Diagnosis and Preventive Treatment of Mycobacterium Tuberculosis Infection in Anti-TNFα Candidates
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
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Ievads: Tumora nekrozes faktora alfa (TNFα) inhibējošās terapijas pielietošana ir radikāli mainījusi reimatoloģisko un iekaisīgo zarnu slimību ārstēšanu, taču tai piemīt arī trūkumi, tostarp palielināts aktīvās tuberkulozes (TB) attīstības risks. Lai izprastu un aprakstītu TNFα inhibējošās terapijas saistību ar Mycobacterium tuberculosis (Mtb) infekciju, ir veikti daudzi pētījumu. Iegūtie rezultāti liecina, ka lielākā daļa aktīvo TB gadījumu rodas latentās tuberkulozes infekcijas (LTBI) reaktivācijas rezultātā. Lai samazinātu Mbt infekcijas reaktivācijas risku, valstīs ir izstrādātas vadlīnijas LTBI diagnostikai un ārstēšanai pacientiem, kuriem plāno uzsākt TNFα inhibējošo terapiju.
Mērķis: Pētījuma mērķis ir aprakstīt saistību starp TNFα inhibējošo terapiju un Mtb infekciju un izpētīt dažādu valstu vadlīnijas LTBI diagnostikai un ārstēšanai pacientiem, kuriem plāno uzsākt TNFα inhibējošo terapiju.
Hipotēze: Pacientiem, kuri saņem TNFα inhibējošo terapiju, salīdzinot ar vispārējo populāciju, ir paaugstināts LTBI progresēšanas risks aktīvā TB slimībā.
Metode: Pētījums ir veikts literatūras apskata veidā. Apskatā ietvertas atbilstoši atslēgas vārdiem atrastās publikācijas zinātniskās datubāzēs iekļautajos medicīnas žurnālos, tīmekļa vietnēs un raksti, kas minēti publicēto pētījumu atsaucēs. Starp visiem apskatītajiem un starp 51 šajā pētījumā citētajiem rakstiem, publicētas vadlīnijas LTBI diagnostikai un ārstēšanai TNFα inhibējošās terapijas kandidātiem bija pieejamas tikai no 6 dažādām valstīm. Visas publicētās vadlīnijas tika iekļautas analīzē.
Secinājums: Pacientiem, kuri saņem TNFα inhibējošo terapiju, ir paaugstināts LTBI reaktivācijas risks sakarā ar TNFα kritisko lomu imūnreakcijā pret Mtb. Pašlaik nav universālu vadlīniju par LTBI diagnostiku un ārstēšana pacientiem, kuriem plāno uzsākt TNFα inhibējošo terapiju.Tā iemesls ir dažāda TB izplatība, atšķirīga BCG vakcinācijas stratēģija un ekonomiskā situācija dažādās valstīs, kā arī pieejamo skrīninga testu nepilnības. Optimālais LTBI skrīninga algoritms joprojām nav skaidrs. Publicātajas vadlīnijās LTBI diagnostikai tiek rekomendēts lietot interferona gamma izdales testus vai nu atsevišķi, vai kombinācijā ar tuberkulīna ādas testu lai palielinātu testu jutību un specifiskumu. Kā pirmo terapijas izvēli LTBI preventīvai arstēšanai lielākā daļa vadlīniju rekomendē izoniazīda monoterapiju 6 vai 9 mēnešus ilgi.
Background: Anti-TNFα therapy has revolutionized the treatment of rheumatological and inflammatory bowel diseases, but comes with its drawbacks, including the increased risk for developing active tuberculosis (TB) disease. A lot of research has been conducted on the topic to understand and describe the association to Mycobacterium tuberculosis (Mtb) infection. Studies suggest that the majority of active TB cases result from latent tuberculosis infection (LTBI) reactivation. Therefore, several diagnostic- and preventive guidelines have been established to locate and treat LTBI in anti-TNFα candidates in order to decrease the risk of reactivation. Aim: The research paper aims to describe the connection between anti-TNFα therapy and Mtb infection, and investigate guidelines for the diagnosis and treatment of LTBI in anti-TNFα candidates. Hypothesis: Anti-TNFα candidates are at increased risk for LTBI progression to active TB disease compared to the general population. Method: This research has been conducted in the form of a literature review. Information by search on specific keywords was obtained from various sources including, medical journals, scientific databases, webpages, and review of reference lists of articles cited in this paper. Out of all the reviewed material, 51 references were finally included. A search for articles on LTBI diagnostic- and preventive guidelines in anti-TNFα candidates was performed, in which articles from six different countries were obtained and analyzed. Conclusion: Anti-TNFα candidates are at increased risk for LTBI reactivation owing to TNFα’s critical role in the immune response to Mtb. Currently, no universal guidelines on the diagnosis and treatment of LTBI in anti-TNFα candidates exist due to the difference in the prevalence of TB, BCG vaccination strategy, and economic situation in different countries as well as the pitfalls of available screening tests. The optimal screening algorithm remains to be a question without a definite answer. It is concluded that there is an increased tendency to use interferon gamma release assays alone or in combination with tuberculin skins test for LTBI diagnostics in anti-TNFα candidates owing to its presumed increased sensitivity and specificity. Regarding treatment of LTBI in this patient group, guidelines agree on isoniazid monotherapy for 6 or 9 months as first choice of therapy.
Background: Anti-TNFα therapy has revolutionized the treatment of rheumatological and inflammatory bowel diseases, but comes with its drawbacks, including the increased risk for developing active tuberculosis (TB) disease. A lot of research has been conducted on the topic to understand and describe the association to Mycobacterium tuberculosis (Mtb) infection. Studies suggest that the majority of active TB cases result from latent tuberculosis infection (LTBI) reactivation. Therefore, several diagnostic- and preventive guidelines have been established to locate and treat LTBI in anti-TNFα candidates in order to decrease the risk of reactivation. Aim: The research paper aims to describe the connection between anti-TNFα therapy and Mtb infection, and investigate guidelines for the diagnosis and treatment of LTBI in anti-TNFα candidates. Hypothesis: Anti-TNFα candidates are at increased risk for LTBI progression to active TB disease compared to the general population. Method: This research has been conducted in the form of a literature review. Information by search on specific keywords was obtained from various sources including, medical journals, scientific databases, webpages, and review of reference lists of articles cited in this paper. Out of all the reviewed material, 51 references were finally included. A search for articles on LTBI diagnostic- and preventive guidelines in anti-TNFα candidates was performed, in which articles from six different countries were obtained and analyzed. Conclusion: Anti-TNFα candidates are at increased risk for LTBI reactivation owing to TNFα’s critical role in the immune response to Mtb. Currently, no universal guidelines on the diagnosis and treatment of LTBI in anti-TNFα candidates exist due to the difference in the prevalence of TB, BCG vaccination strategy, and economic situation in different countries as well as the pitfalls of available screening tests. The optimal screening algorithm remains to be a question without a definite answer. It is concluded that there is an increased tendency to use interferon gamma release assays alone or in combination with tuberculin skins test for LTBI diagnostics in anti-TNFα candidates owing to its presumed increased sensitivity and specificity. Regarding treatment of LTBI in this patient group, guidelines agree on isoniazid monotherapy for 6 or 9 months as first choice of therapy.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Atslēgas vārdi
TNFα inhibējošo terapiju, latentās tuberkulozes infekcijas, Mycobacterium tuberculosis, tuberkulīna ādas testu, interferona gamma izdales testu, vadlīnijas., Anti-TNFα therapy, latent tuberculosis infection, mycobacterium tuberculosis, tuberculin skin test, interferon-gamma release assay, guidelines.