title: Diagnosis and treatment of latent tuberculosis in patients with chronic inflammatory diseases: use of TNF-alpha-targeting biological products.
abstract: OBJECTIVE
  To determine the clinical and epidemiological profile of patients who are candidates for TNF-α inhibitor use and are classified as having latent tuberculosis (LTB), as well as to evaluate the outcomes of prophylactic treatment with isoniazid.
  
  
  METHODS
  A prospective descriptive analysis followed by an analytical, observational, cross-sectional study of the outcomes of prophylactic treatment in a group of 45 candidates for TNF-α inhibitor use. We evaluated the patients through anamnesis, clinical examination, chest X-ray, and tuberculin skin test (TST) using the Mantoux method.
  
  
  RESULTS
  The mean age was 45 years, and 56.0% of the patients were female. Chronic rheumatic diseases, chronic dermatological diseases, and Crohn's disease were present in 46.7%, 40.0%, and 13.3% of the patients, respectively. The mean TST induration was 14.6 mm (range: 5-30 mm). The majority (n = 30) of the 45 patients (66.7%) had an induration > 10 mm. In the 16 patients with BCG vaccination scars, the mean induration was 15.7 mm, and 14 of those patients had an induration > 10 mm. Chest X-ray results were considered normal, with minimal alterations, in 64.4% and 35.6% of the patients, respectively. The treatment with isoniazid was abandoned by 1 patient (2.2%) and completed by 41 (91.2%), whereas it was interrupted because of drug-induced hepatitis in 2 (4.4%), and 1 patient (2.2%) was transferred to another hospital. Of those who completed the treatment, 5 experienced mild side effects.
  
  
  CONCLUSIONS
  Determining the profile of candidates for TNF-α inhibitor use is important for the management of LTB treatment and for the establishment of clinical protocols for the use and monitoring of the use of these medications.
authors.affiliation: Universidade Federal do Ceará, Fortaleza, CE, Brasil. dianalopes5@hotmail.com
authors.forename: Diana Maria de Almeida
authors.initials: DM
authors.lastname: Lopes
authors.forename: Valéria Goes Ferreira
authors.initials: VG
authors.lastname: Pinheiro
authors.forename: Helena Serra Azul
authors.initials: HS
authors.lastname: Monteiro
authors.forename: José Ajax Nogueira
authors.initials: JA
authors.lastname: Queiroz
authors.forename: Lucivaldo Dos Santos
authors.initials: Ldos S
authors.lastname: Madeira
authors.forename: Mônica Maria de Almeida
authors.initials: MM
authors.lastname: Lopes
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy / Q000382:microbiology*; D007538:Isoniazid / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D007538:Isoniazid