Frequency of latent tuberculosis in patients receiving Anti-TNF-Alpha therapy.

Setting-Objective: In this study, it was aimed to reveal the incidence of tuberculosis development in patients receiving tumor necrosis factor-alpha (TNF-α) blocker therapy, despite tuberculosis chemoprophylaxis. Design: 520 patients who were receiving anti TNF-α treatment in the last 3 years were evaluated retrospectively. Radiological imaging tuberculin skin test (TST), history of tuberculosis, BCG vaccine, chemoprophylaxis administration, used anti TNF-α drugs were recorded. Results: There were 265(51.0%) of the patients with ankylosing spondylitis (AS), 175(33.7%) with rheumatoid arthritis, 35(6.7%) with Crohn's, 10(1.9%) with ulcerative colitis (UC), 21(4.0%) with psoriatic arthritis, 14(2.7%) with psoriasis vulgaris. In total, 455 (79.6%) patients were given INH prophylaxis. Active tuberculosis development was observed in five patients (4: pulmonary,1: extrapulmonary; 3: UC, 2:AS) who all received anti TNF-α treatment (0.96%), infliximab. Three patients had tuberculosis disease in the 6th month, and the other 2 patients in the 5th and 24th month of their anti TNF-α treatments, and two had 9-month, and 1 had 6-month chemoprophylaxis history. Conclusion: The incidence of tuberculosis development in patients treated with anti TNF-α was found to be higher than the general population. In our country, where tuberculosis is still prevalent, patients receiving Anti TNF-α treatment (especially infliximab) should be carefully questioned and examined about tuberculosis.

Tuberculosis in diabetics: features in an endemic area.

Diabetes mellitus (DM) is known as one of the factors that increases the risk of tuberculosis (TB). TB can also show atypical clinical presentation and localization in diabetics. The aim of the study was to evaluate the features of TB in diabetics in our region. Between 1997 and 2003, all cases of diabetic TB patients and an equal number of non-diabetics treated and followed at the Esrefpasa Tuberculosis Dispensary were analyzed retrospectively. A total of 78 (7.3%) TB cases in DM patients was encountered among 1,063 TB cases. Cavity formation and atypical localization were more often found in diabetics (P<0.05). Duration of treatment was longer in diabetics (P<0.05). The rate of drug resistance was higher in DM cases, but cure rates were similar between groups. A diagnosis of TB should be considered in diabetics with an abnormal chest radiograph, in the presence of absence of specific clinical symptoms, in endemic regions. Diabetic TB cases should be followed especially closely in terms of cure time and drug resistance.