Primoinfección tuberculosa en pacientes con anti-TNF-α y cribado inicial negativo / Primary tuberculosis infection in patients treated with tumor necrosis factor-alpha antagonists and a negative initial screening

Introducción. A pesar de las medidas de cribado de tuberculosis (TB) siguen detectándose casos en pacientes tratados con anti-TNF-α y cribado inicial negativo, algunos tras largo tiempo de tratamiento, lo que apunta más a una nueva infección. Objetivos. Describir los casos que presumiblemente han desarrollado primoinfección tuberculosa durante el tratamiento con fármacos anti-TNF-α. Métodos. Revisión retrospectiva (1999-2012), seleccionando según los siguientes criterios: a) tratamiento anti-TNF-α; b) cribado de TB inicial negativo; c) TB diagnosticada durante tratamiento anti-TNF-α, y d) sospecha de primoinfección tuberculosa (tras mínimo 12 meses de anti-TNF-α). Se han revisado sus variables clínicas, epidemiológicas, terapéuticas y de desenlace. Resultados. Dos casos de primoinfección tuberculosa de 771 pacientes tratados con anti-TNF-α (0,2%). Una mujer de 41 años y 35 meses de tratamiento con adalimumab y un varón de 37 años y 107 meses de tratamiento con infliximab. La mujer presentó una neumonía y el varón una TB diseminada. Conclusiones. Durante la terapia anti-TNF-α persiste el riesgo de TB a pesar de cribado inicial negativo, por lo que el grado de sospecha debe ser elevado durante todo el tratamiento (AU)

Introduction. Despite screening for latent tuberculosis (TB), new cases of TB infection are detected in patients treated with anti-TNF-α and negative initial screening, some of them after long treatment, which points more to a new infection. Objectives. To describe the cases that have presumably developed a primary tuberculous infection during treatment with anti-TNF-α drugs. Methods. Retrospective audit (1999-2012). Inclusion criteria were: a) anti-TNF-α treatment; b) initial latent TB screening negative; c) TB diagnosed during anti-TNF-α treatment; d) suspected primary TB infection (diagnosis after at least 12 months on anti-TNF-α). Clinical, epidemiological, therapeutic and outcome variables were reviewed. Results. Two cases of primary TB infection were found out of of 771 anti-TNF-α treated patients (0.2%). One woman aged 41 suffered TB pneumonia after 35 months of treatment with adalimumab, and a male aged 37 who developed disseminated TB after 107 months of treatment with infliximab. Conclusions. Although uncommon, during TNF antagonist therapy, TB risk persists despite negative initial screening, so clinicians should be aware of TB during the entire treatment (AU)

Primary tuberculosis infection in patients treated with tumor necrosis factor-alpha antagonists and a negative initial screening.

INTRODUCTION: Despite screening for latent tuberculosis (TB), new cases of TB infection are detected in patients treated with anti-TNF-α and negative initial screening, some of them after long treatment, which points more to a new infection. OBJECTIVES: To describe the cases that have presumably developed a primary tuberculous infection during treatment with anti-TNF-α drugs. METHODS: Retrospective audit (1999-2012). Inclusion criteria were: a) anti-TNF-α treatment; b) initial latent TB screening negative; c) TB diagnosed during anti-TNF-α treatment; d) suspected primary TB infection (diagnosis after at least 12 months on anti-TNF-α). Clinical, epidemiological, therapeutic and outcome variables were reviewed. RESULTS: Two cases of primary TB infection were found out of of 771 anti-TNF-α treated patients (0.2%). One woman aged 41 suffered TB pneumonia after 35 months of treatment with adalimumab, and a male aged 37 who developed disseminated TB after 107 months of treatment with infliximab. CONCLUSIONS: Although uncommon, during TNF antagonist therapy, TB risk persists despite negative initial screening, so clinicians should be aware of TB during the entire treatment.