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  3. Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-alpha inhibitor initiation in children in Spain.

Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-alpha inhibitor initiation in children in Spain.

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Calzada-Hernandez, Joan
  • Anton, Jordi
  • Martin de Carpi, Javier
  • Nunez, Esmeralda
  • Blasco Alonso, Javier
  • Mellado MJ
  • Baquero-Artigao, Fernando
  • Leis, Rosaura
  • Vegas-Álvarez AM
  • Medrano San Ildefonso, Marta
  • Pinedo-Gago, Maria Del Carmen
  • Eizaguirre FJ
  • Tagarro, Alfredo
  • Camacho-Lovillo, Marisol
  • Perez-Gorricho, Beatriz
  • Gavilan-Martin, Cesar
  • Guillen, Sara
  • Sevilla-Perez, Belen
  • Pena-Quintana, Luis
  • Mesa-Del-Castillo, Pablo
  • Fortuny, Claudia
  • Tebruegge, Marc
  • Noguera-Julian, Antoni

Grupos

Abstract

Tumor-necrosis-factor-alpha inhibitors (anti-TNF-alpha) are associated with an increased risk of tuberculosis (TB) disease, primarily due to reactivation of latent TB infection (LTBI). We assessed the performance of parallel LTBI screening with tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube assays (QFT-GIT) before anti-TNF-alpha treatment in children with immune-mediated inflammatory disorders in a low TB-burden setting. We conducted a multicenter cohort study involving 17 pediatric tertiary centers in Spain. LTBI was defined as the presence of a positive TST and/or QFT-GIT result without clinical or radiological signs of TB disease. A total of 270 patients (median age:11.0years) were included, mainly with rheumatological (55.9%) or inflammatory bowel disease (34.8%). Twelve patients (4.4%) were diagnosed with TB infection at screening (LTBI, n=11; TB disease, n=1). Concordance between TST and QFT-GIT results was moderate (TST+/QFT-GIT+, n=4; TST-/QFT-GIT+, n=3; TST+/QFT-GIT-, n=5; kappa coefficient: 0.48, 95% CI: 0.36-0.60). Indeterminate QFT-GIT results occurred in 10 patients (3.7%) and were associated with young age and elevated C-reactive protein concentrations. Eleven of 12 patients with TB infection uneventfully completed standard LTBI or TB treatment. During a median follow-up period of 6.4years, only 2 patients developed TB disease (incidence density: 130 (95% CI: 20-440) per 100,000 person-years), both probable de novo infections. CONCLUSION: A substantial number of patients were diagnosed with LTBI during screening. The dual strategy identified more cases than either of the tests alone, and test agreement was only moderate. Our data show that in children in a low TB prevalence setting, a dual screening strategy with TST and IGRA before anti-TNF-alpha treatment is effective. WHAT IS KNOWN: The optimal screening strategy for latent tuberculosis in children with immune-mediated inflammatory disorders remains uncertain. Children receiving anti-TNF-alpha drugs are at increased risk of developing severe tuberculosis disease. WHAT IS NEW: A dual screening strategy, using TST and an IGRA assay, identified more children with latent tuberculosis than either of the tests alone. Identification and treatment of latent tuberculosis before initiation of anti-TNF-alpha therapy averted incident tuberculosis cases.

© 2022. The Author(s).

Datos de la publicación

ISSN/ISSNe:
0340-6199, 1432-1076

EUROPEAN JOURNAL OF PEDIATRICS  SPRINGER

Tipo:
Article
Páginas:
307-317
PubMed:
36335186
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
0,806 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 20

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Keywords

  • Inflammatory bowel disease; Interferon-gamma release assay; Juvenile idiopathic arthritis; Pediatrics; Tuberculosis

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