Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study
| Autor: | Noguera-Julian A., Calzada-Hernandez J., Brinkmann F., Roy R. B., Bilogortseva O., Buettcher M., Carvalho I., Chechenyeva V., Falcon L., Goetzinger F., Guerrero-Laleona C., Hoffmann P., Jelusic M., Niehues T., Ozere I., Shackley F., Suciliene E., Welch S. B., Scholvinck E. H., Ritz N., Tebruegge M., Curtis N., Villanueva P., Marais B., Britton P., Clark J., Pichler J., Zschocke A., Bogyi M., Dreesman A., Mouchet F., Velizarova S., Pavic I., Nygaard U., Pulsen A., Kontturi A., Salo E., Chadelat K., Kruger R., Tee S., Ahrens F., Barker M., Zimmermann T., Schulze-Sturm U., Kaiser-Labusch P., Tsolia M., Ghanaie O. M., Buonsenso D., Lo Vecchio A., Ivaskeviciene I., Vilc V., Smyrnaios A., Arbore A. S., Starshinova A., Solovic I., Krivec U., Aldeco M., Espiau M., Soriano-Arandes A., Neth O., Santiago B., Gomez-Pastrana D., Blazquez D., Bustillo M., Perez-Porcuna T. M., Cilleruelo M. J., Kotz K., Bennet R., Relly C., Niederer-Loher A., Rochat I., Pavskyi S., Riordan A., Doherty C., Bamford A., Shingadia D., Emonts M., Ferreras-Antolin L., McMaster P., Moriarty P. |
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| Přispěvatelé: | Noguera-Julian, A., Calzada-Hernandez, J., Brinkmann, F., Roy, R. B., Bilogortseva, O., Buettcher, M., Carvalho, I., Chechenyeva, V., Falcon, L., Goetzinger, F., Guerrero-Laleona, C., Hoffmann, P., Jelusic, M., Niehues, T., Ozere, I., Shackley, F., Suciliene, E., Welch, S. B., Scholvinck, E. H., Ritz, N., Tebruegge, M., Curtis, N., Villanueva, P., Marais, B., Britton, P., Clark, J., Pichler, J., Zschocke, A., Bogyi, M., Dreesman, A., Mouchet, F., Velizarova, S., Pavic, I., Nygaard, U., Pulsen, A., Kontturi, A., Salo, E., Chadelat, K., Kruger, R., Tee, S., Ahrens, F., Barker, M., Zimmermann, T., Schulze-Sturm, U., Kaiser-Labusch, P., Tsolia, M., Ghanaie, O. M., Buonsenso, D., Lo Vecchio, A., Ivaskeviciene, I., Vilc, V., Smyrnaios, A., Arbore, A. S., Starshinova, A., Solovic, I., Krivec, U., Aldeco, M., Espiau, M., Soriano-Arandes, A., Neth, O., Santiago, B., Gomez-Pastrana, D., Blazquez, D., Bustillo, M., Perez-Porcuna, T. M., Cilleruelo, M. J., Kotz, K., Bennet, R., Relly, C., Niederer-Loher, A., Rochat, I., Pavskyi, S., Riordan, A., Doherty, C., Bamford, A., Shingadia, D., Emonts, M., Ferreras-Antolin, L., Mcmaster, P., Moriarty, P. |
| Rok vydání: | 2019 |
| Předmět: |
reactivation
Disease anti-TNF-alpha 0302 clinical medicine Medicine children 030212 general & internal medicine JUVENILE IDIOPATHIC ARTHRITIS Child Anti–TNF-alpha RISK Latent tuberculosis GAMMA RELEASE ASSAYS Miliary tuberculosi SERIOUS INFECTION Infectious Diseases tuberculosis anti–TNF-alpha medicine.drug miliary tuberculosis Microbiology (medical) Adult medicine.medical_specialty Miliary tuberculosis Tuberculosis Adolescent CORTICOSTEROIDS Tuberculin DIAGNOSIS CLASSIFICATION 03 medical and health sciences Necrosis Latent Tuberculosis Internal medicine SURVEILLANCE INFLIXIMAB Humans Retrospective Studies 030203 arthritis & rheumatology business.industry Tuberculin Test Tumor Necrosis Factor-alpha Retrospective cohort study medicine.disease FACTOR INHIBITORS Infliximab Clinical research business Interferon-gamma Release Tests |
| Zdroj: | CLINICAL INFECTIOUS DISEASES r-FSJD: Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu Fundació Sant Joan de Déu r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu instname Clinical Infectious Diseases, 71(10), 2561-2569. Oxford University Press |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background In adults, anti–tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. Methods Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients Results Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn’s disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti–TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti–TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1–20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46–66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. Conclusions LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti–TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings. |
| Databáze: | OpenAIRE |
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