在接受TNF抑制剂治疗的患者中,分散的MDR-TB错过了治疗
Sophie Dam Harmundal Hansen1, Frauke Rudolf2, Nina Schram Gregersen3
1Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, Denmark sophhs@rm.dk.
BMJ case reports
|September 4, 2024
概括
一名接受瘤亡因子 (TNF) 抑制剂治疗的患者患有多药耐药结核病 (MDR-TB). 这一案例凸显了与TNF抑制剂治疗相关的诊断挑战和风险,特别是针对免疫抑制个体的干扰素-释量测试 (IGRA) 测试.
科学领域:
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
背景情况:
- 瘤坏死因子 (TNF) 抑制剂广泛用于炎症状况.
- 这些疗法可以增加机会性感染的风险,包括结核病 (TB).
- 干扰素-释量测试 (IGRA) 测试通常用于结核病查,但可以受到免疫抑制的影响.
研究的目的:
- 为了说明在接受TNF抑制剂的患者中识别结核病的诊断挑战.
- 为了强调在TNF抑制剂治疗期间结核病再激活或新感染的风险增加.
- 突出IGRA测试在免疫抑制患者的局限性以及考虑先前测试结果的重要性.
主要方法:
- 一个以前健康的男性患者的病例报告.
- 详细的临床病史,包括启动TNF抑制剂治疗和肺部症状的发展.
- 对诊断工作的审查,包括连续的IGRA测试和中枢淋巴结的微生物学调查.
主要成果:
- 患者在开始TNF抑制剂治疗两周后出现肺部症状.
- 最初的IGRA测试是负的,尽管在17个月前和同时进行免疫抑制的积极测试.
- 多耐药结核病 (MDR-TB) 的诊断在症状出现八个月后得到证实.
结论:
- 这一案例强调了在使用TNF抑制剂的患者中检测结核病的诊断困难.
- 需要提高人们对使用TNF抑制剂增加结核病风险的认识.
- 进一步了解免疫抑制剂如何影响IGRA测试性能,对于精确的结核病查至关重要.
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