■组织胞浆菌病是使用肿瘤坏死因子(TNF)-α抑制剂治疗的患者中第二常见的肉芽肿疾病,仅次于肺结核。然而,关于开始免疫生物学治疗的患者的治疗前筛查程序和预防性治疗需求的信息有限.
■这是一项队列研究,通过检测尿液样本中的组织胞浆菌抗原,在开始使用TNF-α抑制剂之前,评估无症状HIV阴性患者的组织胞浆菌病患病率。在生物制剂开始后,患者完成了180天的随访,以评估提示组织胞浆菌病的症状发作。
■从2021年1月到2022年12月,在巴西南部的中心接受了治疗自身免疫性疾病的TNF-α抑制剂的54名患者。在治疗前的筛查中,尿组织胞浆抗原检测阳性的患病率为14.8%.免疫生物学治疗6个月后,54例患者均未出现组织胞浆菌病,包括8名检测呈阳性的病人.
■慢性患者的荚膜组织支原体感染的患病率可能高于预期,但潜伏感染对无症状患者的影响仍不确定,包括用免疫生物学药物如TNF-α抑制剂开始治疗的那些。我们的研究没有确定该组中播散性组织胞浆菌病诊断的危险因素,包括免疫生物学治疗前进行的抗原测试的阳性结果。迄今为止,在开始使用TNF-α抑制剂之前,没有证据推荐组织胞浆菌病的常规抗原筛查或预防性治疗.
使用尿液检测真菌感染来筛查即将开始服用免疫生物学药物的无症状人群。这项研究观察了组织胞浆菌病的患病率,真菌感染,在即将开始使用TNF-α抑制剂治疗的无症状患者中,这是用于自身免疫性疾病的药物。研究人员在患者开始治疗之前对尿液样本进行了组织胞浆抗原检测,并在开始用药后随访180天,看看他们是否出现了组织胞浆菌病的症状。该研究包括巴西南部的54名患者,他们发现14.8%的患者在开始治疗前组织胞浆抗原检测呈阳性。然而,没有病人,包括那些测试呈阳性的人,在6个月的随访期间发生了组织胞浆菌病。研究人员得出结论,组织胞浆菌病感染在这些患者中可能比以前认为的更常见,但目前尚不清楚抗原检测阳性的无症状患者在开始TNF-α抑制剂治疗时是否会出现感染。该研究没有发现该组患者发生组织胞浆菌病的任何具体危险因素,根据他们的发现,他们不建议在开始TNF-α抑制剂治疗前对组织胞浆菌病进行常规筛查或预防性治疗.
UNASSIGNED: Histoplasmosis is the second most frequent granulomatous disease in patients treated with tumor necrosis factor (TNF)-α inhibitors, second only to tuberculosis. However, there is limited information about pre-therapy screening procedures and the need for preventive treatments for patients who will start immunobiologicals.
UNASSIGNED: This is a cohort study that evaluated the prevalence of histoplasmosis in asymptomatic HIV-negative patients before initiation of TNF-α inhibitors by testing for Histoplasma antigen in urine samples. The patients included completed a 180-day follow-up after the initiation of the biologics to assess the onset of symptoms suggestive of histoplasmosis.
UNASSIGNED: From January 2021 to December 2022, 54 patients who were prescribed a TNF-α inhibitor agent for treating autoimmune diseases in centers in southern Brazil were included. In the screening before therapy, the prevalence of a positive urinary Histoplasma antigen test was 14.8%. None of the 54 patients developed histoplasmosis after 6 months of immunobiological therapy, including the eight patients who tested positive.
UNASSIGNED: The prevalence of Histoplasma capsulatum infection in chronic patients may be higher than expected, but the impact of latent infection in asymptomatic patients is still uncertain, including those starting treatment with immunobiological drugs such as TNF-α inhibitors. Our study did not identify risk factors for the diagnosis of disseminated histoplasmosis in this group, including a positive result in an antigen test performed before immunobiological therapy. To date, there is no evidence to recommend routine antigen-based screening or preventive therapy for histoplasmosis before initiating a TNF-α inhibitor.
Using a urine test for fungal infection to screen people without symptoms who are about to start taking immunobiologic medications This study looked at the prevalence of histoplasmosis, a fungal infection, in asymptomatic patients who were about to start treatment with TNF-α inhibitors, which are medications used for autoimmune diseases. The researchers tested urine samples for Histoplasma antigen before the patients started the treatment and followed them for 180 days after starting the medication to see if they developed any symptoms of histoplasmosis. The study included 54 patients in southern Brazil, and they found that 14.8% of the patients tested positive for the Histoplasma antigen before starting the treatment. However, none of the patients, including those who tested positive, developed histoplasmosis during the 6-month follow-up. The researchers concluded that histoplasmosis infection may be more common in these patients than previously thought, but it’s still not clear if asymptomatic patients with a positive antigen test will develop the infection when starting TNF-α inhibitor treatment. The study did not find any specific risk factors for developing histoplasmosis in this group of patients, and based on their findings, they did not recommend routine screening or preventive therapy for histoplasmosis before starting TNF-α inhibitor treatment.