DIJAGNOSTIKA LATENTNE TUBERKULOZE (TB) ODRASLIH CIJEPLJENIH BOLESNIKA (BCG) U HRVATSKOJ PRIJE UVOĐENJA TERAPIJE ANTAGONISTIMA FAKTORA TUMORSKE NEKROZE

Sanja Popović-Grle, Đurđica Babić-Naglić

Tuberculosis is now well known adverse event during anti-TNFα therapy and screening for TB is highly recommended before the administration of anti-TNF blockers. The purpose of screening is to asses the risk of reactivation of latent TB or new infection with mycobacterium tuberculosis. Skin test for TB with induration of 5 mm and more is considered positive. Negative skin test in immunocompromised persons does not exclude latent inefction and booster testing after 7 days is suggested. All patients with any suspicious or unclear skin testing (PPD > 5 mm on initial or booster testing) need immunologic diagnostic approach. Patients with confirmed risk for TB must take chemoprofi laxis for 6 months (isoniasid 5 mg per kilogram of body weight). Anti-TNF therapy could be started after 2 months of chemotherapy. All 3 anti-TNF biologics have the same risk of new TB infection and it seems that monoclonal antibodies have some higher risk for reactivation of latent TB. Anyhow for all biologics the same pre-therapy screening procedure is strongly recommended.

Tuberkuloza (TB) je realna komplikacija tijekom liječenja inhibitorima TNFα i u svakog bolesnika neophodna je preterapijska obrada s ciljem otkrivanja rizika reaktivacije latentne infekcije ili nove zaraze mikobakterijem tuberkuloze. Prema novim saznanjima u imunokompromitiranih bolesnika, u slučaju negativnog PPD nalaza, uputno je u razmaku od 7 dana ponoviti PPD test još jedan put (booster PPD). Induracija od 5 mm i više predstavlja patološki nalaz koji nalaže imunološku dijagnostiku i daljnju detaljnu obradu/liječenje u suradnji s pulmologom. U svakog bolesnika s rizikom TB indicirana je kemoprofilaksa izonijazidom, 5 mg/kg TT dnevno kroz 6 mjeseci. AntiTNF terapija može se započeti najranije nakon 2 mjeseca kemoterapije TB. Čini se da monoklonska anti-TNF protutijela u odnosu na solubilni receptor predstavljaju veći rizik za reaktivaciju latentne dok svi imaju podjednak rizik za novonastalu zarazu TB. Bez obzira na spomenute razlike u svih bolesnika mora se isključiti rizik TB.