Screening for Latent Tuberculosis in Children With  Immune-Mediated Inflammatory Diseases Treated With  Anti-Tumor Necrosis Factor Therapy:  Comparison of Tuberculin Skin and T-SPOT Tuberculosis Tests

Girit, Saniye; Atabek, Ayşe Ayzıt; Şenol, Ebru; Kizilirmak, Tuba Koçkar; Pekcan, Sevgi; Göktaş, Şafak; Öktem, Sedat; Kasapçopur, Özgür; Çokuğraş, Haluk

doi:10.5606/archrheumatol.2020.7294

Cited by 6 publications

(8 citation statements)

References 26 publications

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“…Similarly, in a study conducted by Kılıç et al with 144 children receiving anti-TNF in our country, they reported the rate of LTBI as 4.8% (13). Girit et al reported the rate of LTBI before treatment as 28.1% in their study with 57 cases (14).…”

Section: Discussionmentioning

confidence: 53%

“…Similarly, the rate of tuberculosis development was reported as 0.85% by Çağatay et al, and 1.5% by Hanta et al(18,19). Contrary to these studies, Girit et al and Kurt et al reported that tuberculosis did not develop in any of the patients receiving anti-TNF (14,20). Con icting results have been reported in studies examining the bene t of prophylaxis for LTBI.…”

Section: Discussionmentioning

confidence: 92%

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Evaluation of Tuberculosis in Children Using Biological Agent Therapy

Kara

KIZIL

Nepesov

et al. 2022

Preprint

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Introduction: Treatment with biological agents, which are classified as monoclonal antibodies, cytokines and fusion proteins, increases patient risk for developing tuberculosis (TB) and non-tuberculous mycobacterial infections. In this study, we aimed to investigate the risk of tuberculosis development in pediatric patients using anti-TNF drugs.Method: One hundred and fifteen pediatric cases who were followed up in Eskişehir Osmangazi University Faculty of Medicine, Department of Pediatrics between January 2011 and December 2021 and received anti-TNF and biological agent treatment were included in the study. The clinical and epidemiological characteristics of the cases were analyzed retrospectively.Results: One hundred and fifteen cases using anti-TNF drugs were included in the study. The mean age of the cases was 13 (2-18) years. Of the cases, 66 (57%) were female and 49 (43%) were male. Of the cases, 76 (66%) had Juvenile Rheumatoid Arthritis, 11 (9.6%) Ulcerative Colitis, 7 (6%) Crohn's, 6 (5.2%) Ankylosing Spondylitis, 5 (%4,3) FMF and 4 of them were followed up due to Psoriasis (3.5%). Etanercept in 74 (64.3%) cases, infliximab in 17 (14.8%) cases, adalimumab in 17 (14.8%) cases, anakinra in 5 (4.3%) cases, and canakinumab was using in 2 (%1.7) cases. PPD was performed in all of the cases and PPD response was measured as <5mm in 89 (77.4%), 5-9 mm in 11 (8.7%), 10-14 mm in 8 (7.4%), >15 mm in 7 (5.6%) cases. Isoniazid (INH) prophylaxis was started for 9 months in 17 cases with the diagnosis of latent tuberculosis. Active tuberculosis was not detected in any of the cases.Conclusion: All patients who are planned to receive anti-TNF therapy should be definitely screened for tüberculosis. Although it is not detected at the beginning of the treatment, regular tuberculosis screening should be continued during the treatment with contact history, symptoms, physical examination, chest X-ray and TST/IGRA in the light of current guidelines

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 92%

Evaluation of Tuberculosis in Children Using Biological Agent Therapy

Kara

KIZIL

Nepesov

et al. 2022

Preprint

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“…Current literature comparing the performance of IGRA (Quantiferon and T-Spot) and TST to identify TB infection in young children reveals limited evidence and conflicting results [5,[30][31][32][33]. Studies focusing on performance of T-Spot in comparison to TST may show discordant results with TST positive and T-Spot negative cases.…”

Section: Viability Of T-spot In Contact Infantsmentioning

confidence: 99%

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

Pop

Kaelin

Kuster

et al. 2022

Antimicrob Resist Infect Control

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Background Several neonatal intensive care units (NICU) have reported exposure to sputum smear positive tuberculosis (TB). NICE guidelines give support regarding investigation and treatment intervention, but not for contact definitions. Data regarding the reliability of any interferon gamma release assay (IGRA) in infants as a screening test for TB infection is scarce. We report an investigation and management strategy and evaluated the viability of IGRA (T-Spot) in infants and its concordance to the tuberculin skin test (TST). Methods We performed an outbreak investigation of incident TB infection in a NICU after prolonged exposure to sputum smear positive miliary TB by an infant’s mother. We defined individual contact definitions and interventions and assessed secondary attack rates. In addition, we evaluated the technical performance of T-Spot in infants and compared the results with the TST at baseline investigation. Results Overall, 72 of 90 (80%) exposed infants were investigated at baseline, in 51 (56.7%) of 54 (60%) infants, follow-up TST at the age of 6 months was performed. No infant in our cohort showed a positive TST or T-Spot at baseline. All blood samples from infants except one responded to phytohemagglutinin (PHA), which was used as a positive control of the T-Spot, demonstrating that cells are viable and react upon stimulation. 149 of 160 (93.1%) exposed health care workers (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection. 5 of 92 (5.5%) exposed primary contacts were tested positive, all coming from countries with high TB incidences. In total, 1 of 342 exposed contacts was newly diagnosed with latent TB infection. The secondary attack rate in this study including pediatric and adult contacts was 0.29%. Conclusion This investigation highlighted the low transmission rate of sputum smear positive miliary TB in a particularly highly susceptible population as infants. Our expert definitions and interventions proved to be helpful in terms of the feasibility of a thorough outbreak investigation. Furthermore, we demonstrated concordance of T-Spot and TST. Based on our findings, we assume that T-Spot could be considered a reliable investigation tool to rule out TB infection in infants.

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“…Several guidelines recommend chest X‐ray, tuberculin skin test (TST), and history taking regarding contact with persons with TB for LTBI screening 15,16 . TST is the most common method of bacillus Calmette‐Guerin (BCG) vaccination evaluation and is the most commonly used test for the diagnosis of LTBI.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14] Several guidelines recommend chest X-ray, tuberculin skin test (TST), and history taking regarding contact with persons with TB for LTBI screening. 15,16 TST is the most common method of bacillus Calmette-Guerin (BCG) vaccination evaluation and is the most commonly used test for the diagnosis of LTBI. However, the diagnosis of LTBI with TST has a number of difficulties, particularly in children who have received BCG vaccination.…”

mentioning

confidence: 99%

Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti‐TNF agents for rheumatologic diseases

Kılınç

Önal

Öztosun

et al. 2020

Pediatric Pulmonology

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Objective The use of tumor necrosis factor inhibitors (anti‐TNF) has a risk of activating latent tuberculosis infection (LTBI). This study was performed to investigate LTBI according to tuberculin skin test (TST) size and to determine the frequency of tuberculosis (TB) in bacillus Calmette‐Guerin (BCG)‐vaccinated children receiving anti‐TNF treatment for rheumatological disease. Materials and Methods The study consisted of 559 children. Information on demographics, anti‐TNF agents, TST size, and isoniazid (INH) prophylaxis was recorded. Patients (n = 254) with TST size ≥5 mm were divided into three groups according to TST size and INH prophylaxis: group 1, TST size 5 to 9 mm and no INH prophylaxis; group 2, TST size 5 to 9 mm with INH prophylaxis; and group 3, TST size ≥10 mm with INH prophylaxis. Results The 559 patients comprised 314 (56.3%) females and 245 (43.6%) males; they had a mean age of 13.1 ± 4.1 years. The mean TST size in all patients was 4.2 ± 4.7 mm. Group 1 consisted of 76 (29.9%) patients, group 2 consisted of 88 (34.6%) patients, and group 3 consisted of 90 (35.4%) patients. The mean TST sizes for the three groups were 6.8 ± 3.1 mm, 7.2 ± 3.2 mm, and 13.9 ± 2.8 mm, respectively. New TB was diagnosed in only two (0.35%) patients. Both of them were in group 3. Conclusions A TST size of ≥10 mm in BCG‐vaccinated children receiving anti‐TNF treatment may distinguish children at high risk for reactivation of LTBI.

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Screening for Latent Tuberculosis in Children With Immune-Mediated Inflammatory Diseases Treated With Anti-Tumor Necrosis Factor Therapy: Comparison of Tuberculin Skin and T-SPOT Tuberculosis Tests

Cited by 6 publications

References 26 publications

Evaluation of Tuberculosis in Children Using Biological Agent Therapy

Evaluation of Tuberculosis in Children Using Biological Agent Therapy

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti‐TNF agents for rheumatologic diseases

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