Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain

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-T...

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Autores: Calzada-Hernández J, Anton 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 C, Tebruegge M, Noguera-Julian A
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Fundació Sant Joan de Déu
Repositorio:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
OAI Identifier:oai:fsjd.fundanetsuite.com:p22477
Acceso en línea:https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=22477
Access Level:acceso abierto
Palabra clave:Inflammatory bowel disease
Interferon-gamma release assay
Juvenile idiopathic arthritis
Pediatrics
Tuberculosis
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spelling Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in SpainCalzada-Hernández JAnton JMartín de Carpi JLópez-Montesinos BCalvo IDonat ENúñez EBlasco Alonso JMellado MJBaquero-Artigao FLeis RVegas-Álvarez AMMedrano San Ildefonso MPinedo-Gago MDCEizaguirre FJTagarro ACamacho-Lovillo MPérez-Gorricho BGavilán-Martín CGuillén SSevilla-Pérez BPeña-Quintana LMesa-Del-Castillo PFortuny CTebruegge MNoguera-Julian AInflammatory bowel diseaseInterferon-gamma release assayJuvenile idiopathic arthritisPediatricsTuberculosisTumor-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.SPRINGER2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=22477EUROPEAN JOURNAL OF PEDIATRICSISSN: 03406199ISSNe: 14321076reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déuinstname:Fundació Sant Joan de DéuInglésinfo:eu-repo/semantics/openAccessoai:fsjd.fundanetsuite.com:p224772026-05-27T12:37:41Z
dc.title.none.fl_str_mv Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
title Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
spellingShingle Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
Calzada-Hernández J
Inflammatory bowel disease
Interferon-gamma release assay
Juvenile idiopathic arthritis
Pediatrics
Tuberculosis
title_short Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
title_full Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
title_fullStr Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
title_full_unstemmed Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
title_sort Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-a inhibitor initiation in children in Spain
dc.creator.none.fl_str_mv Calzada-Hernández J
Anton 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 C
Tebruegge M
Noguera-Julian A
author Calzada-Hernández J
author_facet Calzada-Hernández J
Anton 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 C
Tebruegge M
Noguera-Julian A
author_role author
author2 Anton 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 C
Tebruegge M
Noguera-Julian A
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Inflammatory bowel disease
Interferon-gamma release assay
Juvenile idiopathic arthritis
Pediatrics
Tuberculosis
topic Inflammatory bowel disease
Interferon-gamma release assay
Juvenile idiopathic arthritis
Pediatrics
Tuberculosis
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=22477
url https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=22477
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGER
publisher.none.fl_str_mv SPRINGER
dc.source.none.fl_str_mv EUROPEAN JOURNAL OF PEDIATRICS
ISSN: 03406199
ISSNe: 14321076
reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
instname:Fundació Sant Joan de Déu
instname_str Fundació Sant Joan de Déu
reponame_str r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
collection r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
repository.name.fl_str_mv
repository.mail.fl_str_mv
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