Screening with urine Histoplasma antigen test in asymptomatic patients starting TNF-alpha inhibitor therapy: a cohort study.

Autor:	Cipolat MM; Medical Sciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Rodrigues DRR; Faculty of Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Silveira LG; Medical Sciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Silveira IG; Clinical Medicine Department, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil., Nothaft MSV; School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil., Brenol CV; Medical Sciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., da Silva LR; Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil., Pasqualotto AC; Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil.; Internal Medicine Department, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil., Falci DR; Pontif'icia Universidade Catolica do Rio Grande do Sul, Porto Alegre 90619-900, Brazil.; Medical Sciences Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Infectious Diseases Service, Hospital de Clinicas de Porto Alegre, Ipiranga, 6690, 9th Floor, Porto Alegre 90610-000, Brazil.
Jazyk:	angličtina
Zdroj:	Therapeutic advances in infectious disease [Ther Adv Infect Dis] 2024 Jan 04; Vol. 11, pp. 20499361231222134. Date of Electronic Publication: 2024 Jan 04 (Print Publication: 2024).
DOI:	10.1177/20499361231222134
Abstrakt:	Background: Histoplasmosis is the second most frequent granulomatous disease in patients treated with tumor necrosis factor (TNF)-α inhibitors, second only to tuberculosis. However, there is limited information about pre-therapy screening procedures and the need for preventive treatments for patients who will start immunobiologicals. Methods: This is a cohort study that evaluated the prevalence of histoplasmosis in asymptomatic HIV-negative patients before initiation of TNF-α inhibitors by testing for Histoplasma antigen in urine samples. The patients included completed a 180-day follow-up after the initiation of the biologics to assess the onset of symptoms suggestive of histoplasmosis. Results: From January 2021 to December 2022, 54 patients who were prescribed a TNF-α inhibitor agent for treating autoimmune diseases in centers in southern Brazil were included. In the screening before therapy, the prevalence of a positive urinary Histoplasma antigen test was 14.8%. None of the 54 patients developed histoplasmosis after 6 months of immunobiological therapy, including the eight patients who tested positive. Conclusion: The prevalence of Histoplasma capsulatum infection in chronic patients may be higher than expected, but the impact of latent infection in asymptomatic patients is still uncertain, including those starting treatment with immunobiological drugs such as TNF-α inhibitors. Our study did not identify risk factors for the diagnosis of disseminated histoplasmosis in this group, including a positive result in an antigen test performed before immunobiological therapy. To date, there is no evidence to recommend routine antigen-based screening or preventive therapy for histoplasmosis before initiating a TNF-α inhibitor. (© The Author(s), 2024.)
Databáze:	MEDLINE
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