Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α Agents
Objective: Tumor necrosis factor-α antagonists (anti-TNF-α) have improved the treatment and prognosis of patients with several rheumatologic diseases resistant to standard therapy. However, patients on anti- TNF-α agents risk various infections, especially tuberculosis (TB...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Galenos Yayinevi
2023-07-01
|
| Series: | Forbes Tıp Dergisi |
| Subjects: | |
| Online Access: | https://jag.journalagent.com/z4/download_fulltext.asp?pdir=forbes&un=FJM-71463 |
| _version_ | 1827888878165426176 |
|---|---|
| author | Aykut EŞKİ Velat ŞEN |
| author_facet | Aykut EŞKİ Velat ŞEN |
| author_sort | Aykut EŞKİ |
| collection | DOAJ |
| description | Objective: Tumor necrosis factor-α antagonists (anti-TNF-α) have improved the treatment and prognosis of patients with several rheumatologic diseases resistant to standard therapy. However, patients on anti- TNF-α agents risk various infections, especially tuberculosis (TB). We determined the incidence of latent TB infection (LTBI) and TB development and assess the follow-up protocol of patients using anti-TNF-α therapy.
Methods: Children aged under 18 years prescribed an anti-TNF-α agent were included in the study. Patients were evaluated by history, physical examination, tuberculin skin test (TST), chest X-ray, and when required, examination of sputum/early morning gastric aspirates for acid-fast bacilli and chest tomography. A TST ≥10 mm induration for patients with Bacillus Calmette-Guérin (BCG) vaccination was defined as a positive result, whereas a TST ≥5 mm for those without BCG vaccination.
Results: This study included 84 (54.2%) females and 71 (45.8%) males with a median age of 12.0 years (8.0-15.0). The most common diagnoses were oligoarticular juvenile idiopathic arthritis (JIA; n=48) and polyarticular JIA (n=38). Eight patients with positive TST results were administered isoniazid prophylaxis. New TB was determined in one patient with polyarticular JIA on infliximab and idiopathic uveitis on adalimumab. The incidence of LTBI and TB development in children on anti-TNF-α was 2.5% and 0.64%, respectively.
Conclusion: Patients on anti-TNF-α agents have a risk of TB development. TB disease is more likely to be seen in children on inflixiam and adalimumab on etanercept. It is crucial to assess these patients for TB by a pediatric pulmonologist or infectious disease at three monthly intervals. |
| first_indexed | 2024-03-12T20:41:07Z |
| format | Article |
| id | doaj.art-64db9d7667964ce0b86505529a542158 |
| institution | Directory Open Access Journal |
| issn | 2757-5241 |
| language | English |
| last_indexed | 2024-03-12T20:41:07Z |
| publishDate | 2023-07-01 |
| publisher | Galenos Yayinevi |
| record_format | Article |
| series | Forbes Tıp Dergisi |
| spelling | doaj.art-64db9d7667964ce0b86505529a5421582023-08-01T10:46:03ZengGalenos YayineviForbes Tıp Dergisi2757-52412023-07-014219019510.4274/forbes.galenos.2023.71463FJM-71463Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α AgentsAykut EŞKİ0Velat ŞEN1University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Pulmonology, İzmir, TurkeyDicle University Faculty of Medicine, Department of Pediatrics, Clinic of Pediatric Pulmonology, Diyarbakır, TurkeyObjective: Tumor necrosis factor-α antagonists (anti-TNF-α) have improved the treatment and prognosis of patients with several rheumatologic diseases resistant to standard therapy. However, patients on anti- TNF-α agents risk various infections, especially tuberculosis (TB). We determined the incidence of latent TB infection (LTBI) and TB development and assess the follow-up protocol of patients using anti-TNF-α therapy. Methods: Children aged under 18 years prescribed an anti-TNF-α agent were included in the study. Patients were evaluated by history, physical examination, tuberculin skin test (TST), chest X-ray, and when required, examination of sputum/early morning gastric aspirates for acid-fast bacilli and chest tomography. A TST ≥10 mm induration for patients with Bacillus Calmette-Guérin (BCG) vaccination was defined as a positive result, whereas a TST ≥5 mm for those without BCG vaccination. Results: This study included 84 (54.2%) females and 71 (45.8%) males with a median age of 12.0 years (8.0-15.0). The most common diagnoses were oligoarticular juvenile idiopathic arthritis (JIA; n=48) and polyarticular JIA (n=38). Eight patients with positive TST results were administered isoniazid prophylaxis. New TB was determined in one patient with polyarticular JIA on infliximab and idiopathic uveitis on adalimumab. The incidence of LTBI and TB development in children on anti-TNF-α was 2.5% and 0.64%, respectively. Conclusion: Patients on anti-TNF-α agents have a risk of TB development. TB disease is more likely to be seen in children on inflixiam and adalimumab on etanercept. It is crucial to assess these patients for TB by a pediatric pulmonologist or infectious disease at three monthly intervals.https://jag.journalagent.com/z4/download_fulltext.asp?pdir=forbes&un=FJM-71463anti-tnf alphainfliximabrheumatological diseasetuberculosis |
| spellingShingle | Aykut EŞKİ Velat ŞEN Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α Agents Forbes Tıp Dergisi anti-tnf alpha infliximab rheumatological disease tuberculosis |
| title | Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α Agents |
| title_full | Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α Agents |
| title_fullStr | Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α Agents |
| title_full_unstemmed | Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α Agents |
| title_short | Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α Agents |
| title_sort | latent tuberculosis infection and tuberculosis development in children treated with anti tnf 945 agents |
| topic | anti-tnf alpha infliximab rheumatological disease tuberculosis |
| url | https://jag.journalagent.com/z4/download_fulltext.asp?pdir=forbes&un=FJM-71463 |
| work_keys_str_mv | AT aykuteski latenttuberculosisinfectionandtuberculosisdevelopmentinchildrentreatedwithantitnf945agents AT velatsen latenttuberculosisinfectionandtuberculosisdevelopmentinchildrentreatedwithantitnf945agents |