Role for @entity379 release assays in XXXX screening before @entity310 antagonist therapy.

@entity1 @entity310 @entity9178 @entity262 @entity379 @entity378
@entity310 antagonist therapy is associated with a risk of severe, extrapulmonary, disseminated @entity378 , which is fatal in 10% of cases. The risk of @entity378 is increased four-fold in @entity1 on @entity310 antagonist therapy. The main risk factors are a history of untreated or inadequately treated @entity378 , recent contact with a @entity378 @entity1 , and residence in or travel to a high-endemicity region. Infection surveillance agencies throughout the world have issued recommendations to ensure the detection and treatment of @entity9178 before @entity310 antagonist initiation. These recommendations have returned the incidence of @entity378 to the level seen before the introduction of @entity310 antagonists. Nevertheless, there is still room for improvement. Recommendations about @entity9178 screening include the use of tuberculin skin tests. However, these tests are positive in individuals vaccinated with the BCG vaccine, which leads to overuse of @entity378 chemoprophylaxis and, therefore, to unnecessary @entity1 exposure to hepatotoxic effects. Furthermore, tuberculin skin tests may be falsely negative in immunosuppressed @entity1 , leading to underuse of @entity378 prophylaxis. These shortcomings of tuberculin skin tests have generated interest in @entity379 release assays (IGRAs). In @entity1 with overt @entity378 , IGRAs are more sensitive and more specific than tuberculin skin tests. However, the accuracy of IGRAs for diagnosing @entity9178 remains unknown, because no reference standard is available. In addition, @entity1 taking immunosuppressant agents to treat @entity262 may exhibit anergia, which complicates the interpretation of IGRAs. Until additional data become available, caution requires that IGRAs be used only when a positive or negative result, as assessed on a case-by-case basis, will help to decide whether @entity378 chemoprophylaxis is in order.
