Yalçın KARA, Mahmut Can KIZIL, Merve İŞERİ NEPESOV, Aslı KAVAZ TUFAN, Nuran CETIN, Yusuf AYDEMİR, Zeren BARIŞ, Hilal KAYA ERDOĞAN, Ömer KILIÇ, Ener Çağrı DİNLEYİCİ

Biyolojik ajan kullanan çocuklarda tüberküloz sıklığının değerlendirilmesi

Amaç: Anti-TNF ilaçlar tüberküloz enfeksiyon riskini arttırırlar. Bu çalışmayla Anti-TNF ilaç kullanan hastalarda, tüberküloz gelişme sıklığını araştırmayı amaçladık. Gereç ve yöntem: Çalışmaya anti-TNF ilaç kullanan 115 çocuk hasta dahil edildi. Olguların klinik ve epidemiyolojik özellikleri retrospektif olarak değerlendirildi. Bulgular: Anti-TNF ilaç kullanan 115 olgu çalışmaya dahil edildi. Olguların tanıları; Juvenil Romatoid Artrit 76 (%66), Ülseratif Kolit 11 (%9,6), Crohn's 7 (%6), Ankilozan Spondilit 6 (%5,2), FMF 5 (%4,3), Psoriasis 4 (%3,5) şeklindeydi. Hastaların kullandığı ajanların dağılımı ise; etanersept 74 (%64,3), infliximab 17 (%14,8), adalimumab 17 (%14,8), anakinra 5 (%4,3) ve kanakinumab 2 (%1,7) şeklindeydi. Tüm vakaların iki aylıkken BCG aşısı olduğu öğrenildi, aşı kartları ve sağlık bakanlığının aşı takip sisteminden teyit edildi. Tüm olgulara TDT yapıldı ve TDT yanıtı <5mm 89 (%77,4), 5-9 mm 11 (%8,7), 10-14 mm 8 (%7,4), >15 mm 7 (%5,6) olarak ölçüldü. Latent tüberküloz tanısı alan 17 olguya 9 ay izoniazid (INH) profilaksisi başlandı. Olguların hiçbirinde aktif tüberküloz saptanmadı.Sonuç: Anti-TNF alan tüm hastaların tüberküloz açısından değerlendirilmesi gerekmektedir. Tedavi başlangıcında saptanmasa da tedavi süresince güncel kılavuzlar ışığında temas öyküsü, semptomlar, fizik muayene, akciğer grafisi ve TDT/IGRA ile düzenli tüberküloz taramasına devam edilmelidir.

Anahtar Kelimeler:

tüberküloz, çocuk, anti-TNF

Evaluation of tuberculosis frequency in children using biological agents

Purpose: Anti-TNF drugs increase the risk of tuberculosis. In this study we aimed to investigate the incidence of tuberculosis in patients using anti-TNF drugs.Methods: One hundred and fifteen pediatric cases which were received anti-TNF drugs were included in the study. The clinical and epidemiological characteristics of the cases were analyzed retrospectively.Results: One hundred and fifteen cases using anti-TNF drugs were included in the study. The diagnoses of the cases were as follows; Juvenile Rheumatoid Arthritis 76 (66%), Ulcerative Colitis 11 (9.6%), Crohn's 7 (6%), Ankylosing Spondylitis 6 (5.2%), FMF 5 (4.3%), Psoriasis 4 (%3.5). The distribution of the agents used by the patients was; etanercept 74 (64.3%), infliximab 17 (14.8%), adalimumab 17 (14.8%), anakinra 5 (4.3%), and canakinumab 2 (%1.7). It was learned that all cases had BCG vaccinations when they were two months old, confirmed by the vaccination cards and the ministry of health's vaccination follow-up system. TST was performed in all of the cases and TST response was measured as <5mm in 89 (77.4%), 5-9 mm in 11 (8.7%), 10-14 mm in 8 (7.4%), >15 mm in 7 (5.6%) cases. Isoniazid (INH) prophylaxis was started for nine months in 17 cases with the diagnosis of latent tuberculosis. Active tuberculosis was not detected in any of the cases.Conclusion: All patients receiving anti-TNF need to be evaluated for tuberculosis. Although it is not detected at the beginning of the treatment, regular tuberculosis screening should be continued during the treatment with contact history, symptoms, physical examination, chest X-ray, and TST/IGRA in light of current guidelines.

Keywords:

tubercolosis, pediatric, anti-TNF,

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