title: Primary tuberculosis infection in patients treated with tumor necrosis factor-alpha antagonists and a negative initial screening.
abstract: BACKGROUND
  Despite screening for latent tuberculosis (TB), new cases of TB infection are detected in patients treated with anti-TNF-α and negative initial screening, some of them after long treatment, which points more to a new infection.
  
  
  OBJECTIVE
  To describe the cases that have presumably developed a primary tuberculous infection during treatment with anti-TNF-α drugs.
  
  
  METHODS
  Retrospective audit (1999-2012). Inclusion criteria were: a) anti-TNF-α treatment; b) initial latent TB screening negative; c) TB diagnosed during anti-TNF-α treatment; d) suspected primary TB infection (diagnosis after at least 12 months on anti-TNF-α). Clinical, epidemiological, therapeutic and outcome variables were reviewed.
  
  
  RESULTS
  Two cases of primary TB infection were found out of of 771 anti-TNF-α treated patients (0.2%). One woman aged 41 suffered TB pneumonia after 35 months of treatment with adalimumab, and a male aged 37 who developed disseminated TB after 107 months of treatment with infliximab.
  
  
  CONCLUSIONS
  Although uncommon, during TNF antagonist therapy, TB risk persists despite negative initial screening, so clinicians should be aware of TB during the entire treatment.
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España. Electronic address: drjoseantoniobernal@gmail.com.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Bernal
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: Mariano
authors.initials: M
authors.lastname: Andrés
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: Vega
authors.initials: V
authors.lastname: Jovaní
authors.affiliation: Servicio de Neumología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: Raquel
authors.initials: R
authors.lastname: García Sevila
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Begazo
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: Paloma
authors.initials: P
authors.lastname: Vela
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects*; D000328:Adult; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab / Q000009:adverse effects*; D055985:Latent Tuberculosis / Q000175:diagnosis; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis / Q000276:immunology*
chemical_list: D007166:Immunosuppressive Agents; D000069285:Infliximab; D000068879:Adalimumab
keywords: Anti-TNF-α; Immunosuppression; Inmunosupresión; Reactivación tuberculosis latente; Reactivating latent tuberculosis; Tuberculosis