Screening Strategies for the Identification of Latent Tuberculosis
| Autor: | E. Záňová, D. Kozáková, J. Rovenský |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
education.field_of_study
Tuberculosis Latent tuberculosis biology business.industry Population Interferon gamma release assay Tuberculin bacterial infections and mycoses medicine.disease biology.organism_classification Mycobacterium tuberculosis Psoriatic arthritis Rheumatoid arthritis Immunology medicine education business |
| Popis: | Background: The therapeutic blockade of tumour necrosis factor alpha (TNF-α) has emerged as an effective treatment for immune-mediated inflammatory diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). However, TNF-α is a key cytokine involved in protective host defence against Mycobacterium tuberculosis (M. tuberculosis), and together with TNF-α-dependent chemokines, it plays an important role in the development and maintenance of the granuloma that compartmentalises tubercle bacilli during infection. Thus, anti-TNF treatments may reactivate latent tuberculosis infection (LTBI). Methods: LTBI in blood was determined using a QuantiFERON-TB Gold In-Tube test (QFT-G IT) (IGRA, QIAGEN). The results were based on the amount of interferon-gamma (IFN-g) and were obtained by calculating the IFN-g levels in mitogen, TB antigen and negative control tubes, using QFT-G IT analysis software. For detecting LTBI, we have already used the patient’s history of TB infection, the tuberculin skin test (TST) and the chest X-ray. Results: We studied the relationship between the clinical manifestation of tuberculosis and results of the QFT-G IT, the number of conversions of QFT-G IT negative results to QFT-G IT positive results and the changes in IFN-g levels in patients with biological therapy. This chapter details the results. Conclusion: Interferon gamma release assay tests (IGRA) are useful tools for the diagnosis of LTBI in biological treatment, especially in the BCG-vaccinated population. Screening for LTBI and active TB before beginning a biological treatment is very important. IGRAs are more specific and sensitive tests for diagnosing M. tuberculosis infection than are the TST, chest X-ray and history of TB. The exclusion of active TB and the treatment of LTBI are crucial for the onset of an anti-TNF-α treatment. However, the results should be evaluated in combination with the patient’s epidemiological history, actual health state and other diagnostic evaluations. To increase the benefit and decrease the risk of anti-TNF-α treatment, good interdisciplinary cooperation between rheumatologists, pneumologists, and immunologists must occur. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|