Skin test based on &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt; antigens (ESAT-6 and CFP-10) for the detection of tuberculosis infection in world practice

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Introduction. The use of genetic engineering biological agents (GEBA) in the treatment of rheumatic diseases over the past decades has led to a significant improvement in the prognosis in this group of patients. However, against the background of anti-tumor necrosis factor α therapy (anti TNF-α), the risk of developing tuberculosis increases tenfold.Aim. To evaluate the specificity and safety of Mantoux test, recombinant tuberculosis allergen (RTA) test, IGRA tests: TB-Feron IGRA, T-SPOT.TB, QuantiFERON-TB GIT in patients from 5 to 18 years of age, who are at risk for the development of tuberculosis, due to the use of immunosuppressive therapy, including GEBP.Materials and methods. This clinical trial is a prospective single-center open-label study with 120 patients under observation. Girls predominated among the patients – 71 (59.2%), the average age was 12 years (95% CI [5.2–17.4]). As part of the treatment of the underlying disease, patients in the vast majority of cases (78.3%) received iFNO-α drugs: etanercept (67 people), adalimumab (25 people), golimumab (2 people).Results and discussion. According to the results of a comprehensive medical examination, including CT scan of the chest organs, the presence of active tuberculosis was not established in any of the patients. A positive result of the RTA sample was registered in 0.8% of the subjects, Mantoux test in 46.6%, T-SPOT.TB – 1.7%, TB-Feron IGRA and QuantiFERON-TB GIT – 0.8% each. During the safety assessment, it was noted that within 28 days after the study, none of the 120 patients had any adverse events. Patients need appropriate screening before starting treatment and regular follow-up examinations.Conclusions. The Mantoux test with 2 TE has low specificity (0.49), and the sample with RTA (0.99), TB-Feron IGRA (0.99), T-SPOT.TB (0.98) and QuantiFERON-TB GIT (0.99) are highly specific and safe as tests for detecting tuberculosis infection in children with juvenile idiopathic arthritis.

Assessment of specificity of immunologic tests for detection of tuberculosis infection in children with juvenile idiopathic arthritis

Aksenova,

Dementyeva,

Kazakov

et al. 2024

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Efficiency of identification of tuberculosis in high-risk groups of the population under extreme conditions conducive to the formation of an epidemic situation

Kolomietz

2024

An analytical review of scientific literature, international acts and Russian regulatory documents on the issues of implementation of anti-epidemic actions in tuberculosis among the general population and, on a priority basis, in high-risk groups – migrants (refugees and resettlers) are presented. The review is aimed to raise awareness among readers about the RF regulatory environment on this issue, as well as the results of research on migrants’ access to the measures on early detection, diagnosis, prevention and treatment of tuberculosis in Russia. The features of identification of disease cases among migrants have been determined based on the results of observation of the formation of an epidemic situation in the border region of the Russian Federation under extreme conditions and development of a pandemic. In the period before, during the development and after the pandemic, 2268 newly diagnosed and recurrent tuberculosis patients were followed-up, who were identified using various approaches and diagnostic methods: radiation (fluorography + radiography), bacteriological, molecular and genetic, computed tomography, histological studies. There are interesting data on the use of immunological methods. The conclusions: the created regulatory environment to identify, treat and prevent the spread of tuberculosis in the country, including high-risk groups such as migrants/refugees, among whom there are many children, ensured the implementation of controlled anti-epidemic actions under extreme conditions conducive to the formation of an epidemic situation; extreme conditions, including a pandemic/ epidemic of other etiologies, affected the formation of the epidemic situation of tuberculosis, as well as among children and adolescents, in the region; the efficiency of immunological methods, primarily the recombinant tuberculosis allergen, in the high-risk groups under consideration has been proven.

Comorbid conditions in phthisiology: The basis of interdisciplinary collaboration between pediatricians and phthisiologists (literature review and commentaries)

Ovsyankina,

Panova,

Zakharova

et al. 2024

Comorbid conditions in pediatric and adolescent phthisiology determine the need for interdisciplinary collaboration between healthcare professionals in different areas of expertise both at the stage of disease diagnosis and during tuberculosis treatment. This review is aimed to systematize the knowledge of pediatricians in different areas of expertise about comorbid conditions in tuberculosis (causes, risk factors for their development, options for timely diagnosis, impact of forced polypharmacy on the development of drug complications). The data of available methodological documents and published articles on the issue are systematized. The article presents groups at high risk for developing TB disease among patients with somatic pathology, the possibilities of modern diagnostic techniques based on a comprehensive medical examination with due account for the diagnostic algorithm and treatment regimen for a particular disease. If there is a reason to suspect tuberculosis in primary health care facilities and prior to prescribing immunosuppressive drugs, the minimum mandatory diagnostic examination in risk groups is set forth. The importance of key techniques for the detection and diagnosis of tuberculosis in children and adolescents including those with immunocompromised diseases is emphasized: Mantoux test using 5 tuberculin units (TU) of purified protein derivative (PPD)-L, a test with recombinant tuberculosis allergen (RTA), diagnostic tests assessing release of interferon gamma by T-lymphocytes in vitro during selective screening), computed tomography, detection of Mycobacterium tuberculosis in any diagnostic samples. Attention is paid to the impact of forced polypharmacy on the drug complications and treatment failures in patients with comorbidities, which requires collaboration between healthcare professionals in different areas of expertise to provide adequate selection of anti-tuberculosis therapy taking into account comorbidities. This approach to the management of patients with chronic somatic pathology allows for the prevention or early detection of tuberculosis.