La importancia de una adherencia correcta al tratamiento antituberculoso

INTRODUCCIÓN. La tuberculosis (TB) sigue siendo una de las principales causas de morbimortalidad en muchos países y esto comporta un problema grave de salud pública. La adhe­rencia al tratamiento antituberculoso es un eje fundamental para el control de esta enfermedad. DESARROLLO. A nivel mundial existen grandes diferencias en función del territorio en cuanto a las tasas de prevalencia e incidencia de la enfermedad y su mortalidad. España presen­ta una tasa de incidencia superior a la de otros países de su entorno socioeconómico. El tratamiento es prolongado y con efectos secundarios im­portantes. La adherencia al tratamiento es fundamental para que este sea eficaz, para evitar las resistencias a los fármacos y controlar la enfermedad. Los niños son más vulnerables a desarrollar la enfermedad que el resto de la población. Existen distintos tipos de métodos, directos e indirectos, para medir esta adherencia al tratamiento, aunque ninguno es ideal. Están descritos una serie de factores de riesgo de tipo so­ciodemográfico que influyen en la adherencia, como la inmigración. A los factores que dificultan el seguimiento del tratamiento en el adulto se tienen que sumar otros más espe­cíficos a nivel infantil. CONCLUSIONES. La literatura revisada destaca la importancia de un adecuado seguimiento de los pacientes para aumentar la adherencia al tratamiento antituberculoso. El rol de la enfer­mera y sus intervenciones son muy importantes

Educational measure for promoting adherence to treatment for tuberculosis

The aim of this work is to determine the effect of the educational intervention to improve the language barrier on adherence to antituberculosis treatment in the paediatric population. Immigrant population is associated with factors that make it difficult to monitor the treatment and control of tuberculosis infection or disease properly such as language difficulties. 68 patients were included in this study. They came from 15 different countries. The patients/families were given written information (a leaflet) in the form of questions and answers about the most common doubts that people have about antituberculosis treatment. This leaflet was translated into 11 different languages: Spanish, Catalan, English, French, German, Italian, Russian, Romanian, Chinese, Urdu and Arabic. Six patients/families that presented language barrier had successfully completed the treatment. In this study, language barrier was not associated with poorer adherence. We believe delivering information written in the mother tongue can improve understanding about the importance of the tuberculosis disease and its treatment

Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study

Background: Adult patients receiving anti-TNFα drugs are at increased risk of tuberculosis (TB), but studies in pediatric populations are limited, and the best strategy for latent tuberculosis infection (LTBI) screening in this population remains controversial. We describe the prevalence of LTBI prior to anti-TNFα therapy and the long-term follow-up after biological treatment initiation in a cohort of children and adolescents. Methods: Cohort observational study in children and adolescents receiving anti-TNFα agents in a tertiary-care pediatric hospital. LTBI was ruled out prior to the implementation of anti-TNFα drugs by tuberculin skin test (TST), and, from March 2012 on, QuantiFERON Gold-In Tube® test (QTF-G). During anti-TNFα treatment, patients were evaluated every 6 months for TB with history and physical examination. TST/QTF-G were not repeated unless signs or symptoms consistent with TB arose or there was proven TB contact. Results: The final cohort consisted of 221 patients (56.1 % female; 261 treatments), of whom 51.7 %/30.0 %/17.3 % were treated with etanercept/adalimumab/infliximab, respectively, for a variety of rheumatic diseases (75.6 %), inflammatory bowel disease (20.8 %), and inflammatory eye diseases (3.6 %). The median (IQR) age at diagnosis of the primary condition was 6.8 years (2.7-11.0) and the duration of the disease before implementing the anti-TNFα agent was 1.8 years (0.6-4.2). LTBI was diagnosed in 3 adolescent girls (prevalence rate: 1.4 %; 95 % CI: 0.4-4.2) affected with juvenile idiopathic arthritis: TST tested positive in only 1, while QTF-G was positive in all cases (including 2 patients already on etanercept). They all received antiTB chemoprophylaxis and were later (re)treated with etanercept for 24-29 months, without incidences. No incident cases of TB disease were observed during the follow-up period under anti-TNFα treatment of 641 patients-year, with a median (IQR) time per patient of 2.3 years (1.4-4.3). Conclusions: In our study, the prevalence of LTBI (1.4 %) was similar to that reported in population screening studies in Spain; no incident cases of TB disease were observed. In low-burden TB settings, initial screening for TB in children prior to anti-TNFα treatment should include both TST and an IGRA test, but systematic repetition of LTBI immunodiagnostic tests seems unnecessary in the absence of symptoms or known TB contact

La importancia de una adherencia correcta al tratamiento antituberculoso

INTRODUCCIÓN. La tuberculosis (TB) sigue siendo una de las principales causas de morbimortalidad en muchos países y esto comporta un problema grave de salud pública. La adhe­rencia al tratamiento antituberculoso es un eje fundamental para el control de esta enfermedad. DESARROLLO. A nivel mundial existen grandes diferencias en función del territorio en cuanto a las tasas de prevalencia e incidencia de la enfermedad y su mortalidad. España presen­ta una tasa de incidencia superior a la de otros países de su entorno socioeconómico. El tratamiento es prolongado y con efectos secundarios im­portantes. La adherencia al tratamiento es fundamental para que este sea eficaz, para evitar las resistencias a los fármacos y controlar la enfermedad. Los niños son más vulnerables a desarrollar la enfermedad que el resto de la población. Existen distintos tipos de métodos, directos e indirectos, para medir esta adherencia al tratamiento, aunque ninguno es ideal. Están descritos una serie de factores de riesgo de tipo so­ciodemográfico que influyen en la adherencia, como la inmigración. A los factores que dificultan el seguimiento del tratamiento en el adulto se tienen que sumar otros más espe­cíficos a nivel infantil. CONCLUSIONES. La literatura revisada destaca la importancia de un adecuado seguimiento de los pacientes para aumentar la adherencia al tratamiento antituberculoso. El rol de la enfer­mera y sus intervenciones son muy importantes

Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study

Background: Adult patients receiving anti-TNFα drugs are at increased risk of tuberculosis (TB), but studies in pediatric populations are limited, and the best strategy for latent tuberculosis infection (LTBI) screening in this population remains controversial. We describe the prevalence of LTBI prior to anti-TNFα therapy and the long-term follow-up after biological treatment initiation in a cohort of children and adolescents. Methods: Cohort observational study in children and adolescents receiving anti-TNFα agents in a tertiary-care pediatric hospital. LTBI was ruled out prior to the implementation of anti-TNFα drugs by tuberculin skin test (TST), and, from March 2012 on, QuantiFERON Gold-In Tube® test (QTF-G). During anti-TNFα treatment, patients were evaluated every 6 months for TB with history and physical examination. TST/QTF-G were not repeated unless signs or symptoms consistent with TB arose or there was proven TB contact. Results: The final cohort consisted of 221 patients (56.1 % female; 261 treatments), of whom 51.7 %/30.0 %/17.3 % were treated with etanercept/adalimumab/infliximab, respectively, for a variety of rheumatic diseases (75.6 %), inflammatory bowel disease (20.8 %), and inflammatory eye diseases (3.6 %). The median (IQR) age at diagnosis of the primary condition was 6.8 years (2.7-11.0) and the duration of the disease before implementing the anti-TNFα agent was 1.8 years (0.6-4.2). LTBI was diagnosed in 3 adolescent girls (prevalence rate: 1.4 %; 95 % CI: 0.4-4.2) affected with juvenile idiopathic arthritis: TST tested positive in only 1, while QTF-G was positive in all cases (including 2 patients already on etanercept). They all received antiTB chemoprophylaxis and were later (re)treated with etanercept for 24-29 months, without incidences. No incident cases of TB disease were observed during the follow-up period under anti-TNFα treatment of 641 patients-year, with a median (IQR) time per patient of 2.3 years (1.4-4.3). Conclusions: In our study, the prevalence of LTBI (1.4 %) was similar to that reported in population screening studies in Spain; no incident cases of TB disease were observed. In low-burden TB settings, initial screening for TB in children prior to anti-TNFα treatment should include both TST and an IGRA test, but systematic repetition of LTBI immunodiagnostic tests seems unnecessary in the absence of symptoms or known TB contact