scholarly journals COVID-19 and chronic diabetes: the perfect storm for reactivation tuberculosis?: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Genesis P. Aguillón-Durán ◽  
Ericka Prieto-Martínez ◽  
Doris Ayala ◽  
Juan García ◽  
John M. Thomas ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Case Series ◽  
Latent Tuberculosis ◽  
Tuberculosis Control ◽  
Differential Impact ◽  
Common Risk Factor ◽  
Case Presentation ◽  
Negative Effect ◽  
Tuberculosis Reactivation ◽  
Perfect Storm

Abstract Background The coronavirus disease 2019 pandemic is predicted to have a net negative effect on tuberculosis control, with an estimated excess of 6.3 million tuberculosis cases and 1.4 million deaths by 2025. Programmatic issues such as the lockdown of tuberculosis services affect all patients, while biosocial factors have a differential impact on an individual’s risk for tuberculosis or adverse tuberculosis outcomes. Case presentation We report three Hispanic cases of incident tuberculosis (two males, 43 and 44 years old; one female, 49 years old) after resolution of coronavirus disease episodes. Coincidentally, all cases shared a common risk factor: a chronic history poorly controlled diabetes. Conclusions Our findings alert to the threat posed by the synergy between coronavirus disease and diabetes, on tuberculosis reactivation. In medium- to high-risk settings for tuberculosis, we recommend implementation of routine screening for latent tuberculosis infection in these cases, and preventive tuberculosis treatment in those who are positive.

scholarly journals Prevention of Tuberculosis Reactivation

2021 ◽  
Vol 1 (8) ◽  
Author(s):  
Kendra Brett ◽  
Melissa Severn
Keyword(s):  
Latent Infection ◽  
Treatment Effectiveness ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Ltbi Treatment ◽  
Reactivation Treatment ◽  
Increased Risk ◽  
Quality Guideline ◽  
Tuberculosis Reactivation ◽  
Tuberculosis Disease

It is not known if screening for latent tuberculosis infection (LTBI) is useful for reducing the risk of tuberculosis reactivation among people at risk (no evidence was found). In people with LTBI, providing treatment for the latent infection may be helpful for preventing the development of active tuberculosis disease. (In addition, LTBI treatments do not appear to increase the risk for hepatotoxicity.) Treatment effectiveness may depend on the specific LTBI treatment regimen used. For people at an increased risk for tuberculosis ― including those from areas with high rates of tuberculosis ― guidelines recommend screening and treatment for LTBI, as this may help prevent TB reactivation. Treatment is recommended for those who are 65 years old or younger and with a positive LTBI result (recommendation from 1 high-quality guideline).

scholarly journals Efficacy and Safety of Secukinumab in Patients with Plaque Psoriasis and Latent Tuberculosis

2019 ◽  
Vol 11 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Simone Ribero ◽  
Matteo Licciardello ◽  
Pietro Quaglino ◽  
Paolo Dapavo
Keyword(s):  
Plaque Psoriasis ◽  
Latent Tuberculosis Infection ◽  
Systemic Treatment ◽  
Latent Tuberculosis ◽  
Efficacy And Safety ◽  
Biologic Drugs ◽  
Tuberculosis Reactivation ◽  
Factor Α ◽  
Biologic Drug ◽  
Necrosis Factor

Upon the association of biologic treatments with reactivation of latent tuberculosis infection (LTBI), screening for Mycobacterium tuberculosisinfection and anti-tuberculosis chemoprophylaxis in positive patients are required prior to biologic drug administration. Nevertheless, the risk of infection relapses associated with biologic drugs seems to be different. No cases of reactivation of LTBI have been observed in secukinumab-treated subjects, in contrast with clinical reports on the risk associated with anti-tumor necrosis factor α-based therapy. Twelve patients with moderate to severe plaque psoriasis eligible for systemic treatment and found to have LTBI received secukinumab without previous chemoprophylaxis initiation because of clinical contraindication for 10 cases and refusal by 2 patients. None of them had tuberculosis reactivation.

scholarly journals Risk of Tuberculosis Reactivation in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis Receiving Non-Anti-TNF-Targeted Biologics

2017 ◽  
Vol 2017 ◽  
pp. 1-15 ◽  
Author(s):  
Fabrizio Cantini ◽  
Carlotta Nannini ◽  
Laura Niccoli ◽  
Linda Petrone ◽  
Giuseppe Ippolito ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Underdeveloped Countries ◽  
Increased Risk ◽  
Tuberculosis Reactivation ◽  
Necrosis Factor

Tuberculosis (TB) still represents an important issue for public health in underdeveloped countries, but the use of antitumor necrosis factor agents (anti-TNF) for the treatment of inflammatory rheumatic disorders has reopened the problem also in countries with low TB incidence, due to the increased risk of TB reactivation in subjects with latent tuberculosis infection (LTBI). Over the last 5 years, several non-anti-TNF-targeted biologics have been licensed for the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We reviewed the epidemiology of TB, the role of different cytokines and of the immune system cells involved in the immune response against TB infection, the methods to detect LTBI, and the risk of TB reactivation in patients exposed to non-anti-TNF-targeted biologics. Given the limited role exerted by the cytokines different from TNF, as expected, data from controlled trials, national registries of biologics, and postmarketing surveillance show that the risk of TB reactivation in patients receiving non-anti-TNF-targeted biologics is negligible, hence raising the question whether the screening procedures for LTBI would be necessary.

scholarly journals Latent Tuberculosis Infection Increases in Kidney Transplantation Recipients Compared With Transplantation Candidates: A Neglected Perspective in Tuberculosis Control

2020 ◽  
Vol 71 (4) ◽  
pp. 914-923
Author(s):  
Chin-Chung Shu ◽  
Meng-Kun Tsai ◽  
Shu-Wen Lin ◽  
Jann-Yuan Wang ◽  
Chong-Jen Yu ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Old Age ◽  
Specific Antibody ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Tuberculosis Control ◽  
Multivariate Logistic Regression ◽  
Positive Results

Abstract Background The prevalence and incidence of latent tuberculosis infection (LTBI) in patients with kidney transplantation remain unclear. Methods In this prospective study, we enrolled kidney transplantation candidates (KTCs) and recipients (KTRs) from 2014 to 2018. We defined LTBI as a positive result of QuantiFERON-TB Gold In-tube (QFT). We analyzed the predictors for LTBI acquisition and followed up on QFT assay test for 2 years among those initially without LTBI. Results Of 425 patients enrolled, 305 (71.8%) patients belonged to the KTC group and 120 (28.2%) to the KTR group. The initial QFT showed positive results in 32 (10.5%) and 24 (20.0%) patients in the KTC and KTR groups, respectively (P = .009). The QFT response value in patients with LTBI was higher in the KTR group than in the KTC group (1.85 vs 1.06 IU/mL, P = .046). Multivariate logistic regression showed that old age, absence of bacillus Calmette–Guérin (BCG) scar, presence of donor-specific antibody, and KTR group were independent factors for positive LTBI. For participants with initial negative QFT, positive QFT conversion within a 2-year follow-up was higher after kidney transplantation (20%) than in KTCs (5.5%) (P = .034). Conclusions This study is the first cohort to follow up LTBI status in patients with kidney transplantation and shows its higher prevalence and incidence in KTRs. It indicates that surveillance of LTBI after renal transplantation is important. In addition to status of kidney transplantation, old age, no BCG vaccination, and positive donor-specific antibody are also positive predictors for LTBI.

scholarly journals The Role of Interferon-gamma Release Assay in Tuberculosis Control

2012 ◽  
Vol 63 (1) ◽  
pp. 49-59 ◽  
Author(s):  
Anamarija Jurčev-Savičević ◽  
Vera Katalinić-Janković ◽  
Kornelija Miše ◽  
Ivan Gudelj
Keyword(s):  
Interferon Gamma ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Interferon Gamma Release Assay ◽  
Tuberculosis Control ◽  
Aggressive Approach ◽  
Release Assay ◽  
Low Incidence

The Role of Interferon-gamma Release Assay in Tuberculosis ControlTuberculosis is still one of the major global public health threats. Countries with low incidence must focus on exhausting the reservoir of future cases by preventing reactivation. Therefore, it is important to identify and effectively treat those individuals who have latent tuberculosis infection and who may develop active disease. The tuberculin skin test has been the standard for detection of immune response against M. tuberculosis since the beginning of the 20th century. The new millennium has brought advancement in the diagnosis of latent tuberculosis infection. The name of the new blood test is interferon-gamma release assay (IGRA). Croatia is a middle-incidence country with a long decreasing trend and developed tuberculosis control. To reach low incidence and finally eliminate tuberculosis, its tuberculosis programme needs a more aggressive approach that would include intensive contact investigation and treatment of persons with latent tuberculosis infection. This article discusses the current uses of IGRA and its role in tuberculosis control.

scholarly journals 1410. Isoniazid Therapy for Latent Tuberculosis Infection in Patients with Cancer Treated with Checkpoint Inhibitors Immunotherapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S789-S789
Author(s):  
Alexandre Malek ◽  
Patrick Chaftari ◽  
Pablo C Okhuysen ◽  
Hiba Dagher ◽  
Harrys A Torres ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cancer Patients ◽  
Latent Tuberculosis Infection ◽  
Panel Member ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Cancer Center ◽  
Research Support ◽  
Significant Difference ◽  
Tuberculosis Reactivation

Abstract Background Data on the efficacy and tolerability of latent tuberculosis infection (LTBI) treatment in cancer patients receiving checkpoint inhibitor immunotherapy (CPI) is limited. We sought to assess LTBI therapy and its adverse events and outcomes in patients treated with CPI. Methods We performed a retrospective cohort study at MD Anderson Cancer Center of adult patients, between April 2016 and May 2021, who were receiving CPI and were diagnosed with LTBI based on positive T-SPOT TB test. We then compared those patients treated with isoniazid (INH) 5mg/kg daily versus those that did not receive INH therapy. Results We identified 35 patients treated with CPI who had a diagnosis of LTBI. Patients were divided into 2 groups: CPI alone (23 patients, 65.7%) and CPI+INH (12 patients, 34.3%). The majority of patients in both groups had renal cell carcinoma (34.3%) and melanoma (17.1%). Nivolumab as monotherapy was the most commonly used CPI agent in both groups (37.1%), whereas nivolumab and ipilimumab combination was mainly used in the CPI group (34.7%) compared to CPI+INH group (8.3%). In the CPI+INH group, 7 patients (58.3%) developed moderate to severe hepatoxicity that led to discontinuation of INH and CPI therapy versus none in the CPI group (p= 0.001). There was no statistically significant difference in the alanine aminotransferase (ALT) at baseline between both groups (p=0.117), whereas the median ALT level was significantly higher during CPI+INH therapy compared to CPI alone (135 U/L vs 24 U/L respectively, p=0.025. Furthermore, immune-related adverse events were reported in a total of 12 of 35 patients (34.2%). None of the patients in either group developed tuberculosis reactivation during a follow up period of up to 1148 days. Conclusion Our data suggest that latent tuberculosis reactivation is rare in cancer patients on CPI immunotherapy. Hepatotoxicity remains a concern in this patient population with LTBI treated with CPI and INH. With the widespread use of CPI, close laboratory and clinical monitoring is required to avoid life-threatening drug-induced liver injury and interruption of LTBI therapy and immunotherapy. Further clinical studies are warranted to determine the optimal management of LTBI during CPI therapy. Disclosures Pablo C. Okhuysen, MD, FACP, FIDSA, Deinove Pharmaceuticals (Grant/Research Support)Ferring Pharmaceuticals (Consultant)Melinta Therapeutics (Grant/Research Support)Merck & Co. (Grant/Research Support)Napo Pharmaceuticals (Consultant, Scientific Research Study Investigator, Research Grant or Support)Singulex (Consultant)Summit Therapeutics (Grant/Research Support) Dimitrios P. Kontoyiannis, MD, Astellas (Consultant)Cidara Therapeutics (Advisor or Review Panel member)Gilead Sciences (Consultant, Grant/Research Support, Other Financial or Material Support, Honoraria)

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