Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
Por:
Calzada-Hernández J, Anton-Lopez J, Martín-de-Carpi J, López-Montesinos B, Calvo I, Donat E, Núñez E, Blasco Alonso J, Mellado MJ, Baquero-Artigao F, Leis R, Vegas-Álvarez AM, Medrano San Ildefonso M, Pinedo-Gago MDC, Eizaguirre FJ, Tagarro A, Camacho-Lovillo M, Pérez-Gorricho B, Gavilán-Martín C, Guillén S, Sevilla-Pérez B, Peña-Quintana L, Mesa-Del-Castillo P, Fortuny-Guasch C, Tebruegge M and Noguera-Julian A
Publicada:
1 ene 2023
Ahead of Print:
1 nov 2022
Categoría:
Pediatrics, perinatology and child health
Resumen:
Tumor-necrosis-factor-alpha inhibitors (anti-TNF-alpha) are associated with an increased risk of tuberculosis (TB) disease, primarily due to reactivation of latent TB infection (LTBI). We assessed the performance of parallel LTBI screening with tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube assays (QFT-GIT) before anti-TNF-alpha treatment in children with immune-mediated inflammatory disorders in a low TB-burden setting. We conducted a multicenter cohort study involving 17 pediatric tertiary centers in Spain. LTBI was defined as the presence of a positive TST and/or QFT-GIT result without clinical or radiological signs of TB disease. A total of 270 patients (median age:11.0 years) were included, mainly with rheumatological (55.9%) or inflammatory bowel disease (34.8%). Twelve patients (4.4%) were diagnosed with TB infection at screening (LTBI, n = 11; TB disease, n = 1). Concordance between TST and QFT-GIT results was moderate (TST+/QFT-GIT+, n = 4; TST-/QFT-GIT+, n = 3; TST+/QFT-GIT-, n = 5; kappa coefficient: 0.48, 95% CI: 0.36-0.60). Indeterminate QFT-GIT results occurred in 10 patients (3.7%) and were associated with young age and elevated C-reactive protein concentrations. Eleven of 12 patients with TB infection uneventfully completed standard LTBI or TB treatment. During a median follow-up period of 6.4 years, only 2 patients developed TB disease (incidence density: 130 (95% CI: 20-440) per 100,000 person-years), both probable de novo infections.
Conclusion: A substantial number of patients were diagnosed with LTBI during screening. The dual strategy identified more cases than either of the tests alone, and test agreement was only moderate. Our data show that in children in a low TB prevalence setting, a dual screening strategy with TST and IGRA before anti-TNF-alpha treatment is effective.
Filiaciones:
Calzada-Hernández J:
Pediatric Rheumatology Division, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
Anton-Lopez J:
Pediatric Rheumatology Division, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
Martín-de-Carpi J:
Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
Servei de Gastroenterologia, Hepatologia I Nutrició Pediàtrica, Hospital Sant Joan de Déu - Institut de Recerca Sant Joan de Déu, Barcelona, Spain
López-Montesinos B:
Rheumatology Unit, Pediatrics Department, University Hospital La Fe, Valencia, Spain
Calvo I:
Rheumatology Unit, Pediatrics Department, University Hospital La Fe, Valencia, Spain
Donat E:
Pediatric Gastroenterology and Hepatology Unit, Pediatrics Department, University Hospital La Fe, Valencia, Spain
Núñez E:
UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
Blasco Alonso J:
UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
Mellado MJ:
Servicio de Pediatria, Enfermedades Infecciosas Y Patología Tropical, Hospital La Paz, Madrid, Spain
Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
Baquero-Artigao F:
Servicio de Pediatria, Enfermedades Infecciosas Y Patología Tropical, Hospital La Paz, Madrid, Spain
Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
Leis R:
Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatrics Department, University Clinical Hospital of Santiago (CHUS), Santiago de Compostela, Spain
Vegas-Álvarez AM:
Gastroenterología Infantil, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
Medrano San Ildefonso M:
Reumatología Pediátrica, Hospital Universitario Miguel Servet, Saragossa, Spain
Pinedo-Gago MDC:
Unidad de Reumatología Pediátrica, Hospital de Cruces, Barakaldo, Spain
Eizaguirre FJ:
Unidad de Gastroenterología Infantil, Hospital Universitario Donostia, San Sebastián, Spain
Tagarro A:
Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
Paediatrics Department, Hospital Universitario Infanta Sofía
Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
Camacho-Lovillo M:
Servicio de Inmunología, Reumatología e Infectología Pediátrica, Hospital Universitario Virgen del Rocío, Seville, Spain
Pérez-Gorricho B:
Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
Gavilán-Martín C:
Servicio de Pediatría, Hospital Universitario San Juan de Alicante, Alicante, Spain
Guillén S:
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain
Sevilla-Pérez B:
Unidad de Reumatología, Servicio de Pediatría del Hospital Universitario San Cecilio de Granada, Granada, Spain
Peña-Quintana L:
Pediatric Gastroenterology, Hepatology and Nutrition Unit, Mother and Child Insular University Hospital,, Las Palmas, Spain
Centro de Investigación Biomédica en Red de Obesidad Y Nutrición (CIBEROBN), Madrid, Spain
University Institute for Research in Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
Mesa-Del-Castillo P:
Department of Rheumatology, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
Fortuny-Guasch C:
Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Tebruegge M:
Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
Noguera-Julian A:
Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain.
Malalties Infeccioses I Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.
Green Submitted, hybrid
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