alexa Diagnosis and Management of Tuberculosis in Candidates for Tumor Necrosis Factor Alpha Antagonists: An Experts Survey
ISSN: 2161-1068

Mycobacterial Diseases
Open Access

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Research Article

Diagnosis and Management of Tuberculosis in Candidates for Tumor Necrosis Factor Alpha Antagonists: An Experts Survey

Kate E Birkenkamp1#, Michael Lauzardo2, Bonita T Mangura3, Maximo O Brito4, David E Griffith5, Barbara J Seaworth6 and Patricio Escalante7*

1Internal Medicine Program, Mayo Clinic, Rochester, MN, USA

2Southeastern National Tuberculosis Center and the Division of Infectious Diseases, University of Florida Health Science Center, Gainesville, FL, USA

3UMDNJ-New Jersey Medical School and Global TB Institute, Newark, NJ, USA

4Section of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA

5Heartland National TB Center, University of Texas Health Science Center at Tyler, Tyler, TX, USA

6Heartland National TB Center, San Antonio, TX, USA

7Division of Pulmonary and Critical Care Medicine and Mayo Clinic Center for Tuberculosis, Mayo Clinic, Rochester, MN, USA

#Deceased Author

Corresponding Author:
Patricio Escalante
Division of Pulmonary and Critical Care
Mayo Clinic, 200 First Street SW
Rochester, MN 55905, USA
Tel: 5072931031
E-mail: [email protected]

Received Date: May 28, 2014; Accepted Date: October 04, 2014; Published Date: October 14, 2014

Citation: Birkenkamp KE, Lauzardo M, Mangura BT, Brito MO, Griffith DE, et al. (2014) Diagnosis and Management of Tuberculosis in Candidates for Tumor Necrosis Factor Alpha Antagonists: An Experts Survey. J Mycobac Dis 4:171. doi:10.4172/2161-1068.1000171

Copyright: © 2014 Escalante P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Background: There are some controversies regarding the management of latent tuberculosis infection and tuberculosis in patients with rheumatologic indications for biologic therapy.

Objectives: To describe current expert opinions and preferences regarding the evaluation and management of latent tuberculosis infection and tuberculosis in candidates and recipients of tumor-necrosis factor-alpha blocking therapy.

Methods: A questionnaire addressing preferences related to management and treatment of latent tuberculosis infection and active tuberculosis in tumor-necrosis factor-alpha blocking candidates was distributed to tuberculosis and rheumatology experts across the United States between August 18, 2009, and June 21, 2010. Survey responses were formulated as a 5-point Likert scale (strongly disagree to strongly agree), or as a priority rank order list (1 to 6 or 7), and data were analyzed for percent agreement and median rankings.

Measurements and main results: The tuberculin skin test and interferon-gamma release assays for latent tuberculosis infection screening were highly accepted among tuberculosis and rheumatology experts. Most participants supported the use of daily isoniazid for 9 months for latent tuberculosis infection therapy, but responses were mixed regarding timing to initiation of tumor-necrosis factor-alpha blocking therapy. Most tuberculosis experts supported standard anti-tuberculosis therapy for treatment of tuberculosis, but preferences varied among rheumatologists. In contrast, most rheumatologists believed tumor-necrosis factor-alpha blocking therapy should be stopped in individuals with active tuberculosis, while opinions varied among tuberculosis experts.

Conclusions: Agreement among experts was common regarding preferences for diagnosis and management of latent tuberculosis infection and tuberculosis under hypothetical but likely common clinical scenarios, but some differences exist.


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