Tuberculosis reactivation disease

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

Cautions Thromboembolic disorders, history of tuberculosis (may reactivate disease), hypothyroidism, cirrhosis, nonspecific ulcerative colitis, CHF, hypertension, psychosis, renal insufficiency, seizure disorders. Prolonged therapy should be discontinued slowly. 

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

These data show that for three psychotic disorders (schizophrenia, bipolar disorder and unipolar depression) the genetic contribution is over 50% but for reactive depression (in response to a traumatic life event ) and tuberculosis, an infectious disease caused by a species of Mycobacterium, environmental factors account for over 90% of the variance. 

Clinical improvement, especially the disappearance of fever or defervescence, is the best parameter to judge the response to therapy. However, clinical improvement can be difficult to monitor objectively in critically ill patients with multi-system disease. Also, clinical improvement can be very slow for certain infections, e.g. tuberculosis. The peripheral blood leukocyte count including the presence of early stages in leucocyte differention and the level of serum C-Reactive Protein (CRP, an acute phase protein) are parameters that can be sequentially determined to monitor improvement. For monitoring the effect of treatment of chronic infections such as endocarditis or osteomyelitis, weekly determination of the erythrocyte sedimentation rate has been proven useful. 

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... 

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). 

The use of prophylactic isoniazid therapy for transplant patients with evidence of exposure to M. tuberculosis (those with a positive purified protein derivative skin test) remains controversial. Risk of reactivation and development of clinical tuberculosis is enhanced with posttransplant immunosuppression. Some clinicians believe, however, that the risk of isoniazid-induced hepatotoxicity, especially in liver transplant recipients, in whom the rate of hepatotoxicity has been reported as high as 40%, outweighs the benefits of treatment. High-risk patients who may be considered for isoniazid prophylaxis include those with a positive skin test, those with previously diagnosed tuberculosis who may not have been treated adequately, patients in close contact with individuals with active pulmonary disease, and patients with abnormal chest radiographs consistent with old tuberculosis who have not received prior prophylaxis. " ... 

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. 

ACTH is used cautiously in i>atients witli diabetes, diverticulosis, renal insufficiencies, myastlienia gravis, tuberculosis (may reactivate tlie disease), hyiDotliyroidism, cirrhosis, nonspecific ulcerative colitis, heart failure, seizures, or febrile infections. The drug is classified as a Pr iancy Ckt iy C drug and is used cautiously during pr iancy and lactation. ACTH is used cautiously in cMl-dren because it can inliibit skeletal growtli. 

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). 

Examples Silicosis, asbestosis, pneumonitis, pharyngitis, rhinitis or acute congestion farmer s lung, beryllium disease, tuberculosis, occupational asthma, reactive airways dysfunction S5mdrome (RADS), chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis, toxic inhalation injury, such as metal fume fever, chronic obstructive bronchitis, and other pneumoconioses. 

Infections may be caused by reactivation of a primary infection in the recipient, reactivation of a lesion from the donor lung, or as a primary infection. The (Morales et al. 2005) increase in the number of solid organ transplants has resulted in an increased incidence of opportunistic infections, including infection by typical and atypical mycobacteria, with the risk of developing tuberculosis. Pretransplant chemoprophylaxis with isoniazid has become increasingly common in an attempt to prevent the disease. The source of infection in tuberculosis (TB) may be difficult to identify. There are few reports on TB in lung transplantation (Baldi et al. 1997 Miller et al. 1995). 

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