University of Oradea, Romania
Ovidiu Fratila completed his MD and Ph.D. at “Iuliu Hatieganu” University of Medicine from Cluj-Napoca Romania. He is Associated Professor at University of Oradea and Head the Internal Medicine Department from Emergency Clinical County Hospital from Oradea. He has published many papers in well known journals and also several books in the field of Internal Medicine and Gastroenterology. He is participating actively in many renowned international conferences and congresses. He is also involved in conducting clinical trials especially concerning inflammatory bowel disease. He is member in many European profile societies like European Society of Gastrointestinal Endoscopy, European Association for the Study of the Liver, European Society of Digestive Oncology, European Society of Digestive Oncology, European Crohn’s and Colitis Organisation. Currently, Dr. Ovidiu Fratila is also a distinguished member of the Russian Academy of Natural Sciences.
Tuberculosis remains a major health problem worldwide, with the emergence of multidrug-resistant (MDR-TB) or highly resistant (XDR-TB) Mycobacterium tuberculosis. Also, it is estimated that one third of the world population has latent TB infection. Patients with Crohn's disease and Ulcerative Colitis that are treated with anti TNF-alfa agents, have a 14 times higher risk of reactivation of latent TB than healthy subjects. Latent TB reactivation occurs mostly during the first year of anti TNF treatment, with a short median reactivation time to infliximab (3-6 months), compared with adalimumab (8-16 months). When TB occurs in patients receiving anti-TNF, it is usually atypical (extrapulmonary in 50%, disseminated in 25% of cases), making diagnosis more difficult. This is particularly important because the mortality in TB patients during the anti-TNF therapy has been reported to reach up to 13%. To reduce this risk we have three means at hand: screening is the most important mean, second is chimioprophylaxis and the third is careful monitoring of the patient. Therefore several key issues regarding current guidelines in the assessment of tuberculosis risk and its management will be discussed during this presentation. As a conclusion we can emphasize that the emergence of anti-TNF alpha therapy has provided a new therapeutic approach that is often "dramatically" efficient, but which also brought new concerns regarding security, its use being accompanied by the risk of reactivation of latent TB infection. Screening can reduce these risks but it cannot eliminate it completely which is why monitoring for latent TB reactivation in patients with anti-TNF therapy must be extremely vigilant.