Diagnosis of tuberculosis infection in pediatric patients treated with inhibitors of the tumour necrosis factor alpha. A multicenter national study comparing tuberculin skin test and igra tests

In the last years, inhibitors of tumor necrosis factor alpha (antiTNFα) have been a major advance in the treatment of many rheumatic diseases and inflammatory bowel disease, also in the pediatric patient. However, antiTNFα use is associated with an increased risk of serious infections, including tuberculosis (TB). In adults, the new interferon γ release assays (IGRA) tests for the diagnosis of TB infection appear to show better sensitivity and specificity than the tuberculin skin test (TST) in these patients. Data in children are still very scarce. We have previously reported a latent tuberculosis infection (LTI) prevalence rate of 1.4% (95%CI: 0-2.9) in children on antiTNFα treatment, which is similar to that reported in healthy pediatric population studies in Spain. LTI was diagnosed in 3 adolescent girls (out of 221 patients) in whom QTF tested positive, while TST was positive in only one of them.