Conversion of latent tuberculosis in a group of patients treated with biologic therapy in a Rheumatology unit
Conversión de tuberculosis latente en un grupo de pacientes tratados con terapia biológica en una unidad de Reumatología
Ninguna publicación, nacional o extranjera, podrá reproducir ni traducir sus artículos ni sus resúmenes sin previa autorización escrita del editor; sin embargo los usuarios pueden descargar la información contenida en ella, pero deben darle atribución o reconocimiento de propiedad intelectual, deben usarlo tal como está, sin derivación alguna.
Show authors biography
Objective: Patients with rheumatic diseases who undergo treatment with biologic therapies have immunosuppression as a consequence, and are at risk for reactivation of chronic latent diseases such as tuberculosis. Since there are no estimations of this risk in Colombia, it was considered important to carry out a study aimed at assessing the incidence of latent tuberculosis in this population.
Methods: A descriptive study based on a historical cohort was carried out. It included patients of the Rheumatology Unit of Hospital Universitario de San Ignacio, in Bogotá (Colombia). 78 candidates for biologic therapy were assessed, who were free of latent or active tuberculosis on admission to the cohort. Cutaneous tuberculin testing (Tubersol® Sanofi Pasteur) was done at the beginning of biologic therapy and controlled after six months. Conversion of latent tuberculosis was defined as a PPD shift greater than 5 mm with respect to the initial response.
Results: 78 patients met inclusion criteria. 25 had incomplete data and were therefore excluded. 51 patients were included for analysis, 12 of whom showed PPD shift (23,5%).
Conclusions: This study demonstrates the high incidence of conversion of latent tuberculosis, and therefore the high risk of patients on biologic therapy. This should be a starting point for optimizing the study and followup of these patients.
Article visits 1041 | PDF visits 1212
Downloads
- Tufariello JM, Chan J, Flynn JL. Latent tuberculosis: mechanisms of host and bacillus that contribute to persistent infection. Lancet Infect Dis. 2003 Sep;3(9):578-90.
- Cardona P-J, Ruiz-Manzano J. On the nature of Mycobacterium tuberculosis-latent bacilli. Eur Resp J [Internet]. 2004 Dec 24(6):1044–51. [Acceso 10 Feb 2014]; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/15572551
- Jasmer R, Nahid P, Hopewell P. Latent tuberculosis infection. New Eng J Med. 2002;347(23):1860–6.
- Ministerio de Protección Social. Plan Estratégico Colombia Libre de Tuberculosis 2010-2015 Para la Expansión y Fortalecimiento de la Estrategia Alto a la TB. 3a. ed. Bogotá: Ministerio de la Protección Social; 2015.
- Rodríguez Lozano C. Safety of biological therapies: new data from BIOBADASER. Reumatol Clin [Internet]. 2011 Mar 6 S3:S1–6 [Acceso 14 Feb 2014]; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21794763
- Gómez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthr Rheum [Internet]. 2003 Aug 48(8):2122–7 [Acceso 3 Feb 2014];.Disponible en: http://www.ncbi.nlm.nih.gov/pub-med/12905464
- Galloway JB, Hyrich KL, Mercer LK, Dixon WG, Fu B, Ustianowski AP, et al. Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology (Oxford, England) [Internet]. 2011 Jan;50(1):124–31 [Acceso 11 Feb 2014]; Disponible en: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3105607&tool=pmcentrez&rendertype=abstract
- Dixon WG, Hyrich KL, Watson KD, Lunt M, Galloway J, Ustianowski A, et al. Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR). Ann Rheum Dis [Internet]. 2010 Mar 69(3):522–8. [Acceso 3 Feb2014]; Disponible en: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2927681&tool=pmcentrez&rendertype=abstract
- Ja S, Ga W, Christensen R, E TG, Maxwell L, Jk M, et al. Adverse effects of biologics : a network meta-analysis and Cochrane overview (Review ). Cochrane Database of Systematic Reviews. 2011;2(2):1–84.
- Lalvani A. Diagnosing tuberculosis infection in the 21st. century: new tools to tackle an old enemy. Chest [Internet]. 2007 Jun 131(6):1898–906. [Acceso 28 Jan 2014];Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/17565023
- Schwartzman K. Latent tuberculosis infection: old problem, new priorities. CMAJ. 2002 Mar 19;166(6):759-61.
- Bresnihan B, Cunnane G. Infection complications associated with the use of biologic agents. Rheum Dis Clin North Am. 2003 Feb;29(1):185-202. [Internet]. 2003 Feb;29(1):185–202. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/12635507
- Lin PL, Flynn JL. Understanding latent tuberculosis: a moving target. Jf Immunol (Baltimore, Md. : 1950) [Internet]. 2010 Jul 1 185(1):15–22 [Acceso 30 Jan 2014];. Disponible en: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3311959&tool=pmcentrez&rendertype=abstract
- Cengiz K, Seker A. Boosted tuberculin skin testing in hemodialysis patients. Am J Infect Contr [Internet]. 2006 Aug 34(6):383–7 [Acceso14 Feb 2014]; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/16877108
- American Thoracic Society. Targeted tuberulin testing and treatment of latent tuberculosis infection. Am J Respi Crit Care Med. 2000;161:s221–47.
- Centers for disease control and prevention. Morbidity and Mortality Weekly Report World TB Day — March 24 , 2010 Decrease in Reported Tuberculosis Cases — United States, 2009. MMWR. 2010;59(10).
- Keystone K, Papp KA, Wobeser W. Challenges in diagnosing latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. J Rheumatol. 2011;(38):1234–43.
- Lalvani A, Millington KA. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmunity reviews [Internet]. Elsevier B.V.; 2008 Dec 8(2):147–52. [Acceso 23 Jan 2014]; Disponible en: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2593775&tool=pmcentrez&rendertype=abstract
Information
Journal history
Keywords
QR code
Funding
Directories and indexes
