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Scrivo R, Molteni E, Castellani C, Altobelli A, Alessandri C, Ceccarelli F, Di Franco M, Priori R, Riccieri V, Sili Scavalli A, Spinelli FR, Mastroianni CM, Conti F. Are interferon-gamma release assays reliable to detect tuberculosis infection in patients with rheumatoid arthritis treated with Janus kinase inhibitors? PLoS One 2022; 17:e0275329. [PMID: 36170288 PMCID: PMC9518845 DOI: 10.1371/journal.pone.0275329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Screening for latent tuberculosis infection is recommended in patients with rheumatoid arthritis (RA) starting Janus kinase inhibitors (Jaki). Interferon (IFN)-gamma release assays (IGRAs) are increasingly used for this purpose. Jaki tend to decrease the levels of IFNs, questioning the reliability of IGRAs during treatment with these drugs. Objectives To compare the performance of QuantiFERON-TB Gold Plus (QFT-P) and QFT Gold In-tube (QFT-GIT) in RA patients treated with Jaki. Methods RA patients underwent QFT-P and QFT-GIT at baseline (T0), and after 3 (T3) and 12 months (T12) of treatment with Jaki. The agreement between the two tests was calculated. The agreement between IGRAs and tuberculin skin test (TST) or chest radiography at baseline was also determined. The variability of QTF-P results was longitudinally assessed. Results Twenty-nine RA patients (F/M 23/6; median age/IQR 63/15.5 years; median disease duration/IQR 174/216 months) were enrolled. A perfect agreement was found between QFT-P and QFT-GIT at all times (κ = 1). At T0, no agreement was recorded between IGRAs and TST (κ = -0.08) and between TST and chest radiography (κ = -0.07), a low agreement was found between QFT-P and chest radiography (κ = 0.17). A variation of 33.3% in the results of QFT-P was recorded at T3 vs T0, of 29.4% at T12 vs T0, and of 11.8% at T12 vs T3. The median levels of IFN-γ produced by lymphocytes in response to the mitogen of QFT-P decreased after 3 months followed by an increase after 12 months (not significant). No change in the median number of circulating lymphocytes was documented. Glucocorticoids intake was associated with a higher probability of negative or indeterminate IGRA results at T0 (p<0.0001). Conclusion A response to IGRAs is detectable during treatment with Jaki. However, fluctuations in the results of IGRAs have been observed in the absence of correlation with clinical outcomes, thus challenging their interpretation.
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Affiliation(s)
- Rossana Scrivo
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Emanuele Molteni
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Chiara Castellani
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Alessio Altobelli
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristiano Alessandri
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fulvia Ceccarelli
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Manuela Di Franco
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Priori
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Saint Camillus International University of Health Science, Rome, Italy
| | - Valeria Riccieri
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Sili Scavalli
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Romana Spinelli
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Claudio Maria Mastroianni
- Infectious Diseases—Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Rheumatology Unit—Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Cuadros EN, Calzada-Hernández J, Clemente D, Martín SG, Silveira LF, Lirola-Cruz MJ, Tagarro A, Lovillo MC, Rueda RMA, López AL, Aritziturri MS, Calvo C. Position statement of the Spanish Society of Pediatric Rheumatology on infection screening, prophylaxis, and vaccination of pediatric patients with rheumatic diseases and immunosuppressive therapies: Part 1 (screening). Eur J Pediatr 2022; 181:2343-2354. [PMID: 35258699 PMCID: PMC9110499 DOI: 10.1007/s00431-022-04418-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 02/02/2023]
Abstract
This study provides practical recommendations on infection screening in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies. For this reason, a qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using Mesh and free texts to identify articles that analyzed data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the infections prevention and treatment working group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was extended to members of the Spanish Society of Pediatric Rheumatology and Vaccine Advisory Committee of the Spanish Association of Pediatrics. Participants to the process produced a score ranging from 0 = totally disagree to 10 = totally agree. Agreement was considered if at least 70% of participants voted ≥ 7. The literature review included more than 400 articles. Overall, 63 recommendations were generated (21 on infection screening) voted by 59 pediatric rheumatologists and other pediatric specialists, all of them achieving the pre-established agreement level. The recommendations on screening cover all the procedures (serology, assessment of risk factors, and other clinical activities) connected with the screening for infections including tuberculosis; hepatitis A, B, and C viruses; measles; mumps; rubella; diphtheria; and other infections. Conclusion: Screening for infections is an essential part of risk management in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies. What is Known: • Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. • At present, practical information on infectious prophylaxis in children with rheumatic diseases is limited, and often extrapolated from children with cancer. What is New: • In the absence of evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that would be useful in clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.
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Affiliation(s)
- Esmeralda Núñez Cuadros
- Pediatric Rheumatology Unit, UGC Pediatría, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Av. Arroyo de los Ángeles, s/n 29011, Málaga, Spain.
| | - Joan Calzada-Hernández
- Unitat de Reumatologia Pediàtrica, Servei de Pediatria, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Daniel Clemente
- Pediatric Rheumatology Unit, Hospital Infantil Universitario, Niño Jesús, Madrid, Spain
| | - Sara Guillén Martín
- Department of Paediatrics, Hospital Universitario de Getafe, CIBERINFEC ISCIII, Getafe, Madrid, Spain
| | - Laura Fernández Silveira
- Servicio de Inmunología, Reumatología e Infectología Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María José Lirola-Cruz
- Department of Paediatríc Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain
| | - Alfredo Tagarro
- Pediatrics Department, Instituto de Investigación 12 de Octubre (imas12), Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, Spain
| | - Marisol Camacho Lovillo
- Servicio de Inmunología, Reumatología e Infectología Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Agustín López López
- Department of Paediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Cristina Calvo
- Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, and La Paz Research Institute (IdiPaz). CIBERINFEC. ISCIII, Madrid, Spain ,Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
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Akdogan N, Dogan S, Gulseren D, Yalici-Armagan B, Ersoy-Evans S, Elcin G, Karaduman A, Atakan N. Serial Quantiferon-TB Gold test results in 279 patients with psoriasis receiving biologic therapy. Dermatol Ther 2020; 34:e14699. [PMID: 33368959 DOI: 10.1111/dth.14699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 01/19/2023]
Abstract
The risk of active tuberculosis is still a concern in patients receiving biologics. To determine the risk of latent tuberculosis infection (LTBI) reactivation by Quantiferon-TB Gold (QFT) assay in psoriatic patients treated with biologics in 11 years' follow-up, along with chest radiography alterations. This retrospective study included 279 patients with plaque-type and/or pustular, or nail psoriasis who were treated with biologics, and had results for ≥2 LTBI tests. The QFT outcomes were defined according to the baseline and the follow-up QFT results; seroconversion as from negative to positive, seroreversion as from positive to negative, persistently seronegative as invariantly negative, persistently seropositive as invariantly positive, and other any result was accepted as indeterminate. Demographic features, the presence and the type of any chest X-ray abnormality was noted during the follow-up. Of 279 baseline QFT tests, the vast majority were negative (n = 193; 69%), with a less of positive (n = 86; 31%). Ten (5.2%) of 193 patients converted from negative to positive QFT status after starting biologic therapy (P < 0.001) during 11 years' follow-up. Although these 10 patients exhibited seroconversion of QFT from negative to positive, only one patient was diagnosed with active TB. There was no statistically significant difference among biologics as regards with QFT seroconversion risk (P = .09). This study showed that 5.2% of patients showed seroconversion. Annual QFT testing remains a necessary and mandatory tool to prevent further TB reactivation in psoriasis patients taking biologic therapy although only one patient was diagnosed with active TB in this cohort.
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Affiliation(s)
- Neslihan Akdogan
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Sibel Dogan
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Duygu Gulseren
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Basak Yalici-Armagan
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Sibel Ersoy-Evans
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Gonca Elcin
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Aysen Karaduman
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Nilgun Atakan
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
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TST conversions and systemic interferon-gamma increase after methotrexate introduction in psoriasis patients. PLoS One 2020; 15:e0242098. [PMID: 33270676 PMCID: PMC7714364 DOI: 10.1371/journal.pone.0242098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background Tuberculosis screening in psoriasis patients is complex due to the immunological alterations associated with psoriasis, the presence of comorbidities, and the effect of immunosuppressive treatment. However, it is not established whether the results of screening tests are affected by these factors in psoriasis patients. Objectives To determine whether there is a change in the results of the tuberculin skin test (TST) or the interferon-gamma release assay (IGRA) in psoriasis patients living in tuberculosis (TB)-endemic area after 12 weeks of methotrexate (MTX) treatment and to investigate the association of the test results with clinical and inflammatory markers. Methods Forty-five patients were selected for a prospective single-arm self-controlled study and followed for at least 18 months. The TST, IGRA, Psoriasis Area and Severity Index (PASI), and inflammatory factors (erythrocyte sedimentation rate (ESR), C-reactive protein, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha levels), were determined before and after 12 weeks of oral 15 mg per week MTX administration and compared. The associations between the IGRA and TST results were verified before and after treatment according to inflammatory factors and clinical characteristics (age, blood glucose, weight, body mass index, disease duration, and PASI). Results We collected data on 25 patients who completed the full course of therapy and the follow-up. None of the patients developed TB. TST positivity was significantly elevated at week 12 (25% baseline vs 44% at week 12, P < 0.037). Three IGRAs followed the TST conversions. There was no difference between TST and IGRA pre- or posttreatment. Serum IFN-γ increased significantly in week 12 (15.95 pg/ml baseline vs 18.82 pg/ml at week 12, P < 0.005) and tended to be higher among TST-positive patients (P = 0.072). The baseline IGRA was associated with a higher ESR (P = 0.038). None of the test results were associated with clinical characteristics. Conclusions In addition to the classic booster effect, TST conversions in patients using MTX can occur due to an increase in IFN-γ. However, it is not possible to exclude true TST conversions. Therefore, other diagnostic methods, like IGRA or chest tomography, should be used when the TST has intermediate results.
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Stockbridge EL, Loethen AD, Annan E, Miller TL. Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States: Evidence from commercial insurance data. PLoS One 2020; 15:e0243102. [PMID: 33270737 PMCID: PMC7714216 DOI: 10.1371/journal.pone.0243102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background Risk-targeted testing and treatment of latent tuberculosis infection (LTBI) is a critical component of the United States’ (US) tuberculosis (TB) elimination strategy, but relatively low treatment completion rates remain a challenge. Both treatment persistence and completion may be facilitated by diagnosing LTBI using interferon gamma release assays (IGRA) rather than tuberculin skin tests (TST). Methods We used a national sample of administrative claims data to explore associations diagnostic test choice (TST, IGRA, TST with subsequent IGRA) and treatment persistence and completion in persons initiating a daily dose isoniazid LTBI treatment regimen in the US private healthcare sector between July 2011 and March 2014. Associations were analyzed with a generalized ordered logit model (completion) and a negative binomial regression model (persistence). Results Of 662 persons initiating treatment, 327 (49.4%) completed at least the 6-month regimen and 173 (26.1%) completed the 9-month regimen; 129 (19.5%) persisted in treatment one month or less. Six-month completion was least likely in persons receiving a TST (42.2%) relative to persons receiving an IGRA (55.0%) or TST then IGRA (67.2%; p = 0.001). Those receiving an IGRA or a TST followed by an IGRA had higher odds of completion compared to those receiving a TST (aOR = 1.59 and 2.50; p = 0.017 and 0.001, respectively). Receiving an IGRA or a TST and subsequent IGRA was associated with increased treatment persistence relative to TST (aIRR = 1.14 and 1.25; p = 0.027 and 0.009, respectively). Conclusions IGRA use is significantly associated with both higher levels of LTBI treatment completion and treatment persistence. These differences are apparent both when IGRAs alone were administered and when IGRAs were administered subsequent to a TST. Our results suggest that IGRAs contribute to more effective LTBI treatment and consequently individual and population protections against TB.
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Affiliation(s)
- Erica L Stockbridge
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, Arizona, United States of America.,Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Abiah D Loethen
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, Arizona, United States of America
| | - Esther Annan
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Thaddeus L Miller
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
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Thi AA, Abbara A, Bouri S, Collin SM, Wolfson P, Owen L, Buell KG, John L, Hart AL. Challenges in screening for latent tuberculosis in inflammatory bowel disease prior to biologic treatment: a UK cohort study. Frontline Gastroenterol 2018; 9:234-240. [PMID: 30046428 PMCID: PMC6056083 DOI: 10.1136/flgastro-2017-100951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/08/2018] [Accepted: 03/20/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the occurrence of latent tuberculosis infections (LTBI) and active TB in a cohort of patients with inflammatory bowel disease (IBD) treated with biologics. We also examined the effects of immunosuppressive drugs on indeterminate interferon-gamma release assays (IGRA) in LTBI screening. DESIGN Retrospective study of patients treated with biologics between March 2007 and November 2015. SETTING St Mark's Hospital, North West London, UK. PATIENTS 732 patients with IBD who were screened for LTBI using either tuberculin skin test or IGRA before starting a biologic treatment. METHODS Retrospective case note review of all patients with IBD who were screened for LTBI prior to initiating biologics. Patients who developed active TB were identified from the London TB register. RESULTS Of 732 patients with IBD, 31 (4.2%) were diagnosed with and treated for LTBI with no significant side effects. Six of 596 patients (1.0%) who received biologic treatment developed active TB. There was a higher proportion of indeterminate IGRA in the immunosuppressive medication group compared with the non-immunosuppressive group (33% (59/181) compared with 9% (6/66), p<0.001). The combination of steroids and thiopurines had the highest proportion of indeterminate IGRA (64%, 16/25). High and low doses of steroids were equally likely to result in an indeterminate IGRA result (67% (8/12) and 57% (4/7), respectively). CONCLUSIONS This study highlights the challenges of LTBI screening prior to commencing biologic therapy and demonstrates the risk of TB in patients who have been screened and who are receiving prolonged and continuing doses of antitumour necrosis factor.
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Affiliation(s)
- Aye Aye Thi
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
| | - Aula Abbara
- Department of Infectious Diseases, Northwick Park Hospital, London, UK
| | - Sonia Bouri
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
| | - Simon M Collin
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Wolfson
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
| | - Leah Owen
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
| | - Kevin G Buell
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Laurence John
- Department of Infectious Diseases, Northwick Park Hospital, London, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
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Martínez-López A, Rodriguez-Granger J, Ruiz-Villaverde R. Screening for Latent Tuberculosis in the Patient With Moderate to Severe Psoriasis Who Is a Candidate for Systemic and/or Biologic Therapy. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Martínez-López A, Rodriguez-Granger J, Ruiz-Villaverde R. Despistaje de tuberculosis latente en el paciente con psoriasis moderada grave candidato a terapia sistémica y/o biológica. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:207-14. [PMID: 26651325 DOI: 10.1016/j.ad.2015.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/25/2015] [Accepted: 10/04/2015] [Indexed: 01/07/2023] Open
Affiliation(s)
- A Martínez-López
- Unidad de Gestión Clínica Dermatología Médico Quirúrgica y Venereología , Granada, España.
| | | | - R Ruiz-Villaverde
- Unidad de Gestión Clínica Dermatología Médico Quirúrgica y Venereología , Granada, España
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Bernal JA, Andrés M, Jovaní V, García Sevila R, Begazo A, Vela P. Primary tuberculosis infection in patients treated with tumor necrosis factor-alpha antagonists and a negative initial screening. ACTA ACUST UNITED AC 2015; 12:81-4. [PMID: 26099453 DOI: 10.1016/j.reuma.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 02/18/2015] [Accepted: 04/13/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Despite screening for latent tuberculosis (TB), new cases of TB infection are detected in patients treated with anti-TNF-α and negative initial screening, some of them after long treatment, which points more to a new infection. OBJECTIVES To describe the cases that have presumably developed a primary tuberculous infection during treatment with anti-TNF-α drugs. METHODS Retrospective audit (1999-2012). Inclusion criteria were: a) anti-TNF-α treatment; b) initial latent TB screening negative; c) TB diagnosed during anti-TNF-α treatment; d) suspected primary TB infection (diagnosis after at least 12 months on anti-TNF-α). Clinical, epidemiological, therapeutic and outcome variables were reviewed. RESULTS Two cases of primary TB infection were found out of of 771 anti-TNF-α treated patients (0.2%). One woman aged 41 suffered TB pneumonia after 35 months of treatment with adalimumab, and a male aged 37 who developed disseminated TB after 107 months of treatment with infliximab. CONCLUSIONS Although uncommon, during TNF antagonist therapy, TB risk persists despite negative initial screening, so clinicians should be aware of TB during the entire treatment.
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Affiliation(s)
- José Antonio Bernal
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
| | - Mariano Andrés
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España
| | - Vega Jovaní
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España
| | - Raquel García Sevila
- Servicio de Neumología, Hospital General Universitario de Alicante, Alicante, España
| | - Alejandra Begazo
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España
| | - Paloma Vela
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España
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Latorre I, Carrascosa JM, Vilavella M, Díaz J, Prat C, Domínguez J, Ferrándiz C. Diagnosis of tuberculosis infection by interferon-gamma release assays in patients with psoriasis. J Infect 2014; 69:600-6. [PMID: 25148944 DOI: 10.1016/j.jinf.2014.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/05/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In this study, we have performed a direct comparison between both T-cell based assays (QFN-G-IT and T-SPOT.TB) and TST in patients with psoriasis taking different immunosuppressant drug-regimens. METHODS We have prospectively studied 103 patients with moderate-to-severe psoriasis who required latent tuberculosis infection (LTBI) screening before starting systemic immunosuppressive treatment or during its sustained use. RESULTS Overall number of positive results was 16.5%, 17.5% and 8.7% using T-SPOT.TB, QFN-G-IT and TST, respectively. Differences in the percentage of positive results between TST with T-SPOT.TB and QFN-G-IT were significant (p = 0.005 and p = 0.008, respectively). A total of 24.3% of the subjects enrolled were positive for at least one of the three tests performed. Sixteen patients with negative TST (17%) were positive for one of the two IGRAs. We obtained seven indeterminate results by T-SPOT.TB and two by QFN-G-IT. Seven patients with negative TST presented indeterminate results by either of two IFN-γ assays. Positive TST, T-SPOT.TB and QFN-G-IT results were not affected by clinical therapeutic profile. CONCLUSIONS Our results reveal that in vitro assays are useful methods for LTBI diagnosis in patients with psoriasis, suggesting that they might be less influenced by immunosuppression than TST.
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Affiliation(s)
- I Latorre
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Badalona, Spain
| | - J M Carrascosa
- Servei de Dermatologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - M Vilavella
- Servei de Dermatologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - J Díaz
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Badalona, Spain
| | - C Prat
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Badalona, Spain
| | - J Domínguez
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Badalona, Spain.
| | - C Ferrándiz
- Servei de Dermatologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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Duman N, Ersoy-Evans S, Karadağ Ö, Aşçıoğlu S, Şener B, Kiraz S, Şahin S. Screening for latent tuberculosis infection in psoriasis and psoriatic arthritis patients in a tuberculosis-endemic country: a comparison of the QuantiFERON®-TB Gold In-Tube test and tuberculin skin test. Int J Dermatol 2014; 53:1286-92. [DOI: 10.1111/ijd.12522] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nilay Duman
- Department of Dermatology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Sibel Ersoy-Evans
- Department of Dermatology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Ömer Karadağ
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Sibel Aşçıoğlu
- Section of Infectious Diseases; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Burçin Şener
- Department of Microbiology and Clinical Microbiology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Sedat Kiraz
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Sedef Şahin
- Department of Dermatology; Faculty of Medicine; Acibadem University; Istanbul Turkey
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Sauzullo I, Mengoni F, Marocco R, Potenza C, Skroza N, Tieghi T, Lichtner M, Vullo V, Mastroianni C. Interferon-γ release assay for tuberculosis in patients with psoriasis treated with tumour necrosis factor antagonists:in vivoandin vitroanalysis. Br J Dermatol 2013; 169:1133-40. [DOI: 10.1111/bjd.12544] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2013] [Indexed: 01/17/2023]
Affiliation(s)
- I. Sauzullo
- Department of Public Health and Infectious Diseases; Sapienza University; Piazzale Aldo Moro 1 00185 Rome Italy
| | - F. Mengoni
- Department of Public Health and Infectious Diseases; Sapienza University; Piazzale Aldo Moro 1 00185 Rome Italy
| | - R. Marocco
- Infectious Diseases Unit; Fondazione Eleonora Lorillard Spencer Cenci; Sapienza University; Latina Italy
| | - C. Potenza
- Dermatology Unit; Polo Pontino; Terracina Italy
| | - N. Skroza
- Dermatology Unit; Polo Pontino; Terracina Italy
| | - T. Tieghi
- Infectious Diseases Unit; Fondazione Eleonora Lorillard Spencer Cenci; Sapienza University; Latina Italy
| | - M. Lichtner
- Infectious Diseases Unit; Fondazione Eleonora Lorillard Spencer Cenci; Sapienza University; Latina Italy
| | - V. Vullo
- Department of Public Health and Infectious Diseases; Sapienza University; Piazzale Aldo Moro 1 00185 Rome Italy
| | - C.M. Mastroianni
- Department of Public Health and Infectious Diseases; Sapienza University; Piazzale Aldo Moro 1 00185 Rome Italy
- Infectious Diseases Unit; Fondazione Eleonora Lorillard Spencer Cenci; Sapienza University; Latina Italy
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Trajman A, Steffen RE, Menzies D. Interferon-Gamma Release Assays versus Tuberculin Skin Testing for the Diagnosis of Latent Tuberculosis Infection: An Overview of the Evidence. Pulm Med 2013; 2013:601737. [PMID: 23476763 PMCID: PMC3582085 DOI: 10.1155/2013/601737] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022] Open
Abstract
A profusion of articles have been published on the accuracy and uses of interferon-gamma releasing assays. Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for different indications for the use of these tests. We conclude that both tests are accurate to detect latent tuberculosis, although interferon-gamma release assays have higher specificity than tuberculin skin testing in BCG-vaccinated populations, particularly if BCG is received after infancy. However, both tests perform poorly to predict risk for progression to active tuberculosis. Interferon-gamma release assays have significant limitations in serial testing because of spontaneous variability and lack of a validated definition of conversion and reversion, making it difficult for clinicians to interpret changes in category (conversions and reversions). So far, the most important clinical evidence, that is, that isoniazid preventive therapy reduces the risk for progression to disease, has been produced only in tuberculin skin test-positive individuals.
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Affiliation(s)
- A. Trajman
- Gama Filho University, 20740-900 Rio de Janeiro, RJ, Brazil
- Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4
| | - R. E. Steffen
- Federal University of Rio de Janeiro, 21941-913 Rio de Janeiro, RJ, Brazil
| | - D. Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4
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Tuuminen T, Salo E, Kotilainen H, Ruhwald M. Evaluation of the filter paper IP-10 tests in school children after exposure to tuberculosis: a prospective cohort study with a 4-year follow-up. BMJ Open 2012; 2:bmjopen-2012-001751. [PMID: 23212994 PMCID: PMC3533036 DOI: 10.1136/bmjopen-2012-001751] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The prevalence of active tuberculosis (TB) is low in Finland, but outbreaks do occur. Following exposure national guidelines recommend either tuberculosis skin test or interferon-γ-release assay-testing of asymptomatic children. The aim of this study was to compare QuantiFERON-TB Gold In-Tube test (QFT) and interferon-γ-inducible protein (IP-10) release assay for detection of Mycobacterium tuberculosis infection following exposure to TB in a primary school. DESIGN A prospective cohort study. SETTING School children in Helsinki, Finland. PARTICIPANTS Two siblings of the index case and 58 classmates exposed to M tuberculosis. INTERVENTION All the children were screened using the QFT, which was used to guide preventive treatment. All those exposed were followed up through the national TB registry. OUTCOME MEASURES IP-10 was measured in plasma supernatants from the QFT test supernatants and in plasma dried and stored for 1 year on filter paper. IP-10 test results were calculated using preset algorithms for positive and indeterminate tests. The negative predictive values of the tests were assessed. RESULTS At an initial screening 2 months after the debut of symptoms in the index case, QFT was positive in two children; 56 tests were negative; one was indeterminate and one was borderline. IP-10 showed a perfect concordance between the dried plasma spot and plasma method; two children were IP-10 positive and two were IP-10 indeterminate. There were two (3%) discordant results between the QFT and IP-10 tests. Four children converted to positive QFT at a 1-3 month follow-up. None of the QFT negative/borderline children developed TB in the 4-year period since exposure. CONCLUSIONS We demonstrated that IP-10 and QFT perform comparably as screening tools for infection with M tuberculosis in a contact investigation. IP-10 determined in dried plasma spots was at par with IP-10 determined in plasma, which further supports the usefulness of this alternative approach.
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Affiliation(s)
- Tamara Tuuminen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
- Laboratory of Clinical Microbiology, Eastern Finland Laboratory Centre Joint Authority Enterprise, Mikkeli, Finland
| | - Eeva Salo
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | | | - Morten Ruhwald
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
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