Yael Abitbol1, David Laharie2, Jacques Cosnes3, Matthieu Allez4, Stéphane Nancey5, Aurélien Amiot6, Alexandre Aubourg7, Mathurin Fumery8, Romain Altwegg9, Pierre Michetti10, Elise Chanteloup11, Philippe Seksik3, Clotilde Baudry4, Mathurin Flamant12, Guillaume Bouguen13, Carmen Stefanescu14, Anne Bourrier3, Gilles Bommelaer15, Nina Dib16, Marc André Bigard17, Stephanie Viennot18, Xavier Hébuterne19, Jean-Marc Gornet4, Philippe Marteau3, Yoram Bouhnik14, Vered Abitbol20, Stéphane Nahon21. 1. Departement of Hepato-Gastroenterology, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France. 2. Department of Hepato-Gastroenterology, Hôpital Haut-Lévêque, Pessac, France. 3. Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France. 4. Department of Hepato-Gastroenterology, Hôpital Saint Louis, France. 5. Department of Hepato-Gastroenterology Hôpital Lyon-Sud, Hospices Civils de Lyon, Lyon, France. 6. Department of Hepato-Gastroenterology, Hôpital Mondor, Créteil, France. 7. Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Tours, Tours, France. 8. Department of Hepato-Gastroenterology, Hôpital Nord, Amiens, France. 9. Department of Hepato-Gastroenterology, Hôpital Saint-Eloi, Montpellier, France. 10. Department of Hepato-Gastroenterology, Hôpital La Source-Beaulieu, Lausanne, Suisse. 11. Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Paris, France. 12. Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France. 13. Department of Hepato-Gastroenterology, Hôpital Pontchaillou, Rennes, France. 14. Department of Hepato-Gastroenterology, Hôpital Beaujon, Clichy, France. 15. Department of Hepato-Gastroenterology, Hôpital Hôtel Dieu, Clermont Ferrand, France. 16. Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire d'Angers, Angers, France. 17. Department of Hepato-Gastroenterology, Hôpital de Brabois, Nancy, France. 18. Department of Hepato-Gastroenterology, Hôpital Côte de Nacre, Caen, France. 19. Department of Hepato-Gastroenterology, Hôpital de l'Archet, Nice, France. 20. Department of Hepato-Gastroenterology, Hôpital Cochin, Paris, France. 21. Departement of Hepato-Gastroenterology, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France snahon@ch-montfermeil.fr snahon@club-internet.fr.
Abstract
AIM: to describe the characteristics of incident cases of tuberculosis [TB] despite negative TB screening tests, in patients with inflammatory bowel disease [IBD] undergoing anti-TNF treatment, and to identify the risk factors involved. METHODS: A retrospective descriptive study was conducted at GETAID centers on all IBD patients undergoing anti-TNF treatment who developed TB even though their initial screening test results were negative. The following data were collected using a standardized anonymous questionnaire: IBD, and TB characteristics and evolution, initial screening methods and results, and time before anti-TNF treatment was restarted. RESULTS: A total of 44 IBD patients [including 23 men; median age 37 years] were identified at 20 French and Swiss centers at which TB screening was performed [before starting anti-TNF treatment] based on Tuberculin Skin Tests [n = 25], Interferon Gamma Release Assays [n = 12], or both [n = 7]. The median interval from the start of anti-TNF treatment to TB diagnosis was 14.5 months (interquartile range [IQR] 25-75: 4.9-43.3). Pulmonary TB involvement was observed in 25 [57%] patients, and 40 [91%] had at least one extrapulmonary location. One TB patient died as the result of cardiac tamponade. Mycobacterium tuberculosis exposure was thought to be a possible cause of TB in 14 cases [32%]: 7 patients [including 6 health care workers] were exposed to occupational risks, and 7 had travelled to endemic countries. Biotherapy was restarted on 27 patients after a median period of 11.2 months [IQR 25-75: 4.4-15.2] after TB diagnosis without any recurrence of the infection. CONCLUSION: Tuberculosis can occur in IBD patients undergoing anti-TNF treatment, even if their initial screening results were negative. In the present population, TB was mostly extrapulmonary and disseminated. TB screening tests should be repeated on people exposed to occupational risks and/or travelers to endemic countries. Restarting anti-TNF treatment seems to be safe.
AIM: to describe the characteristics of incident cases of tuberculosis [TB] despite negative TB screening tests, in patients with inflammatory bowel disease [IBD] undergoing anti-TNF treatment, and to identify the risk factors involved. METHODS: A retrospective descriptive study was conducted at GETAID centers on all IBDpatients undergoing anti-TNF treatment who developed TB even though their initial screening test results were negative. The following data were collected using a standardized anonymous questionnaire: IBD, and TB characteristics and evolution, initial screening methods and results, and time before anti-TNF treatment was restarted. RESULTS: A total of 44 IBDpatients [including 23 men; median age 37 years] were identified at 20 French and Swiss centers at which TB screening was performed [before starting anti-TNF treatment] based on Tuberculin Skin Tests [n = 25], Interferon Gamma Release Assays [n = 12], or both [n = 7]. The median interval from the start of anti-TNF treatment to TB diagnosis was 14.5 months (interquartile range [IQR] 25-75: 4.9-43.3). Pulmonary TB involvement was observed in 25 [57%] patients, and 40 [91%] had at least one extrapulmonary location. One TB patient died as the result of cardiac tamponade. Mycobacterium tuberculosis exposure was thought to be a possible cause of TB in 14 cases [32%]: 7 patients [including 6 health care workers] were exposed to occupational risks, and 7 had travelled to endemic countries. Biotherapy was restarted on 27 patients after a median period of 11.2 months [IQR 25-75: 4.4-15.2] after TB diagnosis without any recurrence of the infection. CONCLUSION:Tuberculosis can occur in IBDpatients undergoing anti-TNF treatment, even if their initial screening results were negative. In the present population, TB was mostly extrapulmonary and disseminated. TB screening tests should be repeated on people exposed to occupational risks and/or travelers to endemic countries. Restarting anti-TNF treatment seems to be safe.
Authors: Saurabh Kedia; Raju Sharma; Govind K Makharia; Vineet Ahuja; Devendra Desai; Devasenathipathy Kandasamy; Anu Eapen; Karthik Ganesan; Uday C Ghoshal; Naveen Kalra; D Karthikeyan; Kumble Seetharama Madhusudhan; Mathew Philip; Amarender Singh Puri; Sunil Puri; Saroj K Sinha; Rupa Banerjee; Shobna Bhatia; Naresh Bhat; Sunil Dadhich; G K Dhali; B D Goswami; S K Issar; V Jayanthi; S P Misra; Sandeep Nijhawan; Pankaj Puri; Avik Sarkar; S P Singh; Anshu Srivastava; Philip Abraham; B S Ramakrishna Journal: Indian J Gastroenterol Date: 2018-01-06
Authors: Adam Krusiński; Anna Grzywa-Celińska; Katarzyna Szewczyk; Luiza Grzycka-Kowalczyk; Justyna Emeryk-Maksymiuk; Janusz Milanowski Journal: Int J Inflam Date: 2021-01-05