RESUMEN
BACKGROUND: Among chronic condition problems, tuberculosis still represents a serious public health problem globally. OBJECTIVE: To investigate latent tuberculosis infection in patients with Crohn's disease. Retrospective, descriptive cross-sectional study of quantitative analysis. METHODS: The research was conducted on diagnosed cases of Crohn's disease at the University Hospital located in a city in Northeastern Brazil. All cases of patients with Crohn's disease undergoing isoniazid or rifampicin therapy for latent tuberculosis (LTBI) were included in the study. The data obtained were subsequently subjected to statistical analysis using the Statistical Package for the Social Sciences (SPSS) program. RESULTS: We analyzed 235 medical records, and it was observed that 56% were male, with a mean age of 42.7. Among these, 54% declared themselves as brown, 31% had completed high school, and 47% were residents of the city of Teresina. Regarding the clinical and epidemiological characteristics of the studied patients classified as having ILTB, 34% of the medical records were diagnosed by tuberculin test, 48.51% were investigated by x-ray examination, and the recent location affected the colon with 27%. CONCLUSION: Overall, the health profile of the participants in this study aligns with findings previously established in the literature, particularly studies conducted in other Brazilian states, as well as in other developing countries.
Asunto(s)
Enfermedad de Crohn , Hospitales Universitarios , Tuberculosis Latente , Humanos , Masculino , Estudios Retrospectivos , Enfermedad de Crohn/complicaciones , Femenino , Adulto , Estudios Transversales , Tuberculosis Latente/epidemiología , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Brasil/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Persona de Mediana Edad , Adulto Joven , Adolescente , Rifampin/uso terapéutico , Anciano , Isoniazida/uso terapéutico , Antituberculosos/uso terapéuticoRESUMEN
Inflammatory bowel disease (IBD) is a spectrum of chronic immune-mediated diseases that affect the gastrointestinal tract and other extraintestinal systems, behaving as a systemic disease. Thromboembolic phenomena are a frequent complication in IBD, because of hypercoagulability states associated with disease activity, and their presence has a negative impact on prognosis and patient survival. Due to this, the control of the inflammatory activity of IBD is one of the pillars in the control of thromboembolic events. Biological drugs are associated with rapid control of the inflammatory process, however, the security profile for the reactivation of latent infections, particularly tuberculosis, is always discussed. We present the case of a 37-year-old patient who presented with deep vein thrombosis in the left lower limb and later with massive pulmonary thromboembolism. During his evaluation, he was diagnosed with Crohn's disease (CD). When carrying out the studies prior to the use of biologics, PPD and quantiferon tests were positive. After discussing the case, we decided to start treatment with ustekinumab.
Asunto(s)
Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Tuberculosis Latente , Embolia Pulmonar , Tromboembolia , Masculino , Humanos , Adulto , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Ustekinumab/uso terapéutico , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Tromboembolia/complicaciones , Tromboembolia/tratamiento farmacológico , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológicoRESUMEN
Erythema induratum of Bazin is a rare form of cutaneous tuberculosis, considered as part of the spectrum of tuberculids or hipersensitivity reactions to Mycobacterium tuberculosis. Treatment with biologic agents is a known risk factor for tuberculosis reactivation, especially in areas of high incidence like Latin America, which is why screening and treatment protocols must be followed before these therapies are initiated. We present a case of erythema induratum of Bazin as a reactivation of latent tuberculosis infection in a patient with rheumatoid arthritis treated with golimumab.
Asunto(s)
Eritema Indurado , Tuberculosis Latente , Mycobacterium tuberculosis , Tuberculosis Cutánea , Antituberculosos/uso terapéutico , Eritema Indurado/diagnóstico , Eritema Indurado/microbiología , Eritema Indurado/patología , Humanos , Tuberculosis Latente/complicaciones , Tuberculosis Latente/tratamiento farmacológico , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis Cutánea/microbiologíaRESUMEN
Resumen El eritema indurado de Bazin es una tuberculosis cutánea rara, considerada una tuberculide o reacción de hipersensibilidad a Mycobacterium tuberculosis. El tratamiento con agentes biológicos es un factor de riesgo conocido para la reactivación de tuberculosis, especialmente en áreas de alta incidencia como Latinoamérica, por lo que existen protocolos de búsqueda y tratamiento antes del inicio de este tipo de terapias. Se presenta un caso clínico de eritema indurado de Bazin como reactivación de una infección tuberculosa latente en una paciente con artritis reumatoide que recibía tratamiento con golimumab.
Abstract Erythema induratum of Bazin is a rare form of cutaneous tuberculosis, considered as part of the spectrum of tuberculids or hipersensitivity reactions to Mycobacterium tuberculosis. Treatment with biologic agents is a known risk factor for tuberculosis reactivation, especially in areas of high incidence like Latin America, which is why screening and treatment protocols must be followed before these therapies are initiated. We present a case of erythema induratum of Bazin as a reactivation of latent tuberculosis infection in a patient with rheumatoid arthritis treated with golimumab.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/microbiología , Tuberculosis Cutánea/tratamiento farmacológico , Eritema Indurado/diagnóstico , Eritema Indurado/microbiología , Eritema Indurado/patología , Tuberculosis Latente/complicaciones , Tuberculosis Latente/tratamiento farmacológico , Mycobacterium tuberculosis , Antituberculosos/uso terapéuticoRESUMEN
OBJECTIVE: to identify the prevalence of latent tuberculosis in patients with chronic kidney disease on hemodialysis and associated factors. METHOD: a cross-sectional study conducted with 176 patients with chronic kidney disease on hemodialysis. The tuberculin test was performed with the standardized antigen, distributed by the Brazilian Ministry of Health, and the reading occurred after 72 to 96 hours of the application. An association test (Chi-square, Fisher's exact), prevalence ratio, and multivariate regression tests were performed. RESULTS: the prevalence of latent tuberculosis diagnosed through Tuberculosis Skin Test was 8.5% (15/176). The "has/has had diabetes" (aOR: 0.117; 95%CI: 0.015-0.92) and "having regular garbage collection (aOR: 0.076; 95%CI: 0.008-0.702) factors were associated with a lower probability of having a Positive skin test. CONCLUSION: the low prevalence of latent tuberculosis identified and the factors associated with it reinforce the need for screening for latent tuberculosis infection for diabetics combined with an analysis of previous risk factors and comorbidities.
Asunto(s)
Tuberculosis Latente , Insuficiencia Renal Crónica , Brasil/epidemiología , Estudios Transversales , Humanos , Tuberculosis Latente/complicaciones , Tuberculosis Latente/epidemiología , Prevalencia , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: Tuberculosis (TB) has been linked to an increased risk of atherosclerotic cardiovascular disease (ASCVD). We assessed whether latent TB infection (LTBI) is associated with subclinical coronary atherosclerosis in 2 TB-prevalent areas. METHODS: We analyzed cross-sectional data from studies conducted in Lima, Peru, and Kampala, Uganda. Individuals ≥40 years old were included. We excluded persons with known history of ASCVD events or active TB. Participants underwent QuantiFERON-TB (QFT) testing to define LTBI and computed tomography angiography to examine coronary atherosclerosis. A Coronary Artery Disease-Reporting Data System (CAD-RADS) score ≥3 defined obstructive CAD (plaque causing ≥50% stenosis). RESULTS: 113 and 91 persons with and without LTBI, respectively, were included. There were no significant differences between LTBI and non-LTBI participants in terms of age (median [interquartile range]; 56 [51-62] vs 55 [49-64] years; Pâ =â .829), male sex (38% vs 42%; Pâ =â .519), or 10-year ASCVD risk scores (7.1 [3.2-11.7] vs 6.1 [2.8-1.8]; Pâ =â .533). CAD prevalence (any plaque) was similar between groups (29% vs 24%; Pâ =â .421). Obstructive CAD was present in 9% of LTBI and 3% of non-LTBI individuals (Pâ =â .095). LTBI was associated with obstructive CAD after adjusting for ASCVD risk score, HIV status, and study site (adjusted OR, 4.96; 95% CI, 1.05-23.44; Pâ =â .043). Quantitative QFT TB antigen minus Nil interferon-γ responses were associated with obstructive CAD (adjusted OR, 1.2; 95% CI, 1.03-1.41; Pâ =â .022). CONCLUSIONS: LTBI was independently associated with an increased likelihood of subclinical obstructive CAD. Our data indicate that LTBI is a nontraditional correlate of ASCVD risk.
Asunto(s)
Enfermedad de la Arteria Coronaria , Tuberculosis Latente , Adulto , Enfermedad de la Arteria Coronaria/epidemiología , Estudios Transversales , Humanos , Ensayos de Liberación de Interferón gamma , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/epidemiología , Masculino , Persona de Mediana Edad , Perú/epidemiología , Prueba de Tuberculina , Uganda/epidemiologíaRESUMEN
Objective: to identify the prevalence of latent tuberculosis in patients with chronic kidney disease on hemodialysis and associated factors. Method: a cross-sectional study conducted with 176 patients with chronic kidney disease on hemodialysis. The tuberculin test was performed with the standardized antigen, distributed by the Brazilian Ministry of Health, and the reading occurred after 72 to 96 hours of the application. An association test (Chi-square, Fisher's exact), prevalence ratio, and multivariate regression tests were performed. Results: the prevalence of latent tuberculosis diagnosed through Tuberculosis Skin Test was 8.5% (15/176). The "has/has had diabetes" (aOR: 0.117; 95%CI: 0.015-0.92) and "having regular garbage collection (aOR: 0.076; 95%CI: 0.008-0.702) factors were associated with a lower probability of having a Positive skin test. Conclusion: the low prevalence of latent tuberculosis identified and the factors associated with it reinforce the need for screening for latent tuberculosis infection for diabetics combined with an analysis of previous risk factors and comorbidities.
Objetivo: identificar a prevalência de tuberculose latente em pacientes com doença renal crônica em hemodiálise e fatores associados. Método: estudo transversal realizado com 176 pacientes com doença renal crônica em hemodiálise. O teste tuberculínico foi realizado com o antígeno padronizado, distribuído pelo Ministério da Saúde do Brasil, e a leitura ocorreu após 72 a 96 horas da aplicação. Foram realizados teste de associação (Qui-quadrado, exato de Fisher), razão de prevalência e regressão multivariada. Resultados: a prevalência de tuberculose latente (teste tuberculínico positivo) foi de 8,5% (15/176). Os fatores "tem/teve diabetes" (ORa:0,117; IC95% 0,015-0,92) e "ter coleta de lixo regular" (ORa:0,076; IC95% 0,008-0,702) foram associados a menores probabilidades de ter teste tuberculínico positivo. Conclusão: a baixa prevalência de tuberculose latente identificada e os fatores associados à mesma reforçam a necessidade de uma triagem da infecção latente por tuberculose para diabéticos combinada com a análise de fatores de risco e comorbidades prévias.
Objetivo: identificar la prevalencia de tuberculosis latente en pacientes con enfermedad renal crónica en hemodiálisis y factores asociados. Método: estudio transversal realizado con 176 pacientes con enfermedad renal crónica en hemodiálisis. La prueba cutánea de la tuberculina se realizó con el antígeno estandarizado, distribuido por el Ministerio de Salud de Brasil, y la lectura se realizó después de 72 a 96 horas de la aplicación. Se realizaron pruebas de asociación (Chi-cuadrado, exacta de Fisher), razón de prevalencia y regresión multivariante. Resultados: la prevalencia de tuberculosis latente (prueba de tuberculina positiva) fue de 8,5% (15/176). Los factores "tiene/ha tenido diabetes" (ORa: 0,117; IC del 95%: 0,015-0,92) y "tener recolección regular de residuos" (ORa: 0,076; IC del 95%: 0,008-0,702) se asociaron con menores probabilidades de tener una prueba de tuberculina positiva. Conclusión: la baja prevalencia de tuberculosis latente registrada y sus factores asociados refuerzan la necesidad del cribado de la infección tuberculosa latente en diabéticos combinado con el análisis de factores de riesgo y comorbilidades previas.
Asunto(s)
Humanos , Masculino , Femenino , Brasil/epidemiología , Prevalencia , Estudios Transversales , Factores de Riesgo , Diálisis Renal , Insuficiencia Renal/epidemiología , Insuficiencia Renal Crónica/complicaciones , Tuberculosis Latente/complicaciones , Tuberculosis Latente/epidemiologíaRESUMEN
BACKGROUND: Tuberculosis screening in psoriasis patients is complex due to the immunological alterations associated with psoriasis, the presence of comorbidities, and the effect of immunosuppressive treatment. However, it is not established whether the results of screening tests are affected by these factors in psoriasis patients. OBJECTIVES: To determine whether there is a change in the results of the tuberculin skin test (TST) or the interferon-gamma release assay (IGRA) in psoriasis patients living in tuberculosis (TB)-endemic area after 12 weeks of methotrexate (MTX) treatment and to investigate the association of the test results with clinical and inflammatory markers. METHODS: Forty-five patients were selected for a prospective single-arm self-controlled study and followed for at least 18 months. The TST, IGRA, Psoriasis Area and Severity Index (PASI), and inflammatory factors (erythrocyte sedimentation rate (ESR), C-reactive protein, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha levels), were determined before and after 12 weeks of oral 15 mg per week MTX administration and compared. The associations between the IGRA and TST results were verified before and after treatment according to inflammatory factors and clinical characteristics (age, blood glucose, weight, body mass index, disease duration, and PASI). RESULTS: We collected data on 25 patients who completed the full course of therapy and the follow-up. None of the patients developed TB. TST positivity was significantly elevated at week 12 (25% baseline vs 44% at week 12, P < 0.037). Three IGRAs followed the TST conversions. There was no difference between TST and IGRA pre- or posttreatment. Serum IFN-γ increased significantly in week 12 (15.95 pg/ml baseline vs 18.82 pg/ml at week 12, P < 0.005) and tended to be higher among TST-positive patients (P = 0.072). The baseline IGRA was associated with a higher ESR (P = 0.038). None of the test results were associated with clinical characteristics. CONCLUSIONS: In addition to the classic booster effect, TST conversions in patients using MTX can occur due to an increase in IFN-γ. However, it is not possible to exclude true TST conversions. Therefore, other diagnostic methods, like IGRA or chest tomography, should be used when the TST has intermediate results.
Asunto(s)
Tuberculosis Latente/tratamiento farmacológico , Metotrexato/administración & dosificación , Psoriasis/tratamiento farmacológico , Prueba de Tuberculina/efectos adversos , Adulto , Proteína C-Reactiva/metabolismo , Femenino , Humanos , Inmunosupresores/administración & dosificación , Interferón gamma/sangre , Tuberculosis Latente/complicaciones , Tuberculosis Latente/epidemiología , Tuberculosis Latente/microbiología , Masculino , Tamizaje Masivo , Metotrexato/efectos adversos , Persona de Mediana Edad , Psoriasis/sangre , Psoriasis/complicaciones , Psoriasis/epidemiología , Índice de Severidad de la Enfermedad , Factor de Necrosis Tumoral alfa/sangre , Adulto JovenRESUMEN
BACKGROUND: In developing countries, tuberculosis (TB) is a major public health problem and the leading cause of death among patients with HIV (Human Immunodeficiency Virus). Until 2001, the tuberculin skin test (TST) was the only available tool for the diagnosis of latent tuberculosis infection (LTBI), but false-negative TST results are frequently reported. Recently, the interferon-γ (IFN-γ) release assay (IGRA) has gained ground because it can detect the IFN-γ secreted by circulating lymphocytes T cells when stimulated by specific TB antigens. However, the role of IGRA in the diagnosis of LTBI in HIV-infected patients has not been well established. METHODS: This cross-sectional study compared the accuracy of TST (performed by the Mantoux method) and IGRA (QuantiFERON-TB Gold In-Tube, Cellestis, Carnegie, Australia) on the diagnosis of LTBI among patients with HIV. LTBI is defined by LTBI risk and at least one positive test (TST or IGRA), without clinical evidence of active TB. We also assessed the accuracy of TST and IGRA among HIV patients with high and low risk for LTBI. RESULTS: Among 90 HIV patients, 80 met the study criteria for LTBI, fifty-nine (73.7%) patients were TST positive, 21 (26.2%) were negative, whereas 75 patients (93.7%) were IGRA positive, and five (6.2%) were negative. TST showed poor agreement with the diagnosis of LTBI (Kappa: 0.384), while IGRA demonstrated good agreement (Kappa: 0.769). Among 69 patients with high risk and 21 with low risk for LTBI, TST was positive in 48 (69.5%) and 11 (52.4%), while IGRA was positive in 68 (98.5%) and 7 (33.3%) patients, respectively. There were no association between TST and the level of risk (P = 0,191). Conversely, we observed a strong association between the IGRA and risk for LTBI (p < 0.001). CONCLUSIONS: Compared to TST, IGRA positivity is consistent with the risk of TB infection and seems to be a better diagnostic tool for LTBI in HIV-infected patients.
Asunto(s)
Infecciones por VIH/complicaciones , Ensayos de Liberación de Interferón gamma/métodos , Tuberculosis Latente/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/sangre , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , VIH , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Humanos , Interferón gamma/sangre , Tuberculosis Latente/sangre , Tuberculosis Latente/complicaciones , Tuberculosis Latente/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Prueba de Tuberculina/métodosRESUMEN
Background: Tuberculosis has been associated with an increased risk of cardiovascular disease (CVD), including acute myocardial infarction (AMI). We investigated whether latent tuberculosis infection (LTBI) is associated with AMI. Methods: We conducted a case-control study in 2 large national public hospital networks in Lima, Peru, between July 2015 and March 2017. Case patients were patients with a first time diagnosis of type 1 (spontaneous) AMI. Controls were patients without a history of AMI. We excluded patients with known human immunodeficiency virus infection, tuberculosis disease, or prior LTBI treatment. We used the QuantiFERON-TB Gold In-Tube assay to identify LTBI. We used logistic regression modeling to estimate the odds ratio (OR) of LTBI in AMI case patients versus non-AMI controls. Results: We enrolled 105 AMI case patients and 110 non-AMI controls during the study period. Overall, the median age was 62 years (interquartile range, 56-70 years); 69% of patients were male; 64% had hypertension, 40% dyslipidemia, and 39% diabetes mellitus; 30% used tobacco; and 24% were obese. AMI case patients were more likely than controls to be male (80% vs 59%; P < .01) and tobacco users (41% vs 20%; P < .01). LTBI was more frequent in AMI case patients than in controls (64% vs 49% [P = .03]; OR, 1.86; 95% confidence interval [CI], 1.08-3.22). After adjustment for age, sex, hypertension, dyslipidemia, diabetes mellitus, tobacco use, obesity, and family history of coronary artery disease, LTBI remained independently associated with AMI (adjusted OR, 1.90; 95% CI, 1.05-3.45). Conclusions: LTBI was independently associated with AMI. Our results suggest a potentially important role of LTBI in CVD.
Asunto(s)
Tuberculosis Latente/complicaciones , Infarto del Miocardio/complicaciones , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Tuberculosis Latente/diagnóstico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Perú , Factores de RiesgoRESUMEN
Resumen El citomegalovirus (CMV) es uno de los microorganismos oportunistas con mayor prevalencia en pacientes inmunocomprometidos, aunque su reactivación ha descendido después de la introducción de la terapia antirretroviral altamente activa (Highly Active Antiretroviral Therapy, HAART). En las coinfecciones, la encefalitis se ha reportado como una de las condiciones más frecuentes. Se presenta el caso de un paciente adulto joven con infección por virus de la inmunodeficiencia humana (HIV) que tuvo un rápido deterioro neurológico evidenciado en síntomas y signos clínicos clásicos del síndrome de Wernicke-Korsakoff y que no presentaba factores de riesgo para deficiencia de tiamina. En las imágenes de la resonancia magnética cerebral, se detectaron hallazgos típicos del síndrome, y se identificó citomegalovirus (CMV) en el líquido cefalorraquídeo. Con el tratamiento específico para el CMV, se logró el control de los síntomas, aunque hubo secuelas neurológicas que mejoraron. Este es uno de los pocos casos reportados a nivel mundial de síndrome de Wernicke secundario a encefalitis por citomegalovirus.
Abstract Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations. We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement. This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.
Asunto(s)
Adulto , Humanos , Masculino , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones por Citomegalovirus/complicaciones , Encefalitis Viral/complicaciones , Síndrome de Korsakoff/etiología , Antivirales/uso terapéutico , Insuficiencia Respiratoria/etiología , Imagen por Resonancia Magnética , Traqueostomía , Gastrostomía , Trastornos de Deglución/cirugía , Trastornos de Deglución/etiología , Ganciclovir/uso terapéutico , Líquido Cefalorraquídeo/virología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/virología , Infecciones por Citomegalovirus/líquido cefalorraquídeo , Infecciones por Citomegalovirus/tratamiento farmacológico , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/tratamiento farmacológico , Enfermedades del Nervio Abducens/etiología , Citomegalovirus/aislamiento & purificación , Diplopía/etiología , Tuberculosis Latente/complicacionesRESUMEN
BACKGROUND: Diagnosis of latent tuberculosis infection (LTBI) is facilitated by tuberculin skin testing (TST) or interferon-gamma release assays such as the QuantiFERON TB Gold In-Tube (QTF-GIT) assays. Limited data exist on the utility of interferon-gamma release assays in HIV-infected children, which may be falsely negative due to immunosuppression. METHODS: A cross-sectional study comparing TST to QTF-GIT for the diagnosis of suspected LTBI was performed in children in Tijuana, Mexico, and in San Diego, California. Concordance between TST (≥5 mm for HIV infected and ≥10 mm for HIV uninfected) and QTF-GIT was evaluated utilizing kappa coefficients. Multivariate logistic regression assessed factors influencing the results. RESULTS: One hundred sixty-five children (70 HIV infected and 95 HIV uninfected) were evaluated (median age, 8.0 years). Among HIV-infected children, the median CD4 cell count was 913 cells/µL, with 92.9% of subjects on antiretroviral treatment and 80.0% with an HIV RNA load <400 copies/mL (76% <50 copies/mL). Among HIV-infected children with no history of tuberculosis, 12 HIV had either a positive QTF-GIT or TST ≥ 5 mm or both, giving a suspected LTBI prevalence of 20.3% (compared with 61.3% among HIV-uninfected children). Moderate concordance was demonstrated in HIV-infected children (both tests positive, κ = 0.42; 95% confidence interval: 8.9%-75.4%) and HIV-uninfected children (both tests positive, κ = 0.59; 95% confidence interval: 43.0%-76.5%). CONCLUSIONS: A moderate correlation exists between TST and QTF-GIT among HIV-infected and uninfected children with preserved immune function in an area of moderate tuberculosis endemicity.
Asunto(s)
Infecciones por VIH/complicaciones , Ensayos de Liberación de Interferón gamma/estadística & datos numéricos , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Prueba de Tuberculina/estadística & datos numéricos , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: To evaluate, in an endemic country, the long-term efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers. METHODS: This was a retrospective cohort that included JIA patients eligible to anti-TNF therapy. Patients were screened for LTBI prior to anti-TNF using tuberculin skin test (TST), chest X-ray and history of exposure to TB. Subjects were regularly followed at 2-month intervals. RESULTS: Sixty-nine JIA patients with current age of 17.4±5.8 years, mean disease duration of 5.0±4.9 years were included. Forty-seven patients received a single anti-TNF, while 22 patients switched to another anti-TNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TST-positive and history of TB exposure and two had solely TST-positive. No active TB was diagnosed during the study period (median of follow-up was 3.8 years). CONCLUSION: Long-term evaluation revealed that LTBI screening and primary prophylaxis before anti-TNF treatment was effective in a high-risk country and TST was the most sensitive parameter to identify these patients.
Asunto(s)
Adalimumab/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Juvenil/tratamiento farmacológico , Infliximab/uso terapéutico , Tuberculosis Latente/diagnóstico , Adolescente , Antituberculosos/uso terapéutico , Artritis Juvenil/complicaciones , Niño , Preescolar , Enfermedades Endémicas , Femenino , Estudios de Seguimiento , Humanos , Lactante , Tuberculosis Latente/complicaciones , Tuberculosis Latente/prevención & control , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Abstract Objectives: To evaluate, in an endemic country, the long-term efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers. Methods: This was a retrospective cohort that included JIA patients eligible to anti-TNF therapy. Patients were screened for LTBI prior to anti-TNF using tuberculin skin test (TST), chest X-ray and history of exposure to TB. Subjects were regularly followed at 2-month intervals. Results: Sixty-nine JIA patients with current age of 17.4 ± 5.8 years, mean disease duration of 5.0 ± 4.9 years were included. Forty-seven patients received a single anti-TNF, while 22 patients switched to another anti-TNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TST-positive and history of TB exposure and two had solely TST-positive. No active TB was diagnosed during the study period (median of follow-up was 3.8 years). Conclusion: Long-term evaluation revealed that LTBI screening and primary prophylaxis before anti-TNF treatment was effective in a high-risk country and TST was the most sensitive parameter to identify these patients.
Resumo Objetivo: Avaliar, em um país endêmico, a eficácia em longo prazo do rastreamento à procura de infecção latente por tuberculose (ILTB) e profilaxia primária em pacientes com AIJ em uso de bloqueadores do TNF. Métodos: Trata-se de uma coorte retrospectiva que incluiu pacientes com AIJ elegíveis para a terapia anti-TNF. Os pacientes foram rastreados à procura de ILTB previamente ao uso de anti-TNF por meio do teste tuberculínico (TT), radiografia de tórax e história de exposição à TB. Os indivíduos foram acompanhados regularmente em intervalos de dois meses. Resultados: Incluíram-se 69 pacientes com AIJ com idade atual de 17,4 ± 5,8 anos, com média de duração da doença de 5 ± 4,9 anos; 47 pacientes receberam um único anti-TNF, enquanto 22 foram transferidos para outro anti-TNF uma ou duas vezes: 57 foram tratados com etanercepte, 33 com adalimumabe e três com infliximabe. O rastreamento à procura de ILTB foi positivo em três pacientes: um era TT positivo e tinha história de exposição à TB e dois apenas eram TT positivo. Não foi diagnosticado caso de TB ativa durante o período de estudo (mediana de seguimento de 3,8 anos). Conclusão: A avaliação em longo prazo revelou que o rastreamento à procura de ILTB e a profilaxia primária antes do tratamento com anti-TNF foram eficazes em um país de alto risco para TB e o TT foi o parâmetro mais sensível para identificar esses pacientes.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Artritis Juvenil/tratamiento farmacológico , Antirreumáticos/uso terapéutico , Tuberculosis Latente/diagnóstico , Adalimumab/uso terapéutico , Infliximab/uso terapéutico , Artritis Juvenil/complicaciones , Estudios Retrospectivos , Estudios de Seguimiento , Resultado del Tratamiento , Enfermedades Endémicas , Tuberculosis Latente/complicaciones , Tuberculosis Latente/prevención & control , Antituberculosos/uso terapéuticoRESUMEN
INTRODUCTION: Children and adolescents with rheumatic diseases receiving TNF blockers are at risk for the activation of latent Mycobacterium tuberculosis infection (LTBI). Although LTBI treatment is indicated in this group, there are different therapeutic regimens in the literature, without a definite consensus. OBJECTIVES: To review in the literature therapeutic schemes used and indicated for the treatment of LTBI in these patients. METHODS: Systematic review of the literature, using health databases, selecting studies that addressed the treatment of LTBI in patients with juvenile rheumatic diseases using TNF blockers, from 1990 to 2015. All study designs were considered. RESULTS: A total of 162 studies were identified through the electronic databases and one was found through a manual search by the author, totaling 163 articles. We excluded studies that did not meet the mentioned inclusion criteria, and included a retrospective cohort study and two prospective cohort studies. The three studies addressed treatment with isoniazid (INH) for 9 months and one of them also addressed INH treatment associated with rifampicin for 3 months. CONCLUSIONS: Only one case of LTBI activation was observed; there was good treatment adherence and absence of complications during follow-up. More studies are necessary to evaluate the response to the other available therapeutic regimens, with better tolerability assessment and a larger sample. However, the results showed that INH therapy for 9 months and INH therapy plus rifampicin for 3 months had a low rate of LTBI activation and complications.
Asunto(s)
Antituberculosos/uso terapéutico , Tuberculosis Latente/tratamiento farmacológico , Enfermedades Reumáticas/complicaciones , Adolescente , Niño , Humanos , Tuberculosis Latente/complicaciones , Resultado del TratamientoRESUMEN
ABSTRACT Introduction: Children and adolescents with rheumatic diseases receiving TNF blockers are at risk for the activation of latent Mycobacterium tuberculosis infection (LTBI). Although LTBI treatment is indicated in this group, there are different therapeutic regimens in the literature, without a definite consensus. Objectives: To review in the literature therapeutic schemes used and indicated for the treatment of LTBI in these patients. Methods: Systematic review of the literature, using health databases, selecting studies that addressed the treatment of LTBI in patients with juvenile rheumatic diseases using TNF blockers, from 1990 to 2015. All study designs were considered. Results: A total of 162 studies were identified through the electronic databases and one was found through a manual search by the author, totaling 163 articles. We excluded studies that did not meet the mentioned inclusion criteria, and included a retrospective cohort study and two prospective cohort studies. The three studies addressed treatment with isoniazid (INH) for 9 months and one of them also addressed INH treatment associated with rifampicin for 3 months. Conclusions: Only one case of LTBI activation was observed; there was good treatment adherence and absence of complications during follow-up. More studies are necessary to evaluate the response to the other available therapeutic regimens, with better tolerability assessment and a larger sample. However, the results showed that INH therapy for 9 months and INH therapy plus rifampicin for 3 months had a low rate of LTBI activation and complications.
RESUMO Introdução: Crianças e adolescentes com doenças reumáticas em terapia anti-TNF-α são grupo de risco para ativação da infecção latente por Mycobacterium tuberculosis (ILTB). Embora o tratamento da ILTB seja indicado nesse grupo, existem diferentes esquemas terapêuticos na literatura, sem um consenso definido. Objetivos: Revisar na literatura esquemas terapêuticos usados e indicados para o tratamento da ILTB nesses pacientes. Métodos: Revisão sistemática da literatura, nas bases de dados em saúde, selecionaram-se estudos que abordaram o tratamento da ILTB em pacientes reumáticos juvenis em uso de anti-TNF-α, de 1990 a 2015. Todos os desenhos de estudo foram considerados. Resultados: Foram identificados através das bases de dados eletrônicas 162 estudos e um foi encontrado por meio de busca manual do autor, total de 163. Foram excluídos os estudos que não atenderam aos critérios de inclusão referidos, incluídos um estudo de coorte retrospectiva e dois de estudos de coorte prospectivas. Os três estudos abordaram o tratamento com isoniazida (INH) por nove meses e um deles abordou também o tratamento com INH associado a rifampicina por três meses. Conclusões: Foi observado apenas um caso de ativação da ILTB; uma boa adesão ao tratamento e ausência de complicações durante o acompanhamento. Mais estudos são necessários para avaliar a resposta aos outros esquemas terapêuticos disponíveis, com melhor avaliação da tolerabilidade e maior amostra. Porém, os resultados mostraram que a terapia com INH por nove meses e a terapia com INH mais rifampicina por três meses têm baixo índice de ativação e complicações.
Asunto(s)
Humanos , Niño , Adolescente , Enfermedades Reumáticas/complicaciones , Tuberculosis Latente/tratamiento farmacológico , Antituberculosos/uso terapéutico , Resultado del Tratamiento , Tuberculosis Latente/complicacionesRESUMEN
Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations.We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement.This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones por Citomegalovirus/complicaciones , Encefalitis Viral/complicaciones , Síndrome de Korsakoff/etiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/virología , Enfermedades del Nervio Abducens/etiología , Adulto , Antivirales/uso terapéutico , Líquido Cefalorraquídeo/virología , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/líquido cefalorraquídeo , Infecciones por Citomegalovirus/tratamiento farmacológico , Trastornos de Deglución/etiología , Trastornos de Deglución/cirugía , Diplopía/etiología , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/tratamiento farmacológico , Ganciclovir/uso terapéutico , Gastrostomía , Humanos , Tuberculosis Latente/complicaciones , Imagen por Resonancia Magnética , Masculino , Insuficiencia Respiratoria/etiología , TraqueostomíaRESUMEN
Ocular tuberculosis (TB) is considered to be rare, although its incidence has varied widely over time and in different populations. Latent TB is diagnosed when a person is infected with Mycobacterium tuberculosis but does not have active TB. During the last decade, interferon-gamma release assay tests have been developed that allow identification of patients with latent TB infection with better specificity than the tuberculin skin test and can differentiate between infection and prior vaccination. Although rare, tuberculous scleritis should be considered in the differential diagnosis of posterior scleritis. Here we describe a patient with posterior scleritis and severe visual loss associated with latent TB without uveitis, anterior scleritis, keratitis, or any other previous ocular disease history. The patient responded well to a combined treatment of antitubercular therapy and oral corticosteroids.
Asunto(s)
Escleritis/diagnóstico , Tuberculosis Ocular/diagnóstico , Corticoesteroides/uso terapéutico , Adulto , Antituberculosos/uso terapéutico , Femenino , Humanos , Ensayos de Liberación de Interferón gamma/métodos , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/tratamiento farmacológico , Escleritis/tratamiento farmacológico , Escleritis/etiología , Resultado del Tratamiento , Tuberculosis Ocular/complicaciones , Tuberculosis Ocular/tratamiento farmacológicoRESUMEN
ABSTRACT Ocular tuberculosis (TB) is considered to be rare, although its incidence has varied widely over time and in different populations. Latent TB is diagnosed when a person is infected with Mycobacterium tuberculosis but does not have active TB. During the last decade, interferon-gamma release assay tests have been developed that allow identification of patients with latent TB infection with better specificity than the tuberculin skin test and can differentiate between infection and prior vaccination. Although rare, tuberculous scleritis should be considered in the differential diagnosis of posterior scleritis. Here we describe a patient with posterior scleritis and severe visual loss associated with latent TB without uveitis, anterior scleritis, keratitis, or any other previous ocular disease history. The patient responded well to a combined treatment of antitubercular therapy and oral corticosteroids.
RESUMO A tuberculose (TB) ocular foi considerada rara, embora a sua incidência tenha variado significativamente ao longo do tempo e nas diferentes populações. A TB latente é diagnosticada quando alguém é infetado com Mycobacterium tuberculosis sem possuir doença ativa. Durante a última década, testes tendo por base interferon gamma release assay foram desenvolvidos, permitindo a identificação de pacientes com infeção por tuberculose latente com maior especificidade que o teste tuberculínico e diferenciar infeção e vacinação prévia. Embora rara, a esclerite tuberculosa deve ser tida em consideração no diagnóstico diferencial de esclerite posterior. Reportamos um paciente com esclerite posterior e baixa grave de acuidade visual associada a TB latente, sem uveíte, esclerite anterior, ceratite ou história de doença ocular prévia. O paciente respondeu favoravelmente a um tratamento combinado de fármacos antituberculose e corticoides orais.
Asunto(s)
Humanos , Femenino , Adulto , Escleritis/diagnóstico , Tuberculosis Ocular/diagnóstico , Escleritis/etiología , Escleritis/tratamiento farmacológico , Tuberculosis Ocular/complicaciones , Tuberculosis Ocular/tratamiento farmacológico , Resultado del Tratamiento , Corticoesteroides/uso terapéutico , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/tratamiento farmacológico , Ensayos de Liberación de Interferón gamma/métodos , Antituberculosos/uso terapéuticoRESUMEN
Abstract Setting Patients HIV+ attending in a reference clinic, Southern Brazil. Objective To compare the interferon-gamma-release assay (IGRA – QuantiFERON® TB Gold In-Tube) with the tuberculin skin test (TST – PPD-Rt 23) for latent tuberculosis infection (LTBI) in patients with HIV. Design Cohort study. Patients were simultaneously submitted to the TST and blood collection for the IGRA. Results A total of 140 subjects were included. Nine (6.4%) were IGRA+/TST+, 12 (8.6%) were IGRA+/TST−, 4 (3%) were IGRA−/TST+, and 115 (82%) IGRA−/TST−. There was poor agreement between tests (kappa = 0.2), and no correlation between these results and CD4+ T lymphocyte counts. During follow-up, one patient with negative results on both tests died from sepsis, and another with discordant results (IGRA+/TST−) exhibited TST seroconversion. Compared to the TST, IGRA showed a sensitivity and specificity of 69% and 90%, respectively. The IGRA detected 8% more positive results than the TST. All patients were followed up for 2 years. Conclusion The higher accuracy of the IGRA would result in LTBI treatments being administered to patients who would have otherwise been overlooked, decreasing the number of active tuberculosis cases. The long-term survival of HIV carriers requires further evaluation.