Tuberculosis latent disease

Reactivation of Latent Disease - Herpes Simplex Virus, Tuberculosis... 

Latent tuberculosis infection (LTBI) can lead to reactivation disease years after the primary infection occurred. 

Worldwide, tuberculosis (TB) kills about 2 million people each year, more than any other infectious organism. TB is caused by Mycobacterium tuberculosis, it presents either as latent TB infection (LTBI) or as progressive active disease.1 The latter typically causes progressive destruction of the lungs, leading... 

Centers for Disease Control and Prevention. Update Fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in the American Thoracic Society/CDC recommendations. Morb Mortal Wkly Rep MMWR 2001 50(34) 733-735. 

Tuberculosis (TB) is a communicable infectious disease caused by Mycobacterium tuberculosis. It can produce silent, latent infection as well as progressive, active disease. 

Infections Corticosteroids may mask signs of infection, and new infections may appear during their use. There may be decreased resistance and inability of the host defense mechanisms to prevent dissemination of the infection. Restrict use in active tuberculosis to cases of fulminating or disseminated disease in which the corticosteroid is used for disease management with appropriate chemotherapy. Corticosteroids may exacerbate systemic fungal infections and may activate latent amebiasis. 

Anti-TNF antibodies, eg, infliximab, others Bind tumor necrosis factor and prevent it from binding to its receptors Suppression of several aspects of immune function, especially ThI lymphocytes Infliximab Moderately severe to severe Crohn s disease and ulcerative colitis others approved in Crohn s disease Infusion reactions reactivation of latent tuberculosis increased risk of dangerous systemic fungal and bacterial infections... 

Thberculosis (TB) is caused by mycobacterium tuberculosis and typically manifests as a respiratory infection but can also attack the kidneys, spine, hrain, and skin (refer to Table 23.10—Clinical Profile of Tuberculosis). TB is spread via aerosolized particles transmitted by those who have active TB (those with latent TB cannot infect others). Left untreated, each person with active TB disease will infect on average between 10 and 15 people each year. If not treated properly, TB can be fatal. Those with latent TB can also be treated to prevent development of the disease (CDC, 2005d World Health Organization, 2005). 

Adverse reactions that have been reported include infections, fever, headache, vertigo, hypertension, skin reactions, fatigue, chest pain and worsening congestive cardiac failure, gastrointestinal upset. Active tuberculosis may develop soon after starting treatment with infliximab and patients should be screened for latent infection or disease. 

Centers for Disease Control and Prevention (CDC). Fatal and severe hepatitis associated with rifampin and pyrazinamide for the treatment of latent tuberculosis infection— New York and Georgia, 2000. MMWR Morb Mortal Wkly Rep 2001 50(15) 289-91. 

Reactivation of latent tuberculosis is a major concern with infliximab (SEDA-26, 402), and accounts for about one-third of infections in these patients. According to data from the manufacturers, 130 cases of active tuberculosis were notified up to October 2001. Many of the cases were disseminated or extrapulmonary tuberculosis, and several patients died. Several case reports have provided detailed information in at least seven other patients, including three who developed miliary tuberculosis and one who developed Mycobacterium tuberculosis enteritis (44-48). A detailed analysis of 70 cases of tuberculosis reported to the FDA has been published (49). Two-thirds of the cases were noted after three or fewer infusions and 57% of the patients had extrapulmonary disease. There were 64 cases from countries with a low incidence of tuberculosis. From these reports and the number of patients treated with infliximab, the estimated rate of tuberculosis in patients with rheumatoid arthritis treated with infliximab was four times higher than the background rate. Patients with evidence of active infection should not receive infliximab until the infection is under control all should be screened for tuberculosis before starting infliximab (50). From these and other data it has been estimated that the risk of tuberculosis in the first year of infliximab treatment is 0.035 in US citizens and 0.2% in non-US citizens. Further investigations, such as a chest X-ray and a Mantoux test, and prophylactic treatment with isoniazid, will show whether the incidence can be reduced in patients taking anti-TNF treatment (51). 

Because young children, the elderly, and HIV-positive patients are at greater risk of active disease once infected with M. tuberculosis, they require careful evaluation. Once active TB is ruled out, they should receive treatment for latent infection. ... 

Infliximab therapy is associated with increased incidence of respiratory infections of particular concern is potential reactivation of tuberculosis or other granulomatous infections with subsequent dissemination. The FDA recommends that candidates for infliximab therapy should be tested for latent tuberculosis with purified protein derivative, and patients who test positive should be treated prophylactically with isoniazid. However, anergy with a false-negative skin test has been noted in some patients with Crohn s disease, and some experts routinely perform chest radiographs to look for active or latent pulmonary disease. Infliximab also is contraindicated in patients with severe congestive heart failure. The significant cost of infliximab is an important consideration in some patients. 

CHEMOPROPHYLAXIS OF TUBERCULOSIS Chemoprophylaxis of tuberculosis involves treating latent infection to prevent progression to active disease. Latent infection may be... 

The patient often has a 5—10% chance of developing the active form of tuberculosis (Basoulis et al., 2012). The development of disease depends on the health of the patient, the patient s immunity and susceptibility to the disease, and the patient s age (Basoulis et al., 2012). In around 10% of tuberculosis cases, the disease can be eradicated completely from the patient (Basoulis et al., 2012). The disease stays as a latent tuberculosis form in around 90% of patients (Saviola, 2012). After many years, there is an opportunity for mycobacteria to reactivate and grow inside the infected organs of patient and the disease turns into the active tuberculosis form (Bajaj and Batra, 2012). 

Relative active or latent peptic ulcer disease, recent intestinal anastomoses, nonspecific ulcerative colitis (increased risk of perforation), diabetes, adrenocortical insufficiency (may persist for months after discontinuing therapy), active or latent tuberculosis, cerebral malaria, chicken pox, meades, latent amebiasis or strongyloides infection, inactivated viral or bacterial vaccines where antibody response may not be induced, cirrhosis, congestive heart failure, renal failure or hypertension (increased risk of sodium retention, edema and potassium loss), hypokalemia or hypocalcemia, emotional instability or psychotic tendencies, hypothyroidism, growth retardation in infants and children. 

Tuberculosis chemoprophylaxis has been retrospectively evaluated in 63 Spanish patients with latent tuberculosis out of 497 with inflammatory bowel disease who were candidates for anti-TNFa therapy [31 ]. Skin tests for tuberculosis were positive in 86% after a single exposure, but 14% needed a booster. There were no susceptibility factors for hepatotoxicity. All but one was treated with isoniazid alone for 6 or 9 months, and only one required chemoprophylaxis withdrawal because of hepatotoxicity. There were no cases of active tuberculosis in the patients who were treated with anti-TNFa therapy. The authors concluded that chemoprophylaxis is safe in patients with inflammatory bowel disease, even in those taking concomitant, potentially hepatotoxic drugs. 

Matulis G, Juni P, Villiger PM, et al. Detection of latent tuberculosis in immu-nosupptessed patients with autoimmune diseases performance of a mycobacterium tuberculosis antigen specific IFN-gamma assay. Ann Rheum Dis 2008 67 84—90. 

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