TUBERKULOZA I ANTI-TNFα TERAPIJA

Sanja Popović-Grle

Tuberculosis incidence at the beginning of the third millennium is increasing, together with appearance of multi resistant (MDR-TB) and extremely resistant Mycobacterium tuberculosis (XDR-TB). Tumor necrosis factor (TNFα) increases macrophage phagocytic capacity for Mycobacterias, and is included in granuloma formation. Anti-TNFα therapy used in some diseases in the field of gastroenterology, rheumatology and dermatology increase tuberculosis incidence even 30 times in comparison with imunocompetent persons. Patient’s screening before introduction of anti-TNFα therapy decreases manifest tuberculosis for 90%. Key finding in the screening process (according to the Guidelines shown in the paper) is family history or previously tuberculosis, tuberculin skin test (PPD), chest X-ray, in certain cases immunology diagnostic test for tuberculosis, while in infected persons sputum culture for tuberculosis is needed to ruled out manifest tuberculosis.

Incidencija tuberkuloze na početku trećeg tisućljeća ponovno raste, uz pojavu multirezistentnih (MDRTB) i ekstremno rezistentnih bacila Mycobacterium tuberculosis (XDRTB). Tumor necrosis factor TNFα povećava fagocitnu sposobnost makrofaga da neutralizira mikobakterije, te sudjeluje u formiranju granuloma. Kada se u terapiji nekih reumatskih, gastroeneteoloških i dermatoloških bolesti koriste anti- TNFα lijekovi, incidencija tuberkuloze raste i do 30 puta u odnosu na imunokompetentne osobe. Probir bolesnika prije uvođenja anti- TNFα terapije smanjio je pojavnost tuberkuloze za 90%. U postupku probira (prema konsenzusu Smjernica prikazanima u radu) ključna je obiteljska ili ranija osobna anamneza, tuberkulinski test (PPD), radiogram prsnog koša, u određenim slučajevima i imunološka dijagnostika na tuberkulozu, dok je u inficiranih osoba potrebno učiniti i mikrobiološku obradu iskašljaja, kako bi se isključila aktivna (manifestna) tuberkuloza.