Özet
Tüberküloz (TB), Bacillus Calmette-Guérin aşılamasına rağmen ülkemizde önemini koruyan bir halk sağlığı sorunudur. Romatolojik hastalıkların tedavisinde kullanılan biyolojik ve hedefe yönelik sentetik hastalık modifiye edici antiromatizmal ilaçlar (b/tsDMARD’ler), immün yanıtı baskılamaları nedeniyle latent tüberkülozun reaktivasyonu ve yeni TB gelişimi açısından ek risk oluşturur. Bu nedenle gelişmiş tedavi öncesinde, sırasında ve sonrasında uygun tarama, tedavi ve izlem stratejilerinin belirlenmesi kritik öneme sahiptir. Türkiye Romatoloji Derneği Tüberküloz Çalışma Grubu tarafından hazırlanan bu öneriler, sistematik literatür taraması, ulusal ve uluslararası kılavuzların incelenmesi ve 12 uzmanın katıldığı Delphi konsensus süreci ile oluşturulmuştur. Rehber; latent tüberküloz tanımı, tüberkülin deri testi ve interferon gamma salınım testlerinin kullanımı ve yorumlanması, latent tüberküloz tedavi rejimleri ve süreleri, gebelik ve emzirme döneminde yaklaşım, geçirilmiş TB öyküsü olan hastalarda izlem, gelişmiş tedavi altında TB gelişimi ve yeniden tedavi planlaması gibi başlıkları kapsamaktadır. Latent tüberküloz saptanan hastalarda öncelikli latent tüberküloz tedavi rejimi izoniazid 9 ay olarak önerilmiş, alternatif şemalar tanımlanmıştır. Latent tüberküloz tedavisi ve gelişmiş tedavilerin zamanlamasının hastalık aktivitesine göre planlanması önerilmiştir. Bu rehber ile, b/tsDMARD tedavilerinde latent ve aktif TB tarama ve yönetimi hakkında klinisyenlere pratik ve ulusal verilerle uyumlu bir yol haritası sunulması amaçlanmıştır.
Anahtar Kelimeler:
Latent tüberküloz, biyolojik tedavi, bDMARD, tsDMARD, anti-TNF, IGRA, tüberkülin deri testi, romatolojik hastalıklar, Delphi konsensus
Kaynaklar
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