Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Tuberculosis Associated with Tumor Necrosis Factor- Alpha Antagonists TB is a potential consequence of treatment with tumor necrosis factor-alpha (TNF-α) antagonists such as the following: Infliximab (Remicade ® ) Etanercept (Enbrel ® ) Adalimumab (Humira ® ) These drugs work by blocking TNF-α, an inflammatory cytokine, and are approved for treating rheumatoid arthritis and other selected autoimmune diseases. Blocking TNF-α can allow TB disease to emerge from latent TB infection (LTBI). Healthcare providers should take steps to prevent TB in immunocompromised patients and remain vigilant for TB as a cause of unexplained febrile illness. 45 Resources Patients should be screened for risk factors for M. tuberculosis infection and tested for infection before initiating immunosuppressive therapies, including TNF-α antagonists. 46 CDC. “Tuberculosis Associated with Blocking Agents against Tumor Necrosis Factor-Alpha—California, 2002–2003” (MMWR 2004;53[No. 30]:83–686). Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5330a4.htm . Culture-Negative Pulmonary Tuberculosis A diagnosis of TB should not be ruled out if M. tuberculosis cannot be isolated from persons suspected of having pulmonary TB on the basis of clinical features and chest radiographic examination. Alternative diagnoses should be carefully considered and further appropriate diagnostic studies undertaken in persons with apparent culturenegative TB. 47 A diagnosis of culture-negative pulmonary TB can be made if all the following conditions are met: Initial acid-fast bacilli (AFB) smears and cultures are negative. Clinical or radiographic response occurs within two months of initiation of therapy. No other diagnosis has been established. 48 See Figure 4: Treatment Algorithm for Active, Culture-negative Tuberculosis and Inactive Tuberculosis in Adults. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment of Tuber culosis Disease 6.35 Revised November 2012
After the initial phase (first two months), continue treatment with an additional two months of isoniazid and rifampin during the continuation phase to complete a total of four months of treatment. 49 However, HIV-infected patients with culture-negative pulmonary TB should be treated for a minimum of six months. 50 Resources For consultation regarding the treatment of TB in a patient with negative cultures, contact the Alaska Tuberculosis Control Officer at 907-269-8000. ATS, CDC, IDSA. “Treatment of Tuberculosis” (MMWR 2003;52[No. RR-11]:10, 61). Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5211.pdf . A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment of Tuber culosis Disease 6.36 Revised November 2012
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After the initial phase (first two months), continue treatment with an additional two<br />
months <strong>of</strong> isoniazid and rifampin during the continuation phase to complete a total <strong>of</strong><br />
four months <strong>of</strong> treatment. 49 However, HIV-infected patients with culture-negative<br />
pulmonary TB should be treated for a minimum <strong>of</strong> six months. 50<br />
Resources<br />
For consultation regarding the treatment <strong>of</strong> TB in a patient with negative<br />
cultures, contact the <strong>Alaska</strong> <strong>Tuberculosis</strong> Control Officer at 907-269-8000.<br />
ATS, CDC, IDSA. “Treatment <strong>of</strong> <strong>Tuberculosis</strong>” (MMWR 2003;52[No. RR-11]:10, 61).<br />
Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5211.pdf .<br />
A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment <strong>of</strong> Tuber culosis Disease 6.36<br />
Revised November 2012
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