Sema DEMİR, Filiz AYKAN SADİ, Derya ÖZTUNA

Ankara Numune Eğitim Araş tırma Hastanesi Göğüs Hastalıkları Kliniğinde son 8 yılda (2006-2013) TNF-alfa blokeri kullanan hastalara verilen latent tüberküloz tedavisi sonuçları

Giriş: Bu çalışmada amac ım ız, tümör nekroz faktörü-alfa (TNF-α) bloker tedavisi almakta olan hastalarda tüberküloz kemoprofilak-sisine ra ğmen tüberküloz gelişme sıklığın ı belirlemektir.Materyal ve Metod: Ankara Numune Eğitim ve Ara ştırma Hastanesi, Gö ğüs Hastalıkları Kliniğine, 2006-2013 yılları arasında ba şvu-ran, TNF-α bloker tedavisi halen alan, tüberküloz kemoprofilaksisi alm ış hastalar, tüberküloz gelişme sıklığı açısından retrospektifolarak de ğerlendirildi. TNF-α bloker tedavi endikasyonu alan, romatolojik ve dermatolojik hastalık tan ıs ı olan; 18-80 ya ş aralığında,134 hasta de ğerlendirildi. Ya ş, cinsiyet, sigara içme durumu, BCG a ş ısı, akciğer grafisi, hastalık tan ısı, ek hastalık varlığı, tüberkülozhikayesi, PPD de ğeri, kemoprofilaksi alma durumu, hangi antitüberküloz ajan ı aldığı ve aldığı süre, TNF-α bloker tedavisi aldığı süre,ba şka immünsüpresif alım ı olup olmadığına bak ıldı.Bulgular: Ço ğu romatolojik hastalık tan ısı olan ve anti-TNF tedavi alan hastalarda (n= 134), izoniyazid ile tüberküloz kemoprofilaksiuygulaması (profilaksi endikasyonu olan %73.9 hasta) sonrasında, pulmoner veya ekstrapulmoner tüberküloz hastalığı geliş memiştir.Sonuç: Anti-TNF tedavi verilecek hastalarda, TCT veya QuantiFERON ile taramada latent tüberküloz infeksiyonu tan ısı konulmu şsa,anti-TNF öncesi en az bir ay kemoprofilaksi almalı, 9 ay INH veya 4 ay RIF ile tüberküloz profilaksisi tamamlanmalıdır. Aylık serumkaraciğer enzimleri, bilirubin ölçümleri; 3 ayda bir fizik muayene ve akciğer radyografisi takipleri yapılmalıdır.

Latent tuberculosis treatment results in patients that taken TNF- alpha blockers at Ankara Numune Training and Research Hospital Chest Diseases Clinic for last 8 years (2006-2013)

Introduction: Tuberculosis occurrence was evaluated in patientsthat applied tuberculosis chemoprophylaxis and currently receiving tumor necrosis factor-alpha (TNF-α) blocker.Materials and Methods: Incidence of tuberculosis were retrospectively evaluated in patients that currently receiving TNF-α-blockingtherapy and received tuberculosis chemoprophylaxis at Ankara Numune Education and Research Hospital, Lung Disease Department,between 2006-2013 years. 134 patients that were diagnosed with rheumatologic and dermatologic diseases, were evaluated. Patientswere in the age range 18-80 years. Age, gender, smoking status, BCG vaccination, chest radiography, diagnose of disease, presenceof concomitant disease, tuberculosis story, PPD value, chemoprophylaxis acquisition, which anti-tuberculosis agents received, dura-tion of chemoprophylaxis, duration of TNF-α blocker, other immunosuppressive using were measured.Results: Rheumatologic diseases were often. Prophylaxis has given at 73.9% of patients. Patients with received anti-TNF-α therapy(n= 134) have not developed pulmonary or extra-pulmonary tuberculosis disease. Conclusion: Patients with received anti-TNF-α therapy, are scanned with TST or QuantiFERON. If latent tuberculosis infection arediagnosed, tuberculosis prophylaxis should be started pre-anti-TNF- α therapy at least one month and INH chemoprophylaxis shouldbe completed on 9 months or RIF should be completed on 4 months. Serum liver enzymes and bilirubin measurements monthly;follow-up physical examination and chest radiography should be performed for 3 months.

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