RT Journal Article
T1 Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON‑TB assays before TNF‑α inhibitor initiation in children in Spain
A1 Calzada-Hernández, Joan
A1 Martín de Carpi, Javier
A1 López-Montesinos, Berta
A1 Calvo, Inmmaculada
A1 Donat, Ester
A1 Núñez, Esmeralda
A1 Blasco Alonso, Javier
A1 Mellado, María José
A1 Baquerí-Artigao, Fernando
A1 Leis Trabazo, María Rosaura
A1 Vegas-Álvarez, Ana María
A1 Medrano San Idelfonso, Marta
A1 Pinedo-Gago, María del Carmen
A1 Eizaguirre, Francisco Javier
A1 Tagarro, Alfredo
A1 Camacho-Lovillo, Marisol
A1 Pérez-Gorricho, Beatriz
A1 Gavilán-Martín, César
A1 Guillén, Sara
A1 Sevilla-Pérez, Belén
A1 Peña-Quintana, Luis
A1 Mesa-Del-Castilla, Pablo
A1 Fortuny, Claudia
A1 Trebuegge, Marc
A1 Noguera-Julian, Antoni
K1 Inflammatory bowel disease
K1 Interferon-gamma release assay
K1 Juvenile idiopathic arthritis
K1 Pediatrics
K1 Tuberculosis
AB Tumor-necrosis-factor-α inhibitors (anti-TNF-α) 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-α 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-α treatment is effective.What is known: • The optimal screening strategy for latent tuberculosis in children with immune-mediated inflammatory disorders remains uncertain. • Children receiving anti-TNF-α drugs are at increased risk of developing severe tuberculosis disease.What is new: • A dual screening strategy, using TST and an IGRA assay, identified more children with latent tuberculosis than either of the tests alone. • Identification and treatment of latent tuberculosis before initiation of anti-TNF-α therapy averted incident tuberculosis cases.
PB Springer
SN 0340-6199
YR 2022
FD 2022-11-05
LK https://hdl.handle.net/10347/45510
UL https://hdl.handle.net/10347/45510
LA eng
NO Calzada-Hernández, J., Anton, J., Martín de Carpi, J., López-Montesinos, B., Calvo, I., Donat, E., Núñez, E., Blasco Alonso, J., Mellado, M. J., Baquero-Artigao, F., Leis, R., Vegas-Álvarez, A. M., Medrano San Ildefonso, M., Pinedo-Gago, M. D. C., Eizaguirre, F. J., Tagarro, A., Camacho-Lovillo, M., Pérez-Gorricho, B., Gavilán-Martín, C., Guillén, S., … Noguera-Julian, A. (2023). Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-α inhibitor initiation in children in Spain. European journal of pediatrics, 182(1), 307–317. https://doi.org/10.1007/s00431-022-04640-3
NO Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature
DS Minerva
RD 4 may 2026