Development of Tuberculosis in Child During Treatment with Tumour Necrosis Factor-Alpha Inhibitor Agent: Could This Have Been Prevented?
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 7, Issue 1
Abstract
Patients treated with anti-TNF-α agents are at increased risk of reactivating latent tuberculosis infection. Screening for tuberculosis infection and disease, and appropriate treatment before commencing of anti-TNF therapy is therefore important. However, currently recommended screening tools (tuberculin skin test, interferon-gamma releasing assays, and chest radiograph) may not detect tuberculosis infection in all children. This may result in development of active tuberculosis during TNF-α inhibitor therapy.Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine that plays a critical role in the host response to tuberculosis (TB), having an essential role in the granuloma formation and maintenance of the latency of TB. Blocking TNF-α in cases of active infection with Mycobacterium tuberculosis (Mbt) results in a failure to form tight granuloma’s as well as disintegration of existing granulomas leading to mycobacterial dissemination in a murine model [1-2]. Treatment with anti- TNF-α agents has become an important cornerstone in the treatment of severe, non-remitting forms of juvenile idiopathic arthritis (JIA). However, patients treated with TNF-α inhibitors (in particular, monoclonal antibody preparations, such as infliximab and adalimumab) are at increased risk of reactivating latent tuberculosis infection (LTBI) of approximately two - to eightfold [3-5]. Screening for TB infection and TB disease, and appropriate treatment before commencing of anti-TNF therapy is therefore important [6-7]. Either tuberculin skin test (TST) or interferon-gamma releasing assays (IGRAs) or both, clinical symptom screen for TB disease, and chest radiograph (CXR) are commonly recommended screening tools by most guidelines [8]. Latvia is among five high TB incidence countries in European Union, with a total TB notification rate of 31,3/100 000 in 2015. According to the National Guidelines, all patients are screened for LTBI (TST or IGRA test or both) and TB disease (symptom screen and CXR) before starting treatment with anti- TNF-α agents. Here we report a case of TB which developed in child during treatment with adalimumab.A nine-year-old male patient was hospitalized at children’s Clinical University Hospital on June 16, 2015 due to complaints of high temperature for two weeks, headache, abdominal distension, loss of weight, pain in the right hip, knee and ankle joints. The child was diagnosed with JIA, oligoarthritis, HLA B-27 negative at the age of 4 years in 2010. In February 2012 at the age of 6 years therapy with methotrexate 7-5mg once per week was started. Therapy was tolerated poorly, JIA progressed with involvement of multiple joints. On October 2014, at the age of 8 years treatment with adalimumab was commenced. Prior treatment screening for LTBI and TB disease was performed: T-SPOT. TB test (Oxford Immunotec, Abingdon, UK) was negative, CXR was normal. Since autumn 2014 the child had a non-troublesome recurrent cough. Consultation of rheumatologist on March 2015 did not reveal any respiratory pathology.
Authors and Affiliations
Iveta Ozere, Ruta Šantere, Anita Skangale
Keywords
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- EP ID EP588517
- DOI 10.26717/BJSTR.2018.07.001452
- Views 155
- Downloads 0
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