{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T05:46:55Z","timestamp":1749016015331,"version":"3.37.3"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T00:00:00Z","timestamp":1699574400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T00:00:00Z","timestamp":1699574400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Rheumatol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background: Rheumatic patients have a higher frequency of tuberculosis(TB) than the general population. This study aimed to describe children and adolescents with TB and rheumatic diseases(RD) who were being treated in a reference center. Methods: A series of TB cases were investigated in a reference center for childhood TB in Rio de Janeiro, Brazil, from 1995 to 2022. Results: Fifteen patients with underlying RD and TB were included with 8(53%) being female. The mean age at RD diagnosis was 7.10years (SD\u2009\u00b1\u20090,57 years), and the mean age at TB diagnosis was 9.81 years(SD\u2009\u00b1\u20090.88 years). A total of 9 cases of pulmonary TB(PTB) and 6 cases of extrapulmonary TB\u2014pleural(2), joint\/osteoarticular(1), cutaneous(1), ocular(1), and peritoneal(1)- were described. The RD observed in the 15 patients included juvenile idiopathic arthritis(9), juvenile systemic lupus erythematosus(3), juvenile dermatomyositis(1), polyarteritis nodosa(1), and pyoderma gangrenosum(1). Among the immunosuppressants\/immunobiologics, methotrexate(8) was the most commonly used, followed by corticosteroids(6), etanercept(2), mycophenolate mofetil(1), cyclosporine A(1), adalimumab(1), and tocilizumab(1). The most common symptoms were fever and weight loss, and a predominance of PTB cases was noted. GeneXpert MTB\/RIF\u00ae was performed in six patients and was detectable in two without rifampicin resistance; Xpert Ultra\u00ae was performed in five patients, and traces with indeterminate rifampicin resistance were detected in three. One female patient discontinued treatment, and another passed away. Conclusions: The case series demonstrated the importance of suspecting and investigating TB in RD affected patients who are using immunosuppressants\/ immunobiologics, particularly in countries with high rates of TB such as Brazil.<\/jats:p>","DOI":"10.1186\/s12969-023-00918-4","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T11:02:09Z","timestamp":1699614129000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tuberculosis among children and adolescents with rheumatic diseases - case series"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5621-6204","authenticated-orcid":false,"given":"Lenita de Melo","family":"Lima","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana Rodrigues","family":"Fonseca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemax Couto","family":"Sant\u2019Anna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Alice Amaral Ibiapina","family":"Parente","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafaela Baroni","family":"Aurilio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria de F\u00e1tima Bazhuni Pombo","family":"Sant\u2019Anna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,11,10]]},"reference":[{"key":"918_CR1","unstructured":"World Health Organization. Global tuberculosis report 2020. Geneva: World Health Organization. 2020. Available from: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/336069\/9789240013131-eng.pdf. Accessed May, 2023."},{"key":"918_CR2","unstructured":"Brasil, Minist\u00e9rio da Sa\u00fade. Secretaria de vigil\u00e2ncia em sa\u00fade. Boletim epidemiol\u00f3gico \u2013 Tuberculose 2023. Bras\u00edlia. Minist\u00e9rio da Sa\u00fade. N\u00famero especial. 2023 Available from: https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/publicacoes\/boletins\/epidemiologicos\/especiais\/2023\/boletim-epidemiologico-de-tuberculose-numero-especial-mar.2023. Accessed May, 2023."},{"key":"918_CR3","unstructured":"Brasil, Minist\u00e9rio da Sa\u00fade. Secretaria de Vigil\u00e2ncia em Sa\u00fade. Departamento de Vigil\u00e2ncia das Doen\u00e7as Transmiss\u00edveis. Manual de Recomenda\u00e7\u00f5es para o Controle da Tuberculose no Brasil. Bras\u00edlia. Minist\u00e9rio da Sa\u00fade 2020. Available from:https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/publicacoes\/svsa\/tuberculose\/manual-de-recomendacoes-e-controle-da-ttuberculose-no-brasil-2a-ed.pdf\/view. Accessed May, 2023."},{"key":"918_CR4","doi-asserted-by":"publisher","DOI":"10.36416\/1806-3756\/e20210054","author":"DR Silva","year":"2021","unstructured":"Silva DR, Rabahi MF, Sant\u2019Anna CC, et al. Consenso Sobre o diagn\u00f3stico da tuberculose da Sociedade Brasileira De Pneumologia e Tisiologia. J Bras Pneumol. 2021. https:\/\/doi.org\/10.36416\/1806-3756\/e20210054.","journal-title":"J Bras Pneumol"},{"key":"918_CR5","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.rbr.2016.11.005","volume":"57","author":"JC Leite Junior","year":"2017","unstructured":"Leite Junior JC, Ramos RT, Robazzi TC. Tratamento Da tuberculose latente em pacientes com doen\u00e7as reum\u00e1ticas juvenis: uma revis\u00e3o sistem\u00e1tica. Rev Bras Reumatol. 2017;57:245\u201353.","journal-title":"Rev Bras Reumatol"},{"issue":"2","key":"918_CR6","doi-asserted-by":"publisher","first-page":"e20190023","DOI":"10.1590\/1806-3713\/e20190023","volume":"45","author":"C Anton","year":"2019","unstructured":"Anton C, Machado FD, Ramirez JMA, Bernardi RM, Palominos PE, Brenol CV, Mello FCQ, Silva DR. Infec\u00e7\u00e3o Latente Por tuberculose em pacientes com doen\u00e7as reumatol\u00f3gicas. J Bras Pneumol. 2019;45(2):e20190023.","journal-title":"J Bras Pneumol"},{"key":"918_CR7","doi-asserted-by":"publisher","DOI":"10.7573\/dic.212598","author":"FGG Chaer","year":"2020","unstructured":"Chaer FGG, Valim JML, Reis RC, Klautau GB, Souza BDB. Use of biologic agents and risk of Tuberculosis in Brazil, a Tuberculosis high-burden country. Drugs Context. 2020. https:\/\/doi.org\/10.7573\/dic.212598.","journal-title":"Drugs Context"},{"key":"918_CR8","unstructured":"Brasil, Minist\u00e9rio da Sa\u00fade. Comiss\u00e3o Nacional de Incorpora\u00e7\u00e3o de Tecnologias no SUS (CONITEC). Protocolo Cl\u00ednico e Diretrizes Terap\u00eauticas da Artrite Idiop\u00e1tica Juvenil 2020. Available from: https:\/\/www.gov.br\/conitec\/pt-br\/midias\/relatorios\/2020\/relatorio_pcdt_aij_artrite_aij_513_2020.pdf. Accessed May, 2023."},{"issue":"1","key":"918_CR9","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1097\/INF.0000000000001360","volume":"36","author":"C Guerrero-laleona","year":"2017","unstructured":"Guerrero-laleona C, Hern\u00e1ndez JC, Alonso MB, Albarova JG, Ildefonso MM, Iglesias-Jim\u00e9nez E, Noguera-Julian A. Diseminated Tuberculosis resulting from reinfection in a pediatric patient sequentially treated with etanercept and adalimumab. Pediatr Infect Dis J. 2017;36(1):109\u201310.","journal-title":"Pediatr Infect Dis J"},{"key":"918_CR10","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1093\/rheumatology\/keu457","volume":"54","author":"M Tarkiainen","year":"2015","unstructured":"Tarkiainen M, Tynjala P, Vahasalo P, Lahdenne P. Occurrence of adverse events in patients with JIA receiving biologic agents: long-term follow in a real-life setting. Rheumatology. 2015;54:1170\u20136.","journal-title":"Rheumatology"},{"key":"918_CR11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0128768","author":"YC Hsin","year":"2015","unstructured":"Hsin YC, Zhuang LZ, Yeh KW, Chang CW, Horng T, Huang J. Risk of Tuberculosis in children with juvenile idiopathic arthritis: a nationale population based study in Taiwan. Journalpone. 2015. https:\/\/doi.org\/10.1371\/journal.pone.0128768.","journal-title":"Journalpone"},{"key":"918_CR12","doi-asserted-by":"publisher","first-page":"e20200104","DOI":"10.1590\/0037-8682-0104-2020","volume":"53","author":"RB Aurilio","year":"2020","unstructured":"Aurilio RB, Marsili VV, Malaquias TSS, Kritski AL, Sant`Anna CC. The use of Gene-Xpert MTB RIF in the diagnosis of extrapulmonary Tuberculosis in childhood and adolescence. Rev Soc Bras Med Trop. 2020;53:e20200104.","journal-title":"Rev Soc Bras Med Trop"},{"issue":"6","key":"918_CR13","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1007\/s10787-021-00887-8","volume":"29","author":"DE Onmaz","year":"2021","unstructured":"Onmaz DE, Tezcan D, Abusoglu S, Yilmaz S, Yerlikaya FH, Onmaz M, Abusoglu G, Unlu A. Effects of hydroxychloroquine and its metabolites in patients with connective tissue Diseases. Inflammopharmacology. 2021;29(6):1795\u2013805.","journal-title":"Inflammopharmacology"},{"issue":"12","key":"918_CR14","first-page":"e32494","volume":"14","author":"GS Dhillon","year":"2022","unstructured":"Dhillon GS, Chauhan S, Jalal Y, Ghobrial Y, Ahmed B. Low-dose methotrexate toxicity presenting as Pancytopenia. Cureus. 2022;14(12):e32494.","journal-title":"Cureus"},{"key":"918_CR15","first-page":"281","volume":"45","author":"A Valido","year":"2020","unstructured":"Valido A, Silva-Dinis J, Saavedra MJ, Fonseca JE. Tuberculosis under anti-TNF therapy: case series of a center (reporting the experience from the period 2006\u20132019). Acta Reumatol port. 2020;45:281\u20137.","journal-title":"Acta Reumatol port"},{"key":"918_CR16","doi-asserted-by":"publisher","first-page":"e002726","DOI":"10.1136\/rmdopen-2022-002726","volume":"8","author":"GE Fragoulis","year":"2022","unstructured":"Fragoulis GE, Dey M, Zhao S, et al. Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic Infections in adults with autoimmune inflammatory rheumatic Diseases. RMD Open. 2022;8:e002726.","journal-title":"RMD Open"},{"key":"918_CR17","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s12969-018-0255-8","volume":"16","author":"G Ferrara","year":"2018","unstructured":"Ferrara G, Mastrangelo G, Barone P, La Torre F, Martino S, Pappagallo G, Ravelli A, Taddio A, Zulian F, Cimaz R. Methotrexate in juvenile idiopathic arthritis: advice and recommendations from the MARAJIA expert consensus meeting. Pediatr Rheumatol. 2018;16:46.","journal-title":"Pediatr Rheumatol"},{"issue":"7","key":"918_CR18","doi-asserted-by":"publisher","first-page":"2961","DOI":"10.1177\/0300060518771273","volume":"46","author":"E Dantes","year":"2018","unstructured":"Dantes E, et al. Lethal disseminated Tuberculosis in patients under biological treatment \u2013 two clinical cases and a short review. J Int Med Res. 2018;46(7):2961\u20139.","journal-title":"J Int Med Res"},{"key":"918_CR19","doi-asserted-by":"publisher","DOI":"10.1590\/1984-0462\/2024\/42\/2022084","author":"LM Lima","year":"2023","unstructured":"Lima LM, Aurilio RB, Parente AAAI, Sant`Anna MFB, Sant`Anna CC. Tuberculosis in children and adolescents with rheumatic Diseases using biologic agents: an integrative review. Rev Paul Pediatr. 2023. https:\/\/doi.org\/10.1590\/1984-0462\/2024\/42\/2022084.","journal-title":"Rev Paul Pediatr"}],"container-title":["Pediatric Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-023-00918-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12969-023-00918-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-023-00918-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T11:04:20Z","timestamp":1699614260000},"score":1,"resource":{"primary":{"URL":"https:\/\/ped-rheum.biomedcentral.com\/articles\/10.1186\/s12969-023-00918-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,10]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["918"],"URL":"https:\/\/doi.org\/10.1186\/s12969-023-00918-4","relation":{},"ISSN":["1546-0096"],"issn-type":[{"type":"electronic","value":"1546-0096"}],"subject":[],"published":{"date-parts":[[2023,11,10]]},"assertion":[{"value":"25 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 November 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures were performed in accordance with Brazilian local ethics regulations. The locally appointed ethics committee has approved the research protocol, under number CAAE45099121.3.0000.5264.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics and consent"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"136"}}