts","volume":"6","author":"O T Ranzani","year":"2021","journal-title":"BMJ Glob Health"},{"issue":"03","key":"ref6","doi-asserted-by":"publisher","first-page":"e64","DOI":"10.1016\/S1473-3099(17)30623-0","article-title":"Genetics of human susceptibility to active and latent tuberculosis: present knowledge and future perspectives","volume":"18","author":"L Abel","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"12","key":"ref7","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1038\/s41579-022-00763-4","article-title":"Immune evasion and provocation by Mycobacterium tuberculosis","volume":"20","author":"P Chandra","year":"2022","journal-title":"Nat Rev Microbiol"},{"issue":"11","key":"ref8","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1586\/14737175.2014.962517","article-title":"How do we manage and treat a patient with multiple sclerosis at risk of tuberculosis?","volume":"14","author":"Y D Fragoso","year":"2014","journal-title":"Expert Rev Neurother"},{"issue":"01","key":"ref9","doi-asserted-by":"publisher","first-page":"2055217317752202","DOI":"10.1177\/2055217317752202","article-title":"Diagnosis and treatment of latent tuberculosis in patients with multiple sclerosis, expert consensus. On behalf of the Colombian Association of Neurology, Committee of Multiple Sclerosis","volume":"4","author":"C Navas","year":"2018","journal-title":"Mult Scler J Exp Transl Clin"},{"issue":"03","key":"ref10","doi-asserted-by":"publisher","first-page":"2055217319875467","DOI":"10.1177\/2055217319875467","article-title":"Tuberculosis screening in multiple sclerosis: effect of disease-modifying therapies and lymphopenia on the prevalence of indeterminate TB screening results in the clinical setting","volume":"5","author":"L E Baldassari","year":"2019","journal-title":"Mult Scler J Exp Transl Clin"},{"issue":"04","key":"ref11","doi-asserted-by":"publisher","first-page":"202","DOI":"10.3390\/medicina56040202","article-title":"Active Pulmonary Tuberculosis Triggered by Interferon Beta-1b Therapy of Multiple Sclerosis: Four Case Reports and a Literature Review","volume":"56","author":"C A Sirbu","year":"2020","journal-title":"Medicina (Kaunas)"},{"issue":"08","key":"ref12","doi-asserted-by":"publisher","first-page":"ofy174","DOI":"10.1093\/ofid\/ofy174","article-title":"Infectious Complications of Multiple Sclerosis Therapies: Implications for Screening, Prophylaxis, and Management","volume":"5","author":"D J Epstein","year":"2018","journal-title":"Open Forum Infect Dis"},{"issue":"05","key":"ref13","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1007\/s40120-023-00496-3","article-title":"Expert Narrative Review of the Safety of Cladribine Tablets for the Management of Relapsing Multiple Sclerosis","volume":"12","author":"P Clavelou","year":"2023","journal-title":"Neurol Ther"},{"issue":"12","key":"ref14","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1002\/acn3.491","article-title":"Infectious risk stratification in multiple sclerosis patients receiving immunotherapy","volume":"4","author":"J Graf","year":"2017","journal-title":"Ann Clin Transl Neurol"},{"issue":"01","key":"ref15","first-page":"20","article-title":"Infectious risk in multiple sclerosis patients treated with disease-modifying therapies: A three-year observational cohort study","volume":"8","author":"M A Zingaropoli","year":"2022","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.msard.2015.11.006","article-title":"Pooled safety and tolerability data from four placebo-controlled teriflunomide studies and extensions","volume":"5","author":"G Comi","journal-title":"Multiple Sclerosis and Related Disorders"},{"issue":"9843","key":"ref17","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1016\/S0140-6736(12)61401-9","article-title":"Breathlessness, night sweats, and weight loss on natalizumab","volume":"380","author":"D Dahdaleh","year":"2012","journal-title":"Lancet"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"25","DOI":"10.17116\/jnevro20151158225-35","article-title":"A prospective, open, non-randomized study on the safety and efficacy of natalizumab (tisabri) in the Russian population of patients with relapsing-remitting multiple sclerosis","volume":"115","author":"A N Boyko","year":"2015","journal-title":"Zh Nevrol Psikhiatr Im S S Korsakova"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1177\/11795735211042188","article-title":"Infectious Risk Mitigation in Patients with Multiple Sclerosis under Disease-Modifying Therapies - the Experience of a Collaborative Neurology-Infectious Diseases Approach","author":"D Ferro","year":"2021","journal-title":"J Cent Nerv Syst Dis"},{"issue":"9856","key":"ref20","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1016\/S0140-6736(12)61769-3","article-title":"Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a randomised controlled phase 3 trial","volume":"380","author":"J A Cohen","year":"2012","journal-title":"Lancet"}],"container-title":["Arquivos de Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1810406.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T23:35:28Z","timestamp":1754350528000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1810406"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":19,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2025,6,20]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["s00451810406"],"URL":"https:\/\/doi.org\/10.1055\/s-0045-1810406","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"type":"print","value":"0004-282X"},{"type":"electronic","value":"1678-4227"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}