Difficulties in preventive therapy of tuberculosis infection in patients with severe autoimmune pathology during long-term immunosupressive treatment

Abstract

Aim. To assess the state of vital organs in patients with severe autoimmune pathology before starting preventive therapy of tuberculosis infection.
Methods. Medical records, clinical and laboratory examination results were analysed in 38 patients with severe autoimmune diseases receiving long-term immunosuppressive therapy, which are referred to the TB dispensary to exclude tuberculosis infection. The frequency and severity of comorbid pathology, haematological and biochemical blood parameters before the start of preventive therapy of tuberculosis were assessed.
Results. indications for preventive therapy were determined in 37 (97.4%) patients: residual post-tuberculosis changes were detected in 7 (18.4%), latent tuberculosis infection in 30 (78.9%). A high frequency of significant concomitant pathology (on average 4.63 comorbidities per patient) with predominance of gastrointestinal (54.1%), visual (54.1%) and musculoskeletal (75.7%) diseases was revealed, which required individualisation of preventive therapy schemes and correction of drug doses. After a single 3-month course of preventive therapy, 27% of patients did not experience fading of the skin test with a recombinant tuberculosis allergen; 32.4% of patients still had hyperergic results.
Conclusion. Preventive therapy of tuberculosis infection in patients with severe autoimmune pathology requires a personalized approach with individual selection of regimens and doses of drugs used, careful clinical and laboratory monitoring, followed by long-term follow-up and assessment of the need for repeated preventive courses.