Diagnosis and treatment of latent tuberculosis infection in patients undergoing treatment with immunobiologic agents: a four-year experience in an endemic area

Abstract

Objective: To describe the incidence of active tuberculosis and the occurrence of adverse events after isoniazid treatment in patients with latent tuberculosis infection (LTBI) who also had chronic inflammatory diseases and were treated with immunobiologic agents in an endemic area in Brazil. Methods: The diagnosis of LTBI was based on anamnesis, clinical examination, chest X-ray, and a tuberculin skin test (TST). Patients received prophylactic treatment (isoniazid for six months) in accordance with the Brazilian guidelines. Results: A total of 101 patients were evaluated between July of 2011 and July of 2015. Of those, 55 (54.46%) were women (mean age, 53.16 ± 1.76 years) and 46 (45.54%) were men (mean age, 45.39 ± 2.13 years). A total of 79 patients (78.22%) were being treated with immunobiologic agents and 22 (21.78%) were being treated with immunomodulatory or immunosuppressive agents. In the screening for LTBI, 53 patients (52.48%) had a TST induration ≥ 10 mm. Chest X-ray findings consistent with LTBI were observed in 36 patients (35.64%). Isoniazid preventive therapy was effective in 96 (95.05%) of the 101 patients evaluated. It is of note that 84 (83.17%) of the patients experienced no adverse effects from the use of isoniazid and that 83 (98.81%) of those patients completed the prophylactic treatment (p = 0.002). Active tuberculosis was diagnosed in 5 (6.33%) of the 79 patients treated with immunobiologic agents and in 1 (4.55%) of the 22 patients treated with other immunomodulators/immunosuppressants. Conclusions: A six-month course of isoniazid proved to be safe and effective in the treatment of LTBI, which is essential to reducing the risk of developing active tuberculosis.

Fechar O Cerco: Estratégias Na Busca Ativa De Comunicantes De Tuberculose

“…O estudo destaca esquemas de tratamentos mais curtos e com menos efeitos adver-sos21. A isoniazida VO se mostrou segura, com poucas reações adversas para os pacientes que realizam tratamento com imunossupressores; neste exemplo, a artrite reumatoide 18 . Existe uma discussão sobre a necessidade de se caracterizar um perfil epidemiológico do território; quanto antes a equipe multiprofissional identificar pacientes com HIV, maiores de 60 anos, tabagistas, por meio da busca ativa de comunicantes, maior a oportunidade em delimitar a extensão territorial da doença ( 10;11 ).…”

Active tuberculosis in inflammatory bowel disease patients under treatment from an endemic area in Latin America

“…Research in Fortaleza/Brazil of mostly rheumatological patients and a small group with psoriasis and Crohn's disease diagnosed active TB in 5 (6.3%) of the 79 patients treated with immunobiological agents and in 1 (4.6%) of the 22 patients treated with other immunomodulators/immunosuppressants[ 28 ]. Another study in Campo Grande/Brazil evaluated active TB cases in patients using Adalimumab and found a prevalence of 3.9% (3/77) in one year of follow-up[ 20 ].…”

Tuberculose: novas perspectivas terapêuticas

“…O tratamento de pacientes com agentes imunobiológicos inibidores de citocinas pró-inflamatórias, tais como o TNF-α induz um maior risco dos pacientes desenvolverem infecções oportunistas, incluindo a tuberculose. As principais preocupações em relação ao tratamento com agentes imunobiológicos são as consequências adversas da inibição do TNF-α, pois esse é um mediador das respostas imunes inflamatórias e possui propriedades bactericidas (LOPES DMA, et al, 2019). Os imunomoduladores, quando administrados junto com o regime de Terapia Diretamente Observada (DOT), ajudam tanto com o prognóstico da infecção quanto na prevenção do desenvolvimento de resistência a medicamentos.…”