Assessment of tuberculosis infection during treatment with biologic agents in a BCG-vaccinated pediatric population

Abstract

Biologic therapies, such as tumor necrosis factor-alpha (TNF-α) blockers, are commonly used to treat rheumatological diseases in childhood. Screening patients for tuberculosis (TB) is highly recommended before starting therapy with TNF-α blockers. Despite appropriate screening, TB still remains a problem in patients receiving anti-TNF therapy in countries where TB is not endemic. TB in anti-TNF-treated patients is often diagnosed late due to altered presentation, and this delay results in high morbidity and mortality with a high proportion of extrapulmonary and disseminated disease. The aim of this study is to show the course of TB disease in children who are on biologic therapy, in an era where many of the children are BCG-vaccinated and TB is intermediately endemic. We recruited 71 patients with several types of inflammatory diseases. Six of them had a positive test result during TB screening and began taking isoniazid (INH) prophylactically. During the 3 years of follow-up, none of these patients developed TB disease. Biologic agents can be safely used in a BCG-vaccinated pediatric population, as long as patients are closely monitored to ensure that any cases of TB will be detected early.

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

“…Of the limited studies published in pediatric population, in a study conducted in Turkey, 71 children with inflammatory diseases were screened for LTBI prior to anti-TNF treatment and 8.45% of the children were diagnosed with LTBI with TST cut-off value ≥15 mm and/or QFT-GIT positivity. 24 In our study, we used current local guidelines which suggest TST cut-off value ≥5 mm and/or T-SPOT.TB positivity and diagnosed 18 (31.5%) of our patients with LTBI. Difference between LTBI rates is obviously the result of different TST cut-off values.…”

Impact of internal brand management on sustainable competitive advantage: An explanatory study based on the mediating roles of brand commitment and brand citizenship behavior

“…Moreover, only four departments were selected to meet the purpose of the study: food and beverages, frontline office, housekeeping, and marketing departments [56]. Furthermore, purposive sampling was chosen to focus on people with particular characteristics compatible with the research purpose [81]. Four hundred and nine questionnaires were returned out of 700 distributed among the participants.…”