Review article

SCREENING FOR OPPORTUNISTIC INFECTIONS AND VACCINATION BEFORE INTRODUCTION OF BIOLOGIC THERAPY

BRANKICA MIJANDRUŠIĆ SINČIĆ ; Division of Gastroenterology, Department of Internal Medicine, Rijeka Clinical Hospital Center School of Medicine, University of Rijeka, Rijeka, Croatia
ADRIANA VINCE ; Dr Fran Mihaljević Clinical Hospital for Infectious Diseases, School of Medicine, University of Zagreb, Zagreb, Croatia

Abstract

Patients on anti-TNFmedications carry a higher risk for developing opportunistic infections. In order to introduce anti-TNFα therapy, screening for hepatitis viruses B and C, HIV, EBV, HPV, TBC, bacterial, fungal and parasitic infections should be performed. Screening involves patient’s history of earlier infectious diseases, vaccinations and traveling to parts of the world with endemic diseases. Clinical examination should be supplemented with stomatologic and gynecologic exams. Laboratory results include leukogram, transaminases, C-reactive protein, urine analysis, hepatitis B, C, HIV and EBV serology. Varicella zoster virus serology depends on past medical history. If the patient has traveled to tropical areas, both stool analysis and strongiloidiasis serology should be performed. Other mandatory examinations include chest radiography, PPD and TBC serology using interferon gamma release test (IGRA). If suspecting intra-abdominal abscess, magnetic resonance of the abdomen is recommended. In case of abscess, CMV or Clostridium difficile colitis anti-TNF-therapy is contraindicated. Live vaccine application is contraindicated in patients receiving anti-TNFtherapy. All seronegative patients should be vaccinated against hepatitis B virus. Seasonal flu vaccination is recommended to be applicated yearly and pneumococcal polysaccharide vaccine once in every five years. Based on the past medical history and serologic results, patients are vaccinated against VZV with extra precaution. Human papilloma virus vaccination is performed in a group of women under 23 years of age, after gathering cervical smear sample analysis.

Keywords

anti-TNFα; opportunistic infections; vaccination

Hrčak ID:

111690

URI

https://hrcak.srce.hr/111690

Publication date:

28.11.2013.

Article data in other languages: croatian

Visits: 2.202 *