Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct;55(10):2689-2696.
doi: 10.1002/ppul.24963. Epub 2020 Jul 23.

Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti-TNF agents for rheumatologic diseases

Ayse Ayzit Kilinc  1 , Pinar Onal  2 , Berrak Oztosun  3 , Mehmet Yildiz  4 , Amra Adrovic  4 , Sezgin Sahin  4 , Kenan Barut  4 , Haluk Cokugras  1 , Ozgur Kasapcopur  4
Affiliations

Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti-TNF agents for rheumatologic diseases

Ayse Ayzit Kilinc et al. Pediatr Pulmonol. 2020 Oct.

Abstract

Objective: The use of tumor necrosis factor inhibitors (anti-TNF) has a risk of activating latent tuberculosis infection (LTBI). This study was performed to investigate LTBI according to tuberculin skin test (TST) size and to determine the frequency of tuberculosis (TB) in bacillus Calmette-Guerin (BCG)-vaccinated children receiving anti-TNF treatment for rheumatological disease.

Materials and methods: The study consisted of 559 children. Information on demographics, anti-TNF agents, TST size, and isoniazid (INH) prophylaxis was recorded. Patients (n = 254) with TST size ≥5 mm were divided into three groups according to TST size and INH prophylaxis: group 1, TST size 5 to 9 mm and no INH prophylaxis; group 2, TST size 5 to 9 mm with INH prophylaxis; and group 3, TST size ≥10 mm with INH prophylaxis.

Results: The 559 patients comprised 314 (56.3%) females and 245 (43.6%) males; they had a mean age of 13.1 ± 4.1 years. The mean TST size in all patients was 4.2 ± 4.7 mm. Group 1 consisted of 76 (29.9%) patients, group 2 consisted of 88 (34.6%) patients, and group 3 consisted of 90 (35.4%) patients. The mean TST sizes for the three groups were 6.8 ± 3.1 mm, 7.2 ± 3.2 mm, and 13.9 ± 2.8 mm, respectively. New TB was diagnosed in only two (0.35%) patients. Both of them were in group 3.

Conclusions: A TST size of ≥10 mm in BCG-vaccinated children receiving anti-TNF treatment may distinguish children at high risk for reactivation of LTBI.

Keywords: BCG; antitumor necrosis factor; rheumatological disease; tuberculin skin test; tuberculosis.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

REFERENCES

    1. Toussirot E, Wendling D. The use of TNF-alpha blocking agents in rheumatoid arthritis: an overview. Expert Opin Pharmacother. 2004;5(3):581-594.
    1. Roberts L, McColl, GJ. Tumour necrosis factor inhibitors: risks and benefits in patients with rheumatoid arthritis. Intern Med J. 2004;34:687-693.
    1. Woerner A, Ritz N. Infections in children treated with biological agents. Pediatr Infect Dis J. 2013;32(3):284-288. https://doi.org/10.1097/INF.0b013e3182833cbb
    1. Aygun D, Sahin S, Adrovic A, et al. The frequency of infections in patients with juvenile idiopathic arthritis on biologic agents: 1-year prospective study. Clin Rheumatol. 2019;38(4):1025-1030.
    1. Tubach F, Salmon D, Ravaud P, et al. Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy:The three-year prospective French Research Axed on Tolerance of Biotherapies registry. Arthritis Rheum. 2009;60:1884-1894.

LinkOut - more resources