Looking in the Crystal Ball for TB and CMV in Adult and Pediatric Patients: Are Immunodiagnostics the Future?

This activity offers CE credit for:
1. Physicians (CME)
2. Nurses (CNE)

Credit Expiration Date: January 27, 2018

Faculty

Camille Nelson Kotton, MD, FIDSA
Clinical Director
Transplant Immunocompromised Host Infectious Diseases,
Infectious Diseases Division, Massachusetts General Hospital
Associate Professor, Harvard Medical School
Boston, Massachusetts

Lara A. Danziger-Isakov, MD, MPH
Director, Transplant Infectious Diseases
Professor, UC Department of Pedatrics
Cincinnati Children’s Hospital Medical Center
Cincinnati, Ohio

Russell W. Steele, MD
Division Head, Pediatric Infectious Diseases
Ochsner Health Center For Children - New Orleans
New Orleans, Louisiana

Statement of Need

Tuberculosis infection most often threatens immunocompromised patients, especially those involved in transplant surgery. As one study found, “[t]he incidence of tuberculosis among such persons is 20–74 times higher than that for the general population, with a mortality rate of up to 30%.”1 Typically, transplant patients are most vulnerable to an incidence of reactivated latent tuberculosis stemming from a previous exposure to TB. CMV is also a serious threat to immunocompromised patients. Cytomegalovirus is an important cause of morbidity and mortality in children who have received organ transplants.2 Identifying more strategies for “harnessing the host immune response to CMV” would greatly reduce the negative impact that CMV has on immunocompromised individuals, particularly transplant patients.3 This program will inform health care providers about the importance of screening for TB in both adult and pediatric patients (especially in transplant/immunocompromised patients) and look into the relationship of IGRAs and their utility in screening for TB, as well as using them as an accurate predictor of CMV infection. In today’s global society, children in the US can be at risk for TB infection for many reasons. Travel to TB-endemic countries likely plays an important part in the etiology of pediatric TB infection and disease,4 as children can travel for extended time periods to visit family in high‐risk areas. Young children who are US born of foreign‐born parents have relatively high rates of TB and account for most cases in children under 5 years of age.5 Also, international adoptees have significant risk of LTBI.6 Prompt diagnosis and treatment of adult source cases, effective contact investigations prioritizing young contacts, and targeted testing and treatment of latent TB infection are necessary to reduce TB morbidity in this population.5 Pediatricians and clinicians treating pediatric patients need to see current data on TB screening and treatment to see how best to prevent active TB disease in young children.1

  1. Munoz, P, Rodriguez, C, Bouza, E. Mycobacterium tuberculosis Infection in Recipients of Solid Organ Transplants. Clin Infect Dis. 2005:581-587.
  2. Martin JM, Danziger-Isakov LA. Pediatr Transplant. 2011 May;15(3):229-36.
  3. La Rosa, C, Diamond, DJ. The immune response to human CMV. Future Virol. 2012 Mar; 7(3):279-293.
  4. Rayment JH, Guthrie JL, Lam K et al. “Culture‐positive Pediatric Tuberculosis in Toronto, Ontario: Sources of Infection and Relationship of Birthplace and Mycobacterial Lineage to Phenotype.” Pediatr Infect Dis J. 2016 Jan;35(1):13‐8.
  5. Pang J, Teeter LD, Katz DJ et al. “Epidemiology of tuberculosis in young children in the United States.” Pediatrics. 2014 Mar;133(3):e494‐504.
  6. Mandalakas AM, Kirchner HL, Zhu X, Yeo KT, Starke JR. “Interpretation of repeat tuberculin skin testing in international adoptees: conversions or boosting.” Pediatr Infect Dis J. 2008 Oct;27(10):913‐9.

Activity Goal

This program will inform health care providers about the importance of screening for CMV infection in transplant/ immunocompromised patients, and will look into IGRAs and their utility as an accurate predictor of CMV infection.

Learning Objectives

At the end of this CME activity, participants should be able to:

 

  1. Identify the clinical utility of immunodiagnostics when testing adult and pediatric immunocompromised patients for TB
  2. Review the epidemiology and incidence of TB and CMV infections in adult immunocompromised patients
  3. Describe the clinical value of immunodiagnostics on pre-emptive or prophylaxis strategies for CMV

Target Audience

The target audience of this program are physicians, surgeons, scientists, nurses, organ procurement personnel, and pharmacists who are interested in infectious disease research and patient care, for both adult and pediatric patients. This program is also intended for healthcare providers interested in the clinical and research aspects of solid organ transplantation.

Financial Support

This program is supported by an educational grant from Oxford Immunotec, Inc.

Credit Information

Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of CME Outfitters, LLC and Jespersen & Associates, LLC. CME Outfitters, LLC is accredited by the ACCME to provide continuing medical education for physicians.

CME Outfitters, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CNE Credit (Nurses): Provider approved by the California Board of Registered Nursing, Provider Number CEP 15510, for 1.0 contact hours.

Post-tests, credit request forms, and activity evaluations must be completed online at www.cmeoutfitters.com/JA044 (requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit www.neurosciencecme.com/technical.asp.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of its CME/CE activities. Faculty must disclose to the participants any relationships with the commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CME/CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Camille Nelson Kotton, MD, FIDSA : no relationship to disclose

Lara A. Danziger-Isakov, MD, MPH: no relationship to disclose

Russell W. Steele, MD: no relationship to disclose

Jeffrey Helfand, DO (peer reviewer): no relationships to disclose

Caitlin Harrington (planning committee): no relationships to disclose

Unlabeled Use Disclosure

Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. 

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).