Extrapulmonary tuberculosis: risk factors

Objective. To identify the main demographic and clinical risk factors for the development of extrapulmonary tuberculosis (EPTB).Materials and methods. A retrospective study of tuberculosis cases registered from 2016 to 2020 in the Gomel region was conducted (330 patients with EPTB and 2,505 patients with pulmonary tuberculosis). The odds ratios were calculated to assess the risk factors for the development of EPTB.Results. The prevalence of EPTB was studied over the course of five years. The most significant risk factors for the development of tuberculosis in extrapulmonary localizations have been identified.Conclusion. The risk factors for the development of EPTB are age (EPTB often develops in children and older persons), females, and in those who have had an episode of tuberculosis previously. Awareness of the predisposing factors may help physicians maintain a high index of suspicion regarding the development of EPTB.

POS1153 EFFECTIVENESS OF SCREENING IN PATIENTS WITH RHEUMATIC DISEASE ON BIOLOGICAL THERAPY AND RISK OF ACTIVE TUBERCULOSIS

Background:Treatment with biologic therapy has been associated with a high risk of reactivation of latent tuberculosis (TB). Preventive strategies for tuberculosis remain a crucial step before initiating biologics in rheumatic disease.Treatment with biological therapy has been associated with high risk of reactivation of latent tuberculosis (TB). Prevention strategies remain a crucial step before initiating biologics.Objectives:We aimed to assess the effectiveness of TB screening before the initiation of biologics and the risk of occurrence of active TB among patients with rheumatic diseases on biologic therapies.The study aimed to access the effectiveness of TB screening recommendations before the initiation of biological therapy and identify the incidence of active TB among these patients.Methods:We performed a hospital-based retrospective cohort study among rheumatic disease patients on biological therapy in two centers in Jeddah between January 2005 to December 2019. Medical files were retrospectively reviewed for demographics data, baseline screening for TB, use of prophylaxis, information on DMARDs and biological therapies, and outcomes results were collected.Results:A total of 365 patients were included over a period of 14 years. Two hundred ninety-two (80%) had Rheumatoid arthritis (RA),13% psoriatic arthritis (PSA), 9% spondyloarthritis (SPA), 2% SLE, and 4% others. The mean age was 47.54 (±14.2), 311 (85%) were females with a mean duration of disease 8.45 years (± 6.58). Hundred forty-nine (42.3%) were on steroids. Anti TNFs were prescribed in 213 (58.4%) patients, Non Anti-TNFs 124 (36.6%) patients, and Jak inhibitors 18 (5%) patients.TB screening was done to all patients except 3 patients (data missing) before commencing biologics. Forty-four (12.1%) patients had latent TB at baseline and all received chemoprophylaxis with isoniazid before starting biologics. Four patients with active TB were identified (one with Behcet’s disease and three with RA). One patient had a reactivation of latent TB and 3 patients developed de novo TB. Three out of four had an infection in the first 6 months of treatment (one on infliximab and two on rituximab) and one case after 1 year of stopping adalimumab. Two cases had pulmonary TB and two others with extrapulmonary TB (pericarditis and brain abscess each). All four patients with active TB were treated with standard anti TB medications. Three had complete resolution of their TB and one died.Conclusion:Baseline screening has been effectively carried out in our cohort as per recommendations. Physician should be vigilant not only for reactivation of latent TB but occurrence of de novo TB in patients on biological therapy.References:[1]Gardam, M. A. et al. Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet. Infect. Dis.3, 148-155, doi:10.1016/s1473-3099(03)00545-0 (2003).[2]Winthrop, K. L., Yamashita, S., Beekmann, S. E. & Polgreen, P. M. Mycobacterial and other serious infections in patients receiving anti-tumor necrosis factor and other newly approved biologic therapies: case finding through the Emerging Infections Network. Clin. Infect. Dis.46, 1738-1740, doi:10.1086/587989 (2008).[3]Cantini, F., Niccoli, L. & Goletti, D. Tuberculosis risk in patients treated with non-anti-tumor necrosis factor-α (TNF-α) targeted biologics and recently licensed TNF-α inhibitors: data from clinical trials and national registries. J. Rheumatol. Suppl.91, 56-64, doi:10.3899/jrheum.140103 (2014).Acknowledgements:We would acknowledge Dr. Noran Alhashmi, Dr. Roaa Jodah, and Dr. Lamis Ramadan for their assistance in data collection.Disclosure of Interests:None declared.

Specific parameters for formation of the tuberculosis risk group among children with HIV infection in a big city

The objective of the study: to establish specific parameters for formation of tuberculosis risk group in HIV positive children of 0-17 years old in order to plan tuberculosis prevention activities.Subjects and methods. The main statistical rates on tuberculosis, HIV infection and their combination in children of 0-17 years old for 2009-2018 were studied. All new cases of TB/HIV co-infection were analyzed in children of 0-17 years old in Moscow for 2004-2018.Results. While the incidence of tuberculosis and HIV infection among children has been decreasing in Moscow over a 10-year period (2009-2018), the group with advanced risk to develop tuberculosis due to HIV infection is growing, both due to children born by HIV positive women (by 1.8 times), and children with confirmed HIV infection (by 2.1 times), which is partly explained by intensive migration in the big city.In the structure of the followed up of children with HIV infection, it has been established that the number and proportion of the following categories tend to grow: children above 8 years old; those at the stage of secondary diseases and advanced stages of HIV infection; and migrants from other regions.In 2004-2018, the combination of tuberculosis and HIV infection was detected most often among children aged 8-11 years (14/34; 41.2%), who had not previously been tested for HIV infection, and among people who had lived outside of Moscow before the disease was detected (16/34; 47.1%). The most severe forms of HIV/TB co-infection including fatal ones, were also observed among children from the migrant population without regular medical follow-up.

Associations of Genetic Variants of miRNA Coding Regions With Pulmonary Tuberculosis Risk in China

Background Tuberculosis (TB) is the leading cause of death caused by single pathogenic microorganism of mycobacterium tuberculosis(MTB). The study aims to explore the associations of microRNA (miRNA) single nucleotide polymorphisms (SNPs) with pulmonary TB (PTB) risk. Methods A population-based case-control study was conducted, and 168 newly diagnosed smear-positive PTB cases and 251 non-TB controls were recruited. SNPs located within miR-27a (rs895819), miR-423 (rs6505162), miR-196a-2 (rs11614913), miR-146a (rs2910164), miR-618 (rs2682818) were selected and MassARRAY® MALDI-TOF System was employed for genotyping. SPSS19.0 was adopted for statistical analysis, non-conditional logistic regression was performed. Odds ratios (ORs) and 95%confidence intervals (95%CIs) were computed to estimate the associations. Associations of haplotypes with PTB risk was performed with online tool. Results Rs895819 CT/CC genotype was associated with reduced PTB risk among female population (OR= 0.45, 95%CI: 0.23-0.98), p=0.045. Haplotypes (Combined with rs895819, rs2682818, rs2910164, rs6505162 and rs11614913) TCCCT, TAGCC, CCCCC, CCGCT and TCGAT were associated with reduced PTB risk and the ORs were 0.67 (95%CI: 0.45-0.99), 0.49 (0.25-0.94), 0.34 (95%CI: 0.14-0.81), 0.22 (95%CI: 0.06-0.84) and 0.24 (95%CI: 0.07-0.79)，respectively; while the haplotypes of TAGCT, CCCCT, CACCT and TCCAT were associated with increased PTB risk, and the ORs were 3.63 (95%CI: 1.54-8.55), 2.20 (95%CI: 1.00-4.86), 3.90 (95%CI: 1.47-10.36) and 2.95 (95%CI: 1.09-7.99), respectively. Conclusions Rs895819 CT/CC genotype was associated with reduced female PTB risk and haplotype TCCCT, TAGCC, CCCCC, CCGCT and TCGAT were associated with reduced PTB risk, while TAGCT, CCCCT, CACCT and TCCAT were associated with increased risk.