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J Pediatr Infect Dis 2022; 17(02): 090-097
DOI: 10.1055/s-0042-1743195
Original Article

Active and Latent Tuberculosis in Children Treated with Anti-TNF-α: A Retrospective Multicenter Study

Authors

  • Nazan Dalgic 

    1   Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

  • Ayse Sahin 

    1   Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

  • Selda Hancerli Torun

    2   Department of Pediatric Infectious Disease, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

  • Ozge Kaba

    2   Department of Pediatric Infectious Disease, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

  • Pinar Onal 

    3   Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey

  • Ayse Tekin Yilmaz 

    4   Section of Internal Medical Sciences, Division of Pediatric Infectious Diseases, Department of Pediatrics and Child Health, Kocaeli University Faculty of Medicine, Kocaeli, Turkey

  • Ozden Turel 

    5   Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey

  • Belma Yasar 

    1   Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

  • Manolya Kara

    2   Department of Pediatric Infectious Disease, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

  • Deniz Aygun

    3   Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey

  • Ayse Kilinc

    3   Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey

  • Selim Oncel 

    4   Section of Internal Medical Sciences, Division of Pediatric Infectious Diseases, Department of Pediatrics and Child Health, Kocaeli University Faculty of Medicine, Kocaeli, Turkey

  • Burcu Bursal Duramaz

    5   Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey

  • Nafiye Urganci

    1   Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

  • Ayper Somer

    2   Department of Pediatric Infectious Disease, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

  • Haluk Cokugras 

    3   Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey

  • Emin Sami Arisoy 

    4   Section of Internal Medical Sciences, Division of Pediatric Infectious Diseases, Department of Pediatrics and Child Health, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Abstract

Objective This study aimed to investigate the frequency of latent and active tuberculosis (TB) in pediatric patients receiving anti-tumor necrosis factor (TNF)-α therapy.

Methods Patients younger than 18 years with various inflammatory diseases and treated with anti-TNF-α agents in the past five years were included in the study. The patients' ages, follow-ups, medications received, clinical and laboratory findings, and treatments applied were recorded retrospectively.

Results Of the 160 patients included in the study, 78 (48.8%) were girls. The mean age was 139.54 ± 48.74 (30–226) months. Sixty (37.5%) patients had inflammatory eye disease, 55 (34.4%) had rheumatologic and autoimmune disease, and 45 (28.1%) had inflammatory bowel disease. As anti-TNF-α treatment, 67 (41.9%) patients received adalimumab, 50 (31.2%) received infliximab, and 43 (26.9%) received etanercept. As a result of TB screening performed prior to the treatment, 44 (25.4%) patients were started on isoniazid treatment with the diagnosis of latent TB. During follow-up, latent TB infection was detected in 16 (9.2%) patients and isoniazid treatment was started. The time to develop latent TB under anti-TNF-α treatment ranged from 3 to 28 months. During the treatment, active TB infection developed in two (1.2%) patients and anti-TB treatment was initiated.

Conclusion It is of vital importance to evaluate patients receiving, or planned to receive, anti-TNF-α treatment, for TB infection and to initiate appropriate treatments if latent or active TB infection is identified.

Keywords

tumor necrosis factor - tuberculosis - children


Publication History

Received: 17 February 2021

Accepted: 04 January 2022

Article published online:
28 February 2022

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