Actuality and problems of tuberculosis prevention in patients receiving gene-engineering biological therapy
The aims of the study were to analyse the results of tuberculosis prevention in S.М. Kirov Military Medical Academy patients receiving gene-engineered biologi-cal therapy, to evaluate the topicality of this work and to define existing problems. Methods. The study included 185 patients who were consulted by a phthisiatrician because of the gene-engineered biological therapy in the period of 2018–2019. Patients’ medical case histories were studied. Screening and monitoring of tuberculosis infection was carried out in accordance with the metho-dical recommendations of the Association of Rheuma-tologists of Russia. Results. Among persons, referred to the phthisiatrician consultancy due to biological therapy, patients from department internal medicine clinic pre-vailed (76.2%) with key diagnosis: ankylosing spondylitis (Bekhterev’s disease) — 41.6%, and rheumatoid arthri-tis — 21.1%. Among gene-engineered biologicals, Goli-mumab (44.3%) and Adalimumab (18.5%) were most of-ten used. For the analyzed period, none of those receiving gene-engineered biologicals, got sick with tuberculosis. This indicates the effectiveness of preventive measures. A single clinical case of active pulmonary tuberculosis, that was timely detected in a patient at the preliminary screening stage before the start of biological therapy, is demonstrated. The guidelines on this aspect of the tuber-culosis prevention are analyzed. The current organiza-tion problems in examination and checks, dispensary dynamic observation and chemoprophylaxis are noted and illustrated by a clinical example of a patient with an-kylosing spondylitis (Bekhterev’s disease) and signs of la-tent tuberculosis infection. Ways to solve these problems are suggested. Conclusion. Prevention of tuberculosis in patients receiving gene-engineered biological therapy is atopical task, with a need to update and improve its regu-latory and procedural guidelines.