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- Title
Diagnostic Value of Interferon-Gamma Release Assay in the Diagnosis of Tuberculosis Infection Before the Use of TNF-Alpha Blocker in Pediatric Rheumatology Patients.
- Authors
Çetin, Fatma Tuğba; Kocabaş, Emine; Gündeşlioğlu, Özlem Özgür; Çay, Ümmühan; Altıntaş, Derya Ufuk; Özcan, Dilek; Soyupak, Süreyya; Totik, Nazlı; Ünal, İlker
- Abstract
Objective: In rheumatic diseases, it has been reported that the risk of developing tuberculosis increases 1.6 to 25.1 times after the use of tumor necrosis factor-alpha (TNF-α) blocker treatment. Therefore, latent tuberculosis infection is very important in patients who use TNF-α blocker drugs. In this study, it was aimed to investigate the diagnostic value of interferon-gamma release assay before TNF-α blocker therapy in the diagnosis of latent tuberculosis infection in pediatric patients with chronic inflammatory disease resistant to standard treatments and with TNF-indication. Material and Methods: In this study, 93 pediatric patients with chronic rheumatic inflammatory disease, who would be started on anti-TNF therapy and investigated for latent tuberculosis infection, and 69 control patients without chronic disease, who were examined for any reason, were retrospectively analyzed. QuantiFERON-TB Gold Plus test, which is a commercial test based on interferon-gamma QuantiFERON-ELISA technique, and tuberculin skin test were applied to all patients examined. Results: In the patient group examined in this study, 19 (20.4%) of 93 patients were positive for tuberculin skin test and four (4.3%) for interferon-gamma release test. There were 17 (18.2%) patients with positive tuberculin skin test results and negative interferon-gamma release test results, and two (2.2%) patients with negative tuberculin skin test results and positive interferon-gamma release test results. There were two (2.2%) patients with positive interferon-gamma release test and tuberculin skin test. Tuberculin skin test was negative in all 69 patients in the control group, and interferon-gamma release assay results were positive in three (4.3%) of them. In this study, the agreement between the tuberculin skin test and the interferon-gamma release assay was found to be weak (p< 0.01). Isoniazid prophylaxis was started before biologic agent treatment in 19 (%20.4) patients whose tuberculin skin test was found to be 5 mm and above in 93 patients who were screened with tuberculin skin test and interferon-γ release assay. No active tuberculosis development was detected in the 2.5-year follow-up of 19 patients who were included in the study and diagnosed with latent tuberculosis infection. Conclusion: All patients planned to receive TNF-alpha blockers should be screened for tuberculosis before treatment. In the light of current guidelines, patients should be screened for tuberculosis infection with contact history, symptoms, physical examination, chest X-ray, and tuberculin skin test and/or interferon gamma release assay. Although some studies have shown that IGST may be more useful for LTBI screening before TNF-α blocker treatment, this conclusion could not be reached in our study either.
- Subjects
DRUG therapy for rheumatism; TUBERCULOSIS diagnosis; TUBERCULOSIS risk factors; INTERFERON gamma release tests; CHEST X rays; RHEUMATOLOGY; CHRONIC diseases; INFLAMMATION; LATENT tuberculosis; DRUG resistance; RETROSPECTIVE studies; MEDICAL screening; TUMOR necrosis factors; ENZYME-linked immunosorbent assay; TUBERCULIN test; DESCRIPTIVE statistics; RHEUMATISM; DISEASE complications; CHILDREN
- Publication
Journal of Pediatric Infection / Çocuk Enfeksiyon Dergisi, 2023, Vol 17, Issue 3, pe166
- ISSN
1307-1068
- Publication type
Article
- DOI
10.5578/ced.20239703