Different forms of mycobacterial infections in patients receiving anti-TNF therapy: Case reports

Biological agents, including TNF-alpha antagonists, have been used in treatment of autoimmune diseases for over 20 years. Due to impaired T-cell immunity and blocked effects of TNF-alpha mediator, patients receiving this therapy have increased risk of developing tuberculosis or other non-tuberculous mycobacterial infections. Both tuberculosis and other mycobacterial infections may occur anytime in patients who have ever used these medicines, even after the first injection. Most often we see activation of latent tuberculosis confirmed by screening tests. IGRA tests (QuantiFERON and T-SPOT.TB) are significantly more sensitive and specific for testing population of immunosuppressed patients, in comparison to tuberculosis skin test. There are contemporary recommendations for diagnosing, monitoring, chemoprophylaxis and treatment of latent and active tuberculosis in adults and children in case of planning administration of TNF-alpha antagonists or in cases when these drugs have already been used. Prevention of active tuberculosis via diagnosing LTBI and use of chemoprophylaxis is the crucial component of the strategy of World Health Organization for elimination of TB (End TB Strategy).