scholarly journals P369 Mycobacterium tuberculosis infection among patients with inflammatory bowel disease under biologics: experience of Croatian Tertiary Centre

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S348-S349
Author(s):  
D Ogresta ◽  
A Bišćanin ◽  
V Tomašić ◽  
Z Dorosulić ◽  
D Kralj ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Latent Tuberculosis ◽  
Clinical History ◽  
Tuberculosis Infection ◽  
Interferon Gamma Release Assay ◽  
Observational Period ◽  
Mycobacterium Tuberculosis Infection ◽  
Tertiary Centre ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Abstract Background Mycobacterium tuberculosis infection (TB) causes a huge number of deaths in the world. A majority (95%) of infections remain asymptomatic, defined as latent tuberculosis (LTB). The estimated incidence rate of TB in Croatia is 10.6 cases per 100 000 inhabitants. Patients with inflammatory bowel diseases (IBD) usually require immunosuppressive therapies which puts them at higher risk for infection. LTB diagnosis and prophylactic treatment are recommended for all patients starting biologics. Methods A single-centre retrospective study in the continental part of Croatia included all IBD patients who started treatment with biologics and have presented with TB or LTB from January 2016 till September 2019. The aim was to evaluate the prevalence of LTB among patients with IBD before starting biologic therapy, and TB reactivation during treatment with biologics. All patients underwent Interferon Gamma Release Assay (IGRA) and X-ray. Active infection was excluded or diagnosed using clinical history, bronchoscopy, CT scan and sputum stain for Mycobacteria. Results Study population included 74 patients treated with biologics: 51% female, 73% Crohn’s disease (CD); 37% starting adalimumab, 29% infliximab, 19% ustekinumab and 15% vedolizumab. Prevalence of LTB was 8.1% (6 patients), and all patients underwent isoniazid prophylaxis for 9 months except one patient treated with conventional immunomodulatory therapy which failed prophylactic therapy with both isoniazid and rifampin (liver injury). Among patients with adequate chemoprophylaxis, two patients later on started with anti-TNF therapy (adalimumab), two patients with vedolizumab and one with ustekinumab. One patient with CD and negative LTB screening developed pulmonary TB during induction with infliximab (1 month after initiation); after successful treatment with conventional fourfold therapy, the patient was switched to vedolizumab. During the observational period (median 16 months), all IBD patients with LTB as well with cured TB were in clinical and biochemical remission, without signs of TB (re)activation. Conclusion Our study has demonstrated that prevalence of LTB among our IBD patients starting biologics was significant (8.1%). Treatment with vedolizumab, ustekinumab and anti-TNF (adalimumab) after isoniazid chemoprophylaxis appears to be safe during the observational period, without signs of TB reactivation.

Diagnosis of latent tuberculosis infection among HIV-infected clients in Far North Queensland: use of an interferon-gamma release assay

Sexual Health ◽  
2013 ◽  
Vol 10 (4) ◽  
pp. 389
Author(s):  
Katrina Lyne ◽  
Sandra Downing ◽  
Darren Russell
Keyword(s):  
Interferon Gamma ◽  
Significant Risk ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Interferon Gamma Release Assay ◽  
Test Results ◽  
Mycobacterium Tuberculosis Infection ◽  
Far North ◽  
Release Assay ◽  
Tuberculosis Risk

Latent Mycobacterium tuberculosis infection is a significant risk for those infected with HIV. We examined the use of an interferon-gamma release assay for the diagnosis of latent tuberculosis among HIV-infected clients attending two sexual health services in Far North Queensland. Of 240 clients tested, 19 returned a positive result (7.9%, 95% confidence interval (CI): 4.5–11.3%) and three were indeterminate (1.3%, 95% CI: –0.2%–2.7%). Low CD4 count was found to be significantly associated with an indeterminate test result (P = 0.004). However, we found no significant association between test results and client demographics, self-reported prior tuberculosis infection, Bacille Calmette-Guérin vaccine status or selected tuberculosis risk factors (P-values = 0.2–0.9).

scholarly journals Changes in Transcript, Metabolite, and Antibody Reactivity During the Early Protective Immune Response in Humans to Mycobacterium tuberculosis Infection

2019 ◽  
Vol 71 (1) ◽  
pp. 30-40 ◽  
Author(s):  
January Weiner ◽  
Teresa Domaszewska ◽  
Simon Donkor ◽  
Stefan H E Kaufmann ◽  
Philip C Hill ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Latent Tuberculosis ◽  
Enrichment Analysis ◽  
Gene Set Enrichment Analysis ◽  
Tuberculosis Infection ◽  
Type I ◽  
Infection Status ◽  
Mycobacterium Tuberculosis Infection ◽  
Vitamin B5 ◽  
Negative Reading

Abstract Background Strategies to prevent Mycobacterium tuberculosis (Mtb) infection are urgently required. In this study, we aimed to identify correlates of protection against Mtb infection. Methods Two groups of Mtb-exposed contacts of tuberculosis (TB) patients were recruited and classified according to their Mtb infection status using the tuberculin skin test (TST; cohort 1) or QuantiFERON (QFT; cohort 2). A negative reading at baseline with a positive reading at follow-up classified TST or QFT converters and a negative reading at both time points classified TST or QFT nonconverters. Ribonucleic acid sequencing, Mtb proteome arrays, and metabolic profiling were performed. Results Several genes were found to be differentially expressed at baseline between converters and nonconverters. Gene set enrichment analysis revealed a distinct B-cell gene signature in TST nonconverters compared to converters. When infection status was defined by QFT, enrichment of type I interferon was observed. A remarkable area under the curve (AUC) of 1.0 was observed for IgA reactivity to Rv0134 and an AUC of 0.98 for IgA reactivity to both Rv0629c and Rv2188c. IgG reactivity to Rv3223c resulted in an AUC of 0.96 and was markedly higher compared to TST nonconverters. We also identified several differences in metabolite profiles, including changes in biomarkers of inflammation, fatty acid metabolism, and bile acids. Pantothenate (vitamin B5) was significantly increased in TST nonconverters compared to converters at baseline (q = 0.0060). Conclusions These data provide new insights into the early protective response to Mtb infection and possible avenues to interfere with Mtb infection, including vitamin B5 supplementation. Analysis of blood from highly exposed household contacts from The Gambia who never develop latent Mycobacterium tuberculosis infection shows distinct transcriptomic, antibody, and metabolomic profiles compared to those who develop latent tuberculosis infection but prior to any signs of infection.

scholarly journals Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries

2015 ◽  
Vol 46 (6) ◽  
pp. 1563-1576 ◽  
Author(s):  
Haileyesus Getahun ◽  
Alberto Matteelli ◽  
Ibrahim Abubakar ◽  
Mohamed Abdel Aziz ◽  
Annabel Baddeley ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Skin Testing ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
World Health ◽  
Public Health Approach ◽  
People Living With Hiv ◽  
Tuberculin Skin Testing ◽  
Mycobacterium Tuberculosis Infection ◽  
Systematic Testing

Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3–4 month isoniazid plus rifampicin; or 3–4 month rifampicin alone.

scholarly journals Prevalence of Mycobacterium tuberculosis infection as measured by the QuantiFERON-TB Gold assay and ESAT-6 free IGRA among adolescents in Mwanza, Tanzania

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252808
Author(s):  
Kidola Jeremiah ◽  
Eric Lyimo ◽  
Christian Ritz ◽  
George PrayGod ◽  
Kathryn Tucker Rutkowski ◽  
...  
Keyword(s):  
Latent Tuberculosis ◽  
Target Population ◽  
Cross Sectional Study ◽  
Tuberculosis Infection ◽  
Interferon Gamma Release Assay ◽  
Mycobacterium Tuberculosis Infection ◽  
Government Schools ◽  
Cross Sectional ◽  
Force Of Infection ◽  
Ltbi Prevalence

Background The prevalence of latent tuberculosis infection (LTBI) is vastly higher than that of tuberculosis (TB) disease and this enormous reservoir of individuals with LTBI impacts the global TB control strategy. Adolescents are at greatest risk of TB infection and are thus an ideal target population for a potential effective TB vaccine to be added to the current BCG programme as it could reduce the number of latent infections and consequently the number of adults with TB disease. However, LTBI rates are often unknown for this population. This study aims to estimate the magnitude of LTBI and to determine if Tanzanian adolescents would be a good population for a prevention of TB infection trial. Methods This was a descriptive cross-sectional study that recruited 193 adolescents aged 12 and 16 years from government schools and directly from the community in Mwanza Region, Tanzania. Socio-demographic characteristics were collected for all enrolled participants. Blood was drawn and tested using QuantiFERON-TB Gold In-Tube (QFT-GIT), and Early Secretory Antigenic Target-6–Free Interferon-gamma Release Assay (ESAT-6 free IGRA). Concordance between QFT-GIT and ESAT-6 free IGRA was evaluated using the McNemar’s test. Results Overall estimates of LTBI prevalence were 19.2% [95%CI, 14.1; 25.2] and 18.6% [95%CI, 13.6; 24.6] as measured by QFT-GIT IGRA and ESAT-6 free IGRA, respectively. The 16-year-old cohort had a higher LTBI prevalence (23.7% [95%CI, 16.1; 32.9]) as compared to 12-year-old cohort (14.6% [95%CI, 8.6; 22.7]) as measured by QFT-GIT IGRA. When measured by ESAT-6 Free IGRA, LTBI prevalence was 24.7% (95%CI, 16.9; 34.0) for the 16-year-old cohort and 12.5% (95%CI, 7.0; 20.3) among the 12-year-old cohort. According to both tests the prevalence of TB infection and the corresponding annual risk of tuberculosis infection (ARTI) and force of infection were high and increased with age. Of all enrolled participants, 97.4% had concordant results for QFT-GIT IGRA and ESAT-6 free IGRA (p = 0.65). Conclusions The prevalence of LTBI and the associated ARTI and force of infection among adolescents is high and increases with age in Mwanza Region. There was a high concordance between the QFT-GIT and the novel ESAT-6 free IGRA assays. These findings suggest Mwanza is a promising area to conduct novel TB vaccine research prevention of infection (POI) studies targeting adolescents.

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