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Sheriff MZ, Mansoor E, Luther J, Ananthakrishnan AN, Abou Saleh M, Ho E, Briggs FBS, Dave M. Opportunistic Infections Are More Prevalent in Crohn's Disease and Ulcerative Colitis: A Large Population-Based Study. Inflamm Bowel Dis 2020; 26:291-300. [PMID: 31314891 PMCID: PMC7327158 DOI: 10.1093/ibd/izz147] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Opportunistic infections (OIs) are more common in patients with inflammatory bowel disease (IBD); however, there have been limited large-scale studies of OIs in IBD. We investigated the epidemiological characteristics of OI in Crohn's disease (CD) and ulcerative colitis (UC) using a large population-based database. METHODS Data were collected from a commercial database (Explorys Inc., Cleveland, OH, USA) that provided electronic health records from 26 major integrated US health care systems from 1999 to March 2018. In this data set, we identified all CD and UC patients, based on Systemized Nomenclature of Medicine-Clinical Terms. Within these cohorts, we identified a variety of OIs and compared the prevalence rate of OI in individuals with IBD with that of controls (patients in the database between March 2013 and March 2018 without the diagnosis of IBD). RESULTS Explorys included 153,290 patients with CD and 128,540 patients with UC between March 2013 and March 2018. The prevalence of OIs was 17.8% in CD, 19.2% in UC, and 7% in non-IBD controls. When compared with non-IBD controls, all OIs were more common in CD (prevalence ratio [PR], 2.54; 95% confidence interval [CI], 2.51-2.57) and UC (PR, 2.74; 95% CI, 2.71-2.77). Overall, viral infections were numerically more common, whereas bacterial infections had the highest PRs in CD and UC when compared with controls without IBD. CONCLUSIONS We found significantly higher rates of OI in IBD. Our study suggests the need for close follow-up of IBD patients to diagnose and provide vaccinations where applicable for prevention of infections.
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Affiliation(s)
- Mohammed Zaahid Sheriff
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Emad Mansoor
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jay Luther
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mohannad Abou Saleh
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Edith Ho
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maneesh Dave
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA,Address correspondence to: Maneesh Dave, MD, MPH, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106 ()
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Posterior Reversible Encephalopathy Syndrome and Fatal Cryptococcal Meningitis After Immunosuppression in a Patient With Elderly Onset Inflammatory Bowel Disease. ACG Case Rep J 2016; 3:e98. [PMID: 27807560 PMCID: PMC5062660 DOI: 10.14309/crj.2016.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/28/2016] [Indexed: 02/06/2023] Open
Abstract
Advanced age and associated comorbidities are-recognized predictors of life-threatening adverse outcomes, such as opportunistic infection following immunosuppressive therapy. We describe the case of an elderly patient with stricturing colonic Crohn’s disease and significant clinical comorbidities, initially controlled with corticosteroid induction followed by infliximab, whose course was complicated by fatal disseminated cryptococcal infection and posterior reversible encephalopathy syndrome. Our patient’s case highlights rare, but serious, complications of immunosuppression. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this potentially vulnerable group, maximizing benefit and minimizing harm.
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Olsen GL, Deitz KL, Flaherty HA, Lockhart SR, Hurst SF, Haynes JS. Use of Terbinafine in the Treatment Protocol of Intestinal Cryptococcus neoformans in a Dog. J Am Anim Hosp Assoc 2012; 48:216-20. [DOI: 10.5326/jaaha-ms-5813] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 2.5 yr old sexually intact male vizsla was admitted to the Iowa State University Veterinary Teaching Hospital for persistent diarrhea, weight loss, and panhypoproteinemia. Examination revealed an emaciated condition and melena. Two masses were palpated in the cranial abdomen. Hematology and serum biochemistry exhibited a regenerative anemia and confirmed the presence of panhypoproteinemia, suggestive of a protein-losing eneteropathy. Distinct areas of thickened intestinal wall and enlarged mesenteric lymph nodes were found on abdominal ultrasound. Cytology from those nodes showed the presence of suspected Cryptococcus spp., and infection was confirmed utilizing a cryptococcal antigen titer. Medical therapy with lipid-complexed amphotericin B and fluconazole was unsuccessful. Two surgical procedures were performed to remove the affected areas of intestine and lymph nodes, but the disease persisted as evidenced by a persistently elevated cryptococcal antigen titer. Terbinafine was prescribed, which resulted in complete resolution of clinical signs and a steadily decreasing cryptococcal antigen titer. Very few cases of intestinal cryptococcosis have been reported. In this case, infection resulted in a protein-losing enteropathy. In addition, this article describes the use of terbinafine in the treatment of intestinal cryptococcal infection in the dog, which has not been previously reported.
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Affiliation(s)
- Gavin L. Olsen
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Krysta L. Deitz
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Heather A. Flaherty
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Shawn R. Lockhart
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Steven F. Hurst
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
| | - Joseph S. Haynes
- Department of Veterinary Clinical Sciences, Internal Medicine Services, Iowa State University Veterinary Teaching Hospital, Ames, IA (G.O., K.D., H.F., J.H.); and Antifungal Drug Unit, Fungal Reference Unit, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA (S.L., S.H.)
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