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Pulmonary Tuberculosis IV01:26

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Tuberculosis, more commonly referred to as TB, is an infectious disease stemming from Mycobacterium tuberculosis. While it primarily impacts the lungs, TB can also affect other body areas. Given its severity and global impact, timely and accurate diagnosis is crucial for controlling its spread and improving patient outcomes.
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Medical management of tuberculosis (TB) patients involves a comprehensive approach that includes diagnosis, treatment, and monitoring. The specific strategies can vary depending on the type of tuberculosis (latent or active), the patient's overall health status, and other considerations.
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Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
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Tuberculosis screening in patients receiving biological therapy.

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    Biological therapies increase tuberculosis (TB) risk. Baseline TB screening identified high latent TB rates, with preventive treatment being well-tolerated and preventing active TB. Re-screening rates were low, indicating a need for greater awareness.

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    Area of Science:

    • Immunology
    • Infectious Diseases
    • Public Health

    Background:

    • Biological therapies are associated with an increased risk of tuberculosis (TB).
    • Portuguese guidelines recommend universal baseline TB screening before initiating biologics and annual re-screening if initial tests are negative.
    • The clinical benefit and effectiveness of annual TB re-screening in patients on biological therapy remain unclear.

    Purpose of the Study:

    • To determine the prevalence of latent TB infection at baseline screening in patients initiating biologic therapy.
    • To evaluate follow-up outcomes in patients receiving different biological therapies, including adverse events from preventive therapy, changes in immunodiagnostic tests, and active TB development.
    • To assess the effectiveness of TB screening and re-screening strategies in this patient population.

    Main Methods:

    • Retrospective review of medical files for 183 patients screened for TB before starting biologic therapy between 2008-2012.
    • Data collection included demographic information, baseline and follow-up screening results, and details of biologic therapy.
    • Exclusion criteria included unavailable information on biologic therapy initiation.

    Main Results:

    • Of 115 patients starting biologics, 45.2% had positive baseline TB screening, with 96.2% receiving preventive treatment. Mild hepatotoxicity occurred in 8% without treatment interruption.
    • No active TB cases were observed in patients with positive baseline screening.
    • Among 63 patients with negative baseline screening, 3.2% developed active TB over one year after biologic initiation. Only 41.3% were re-screened, with 19.2% showing TST conversion.

    Conclusions:

    • The baseline prevalence of latent TB infection was higher than anticipated.
    • Preventive TB treatment was generally well-tolerated, and no patients with positive baseline screening developed active TB.
    • Low re-screening rates suggest insufficient awareness of current TB screening recommendations, necessitating further national studies to optimize strategies and identify high-risk groups.