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Clemente D, Cuadros EN, Lovillo MC, Hernández JC, Martín SG, Silveira LF, Cruz MJL, Tagarro A, Rueda RMA, López López A, Aritziturri MS, Calvo C. Position statement on infection screening, prophylaxis, and vaccination of pediatric patients with rheumatic diseases and immunosuppressive therapies, part 3: precautions in situations of surgery, fever, and opportunistic infections. Eur J Pediatr 2024; 183:915-927. [PMID: 38047962 PMCID: PMC10912362 DOI: 10.1007/s00431-023-05295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
The objective of this study is to provide practical recommendations on the management of pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The recommendations specifically address the cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, invasive fungal disease). A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify publications on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the Infection Prevention and Treatment Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process; this was extended to members of the Spanish Society of Pediatric Rheumatology and Spanish Society of Pediatric Infectious Disease of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (totally disagree) to 10 (totally agree). Agreement was defined as a vote ≥ 7 by at least 70% of participants. The literature review included more than 400 articles. Overall, 63 recommendations (19 on surgery, fever, and opportunistic infections) were generated and voted by 59 pediatric rheumatologists and other pediatric specialists. Agreement was reached for all 63 recommendations. The recommendations on special situations cover management in cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, and invasive fungal disease). Conclusions: Hereby, we provided consensus and updated of recommendations about the management of special situations such as surgery, fever, and opportunistic in children with immune-mediated rheumatic diseases receiving immunosuppressive therapies. Several of the recommendations depend largely on clinical judgement and specific balance between risk and benefit for each individual and situation. To assess this risk, the clinician should have knowledge of the drugs, the patient's previous situation as well as the current infectious disease, in addition to experience. What is Known: • Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. • Information on how to manage the treatment in situations of fever, opportunistic infections, and surgery in children is limited, and guidelines for action are often extrapolated from adults. What is New: • In the absence of strong evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could support the clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.
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Affiliation(s)
- Daniel Clemente
- Pediatric Rheumatology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Esmeralda Núñez Cuadros
- Pediatric Rheumatology Unit, UGC Pediatría, Hospital Regional Universitario de Málaga, Instituto de investigación biomédica de Málaga (IBIMA), Málaga, Spain
| | - Marisol Camacho Lovillo
- Servicio de Inmunología, Hospital Universitario Virgen del Rocío, Reumatología e Infectología pediátricas, Seville, Spain
| | - Joan Calzada Hernández
- Unitat de Reumatologia Pediàtrica, Servei de Pediatria, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Sara Guillén Martín
- Department of Pediatrics, Hospital Universitario de Getafe, CIBERINFEC ISCIII, Carretera de Toledo Km 12, 500, 28905, Getafe, Madrid, Spain.
| | - Laura Fernández Silveira
- Servicio de Inmunología, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBIS), Reumatología e Infectología pediátricas, Seville, Spain
| | | | - Alfredo Tagarro
- Pediatrics Department. Hospital Universitario Infanta Sofía, Instituto de Investigación 12 de Octubre (imas12), Universidad Europea, Madrid, Spain
| | | | - Agustín López López
- Department of Paediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Cristina Calvo
- Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, La Paz Research Institute (IdiPaz), Translational Research Network of Pediatric Infectious Diseases (RITIP), CIBERINFEC ISCIII, Madrid, Spain
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2
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Clemente Garulo D, Núñez-Cuadros E, Camacho Lovillo M, Calzada-Hernández J, Guillén Martín S, Fernández Silveira L, Lirola Cruz MJ, Tagarro A, Alcobendas Rueda RM, López López A, Satrustegi Aritziturri M, Calvo C. Position statement on infection screening, prophylaxis, and vaccination in pediatric patients with rheumatic diseases and immunosuppressive therapies, part 2: infection prophylaxis. Eur J Pediatr 2023; 182:4271-4284. [PMID: 37439850 PMCID: PMC10570166 DOI: 10.1007/s00431-023-05080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/14/2023]
Abstract
This study aims to provide practical recommendations on prophylaxis for infection in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify articles that analyzed data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapy. The results were presented and discussed in a nominal group meeting comprising a committee of 12 pediatric rheumatologists from the Prevention and Treatment of Infections Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was extended to members of the Spanish Society of Pediatric Rheumatology and the Vaccine Advisory Committee of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (completely disagree) to 10 (completely agree). Agreement was considered to have been reached if at least 70% of participants voted ≥ 7. The literature review included more than 400 articles. Overall, 63 recommendations were generated (23 on infection prophylaxis) and voted by 59 pediatric rheumatologists and other pediatric specialists, all of whom achieved the pre-established level of agreement. The recommendations on prophylaxis of infection cover vaccination and prophylaxis against varicella zoster virus, tuberculosis, Pneumocystis jiroveccii, and invasive fungal infections in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. Conclusion: Based on current evidence and a Delphi process, we provided consensus and updated recommendations on prophylaxis and treatment of infections to guide those caring for pediatric rheumatology patients. What is Known: •Data largely derived from adults find that infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. •It is crucial to be aware of the preventive measures that should be implemented to prevent these infections in children, although most guidelines are often extrapolated from adult cases. What is New: •In the absence of evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could prove useful in clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists. •The recommendations focus on tuberculosis, herpes zoster virus, fungal infections, and Pneumocystis jirovecii.
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Affiliation(s)
| | - Esmeralda Núñez-Cuadros
- Pediatric Rheumatology Unit, UGC Pediatría, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Av. del Arroyo de los Ángeles, S/N, 29011, Málaga, Spain.
| | - Marisol Camacho Lovillo
- Servicio de Inmunología, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBIS), Reumatología E Infectología Pediátricas, Seville, Spain
| | - Joan Calzada-Hernández
- Unitat de Reumatologia Pediàtrica, Servei de Pediatria, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Sara Guillén Martín
- Department of Paediatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Laura Fernández Silveira
- Servicio de Inmunología, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBIS), Reumatología E Infectología Pediátricas, Seville, Spain
| | - María José Lirola Cruz
- Department of Paediatric Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain
| | - Alfredo Tagarro
- Pediatrics Department, Instituto de Investigación 12 de Octubre (imas12), Hospital Universitario Infanta Sofía, Universidad Europea, Hospital 12 de Octubre, Madrid, Spain
| | | | - Agustín López López
- Department of Paediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Cristina Calvo
- Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, and La Paz Research Institute (IdiPaz), Madrid, Spain
- Translational Research Network of Pediatric Infectious Diseases (RITIP). Madrid, Madrid, Spain
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3
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Antifungal susceptibilities of opportunistic filamentous fungal pathogens from the Asia and Western Pacific Region: data from the SENTRY Antifungal Surveillance Program (2011-2019). J Antibiot (Tokyo) 2021; 74:519-527. [PMID: 34188199 PMCID: PMC8241534 DOI: 10.1038/s41429-021-00431-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023]
Abstract
Antifungal surveillance is an important tool to monitor the prevalence of uncommon fungal species and increasing antifungal resistance throughout the world, but data comparing results across several different Asian countries are scarce. In this study, 372 invasive molds collected in the Asia-Western Pacific region in 2011-2019 were susceptibility tested for mold-active triazoles (isavuconazole, posaconazole, voriconazole, and itraconazole). The collection includes 318 Aspergillus spp. isolates and 53 non-Aspergillus molds. The MIC values using CLSI methods for isavuconazole versus Aspergillus fumigatus ranged from 0.25 to 2 mg l-1. Isavuconazole, itraconazole, posaconazole, and voriconazole acted similarly against A. fumigatus. The mold-active triazoles exhibited a wildtype phenotype to most of the Aspergillus spp. isolates tested (>94%), but poor activity against Fusarium solani species complex and Lomentospora prolificans. Voriconazole was most active against the Scedosporium spp. and posaconazole was most active against the Mucorales. In summary, isavuconazole displayed excellent activity against most species of Aspergillus and was comparable to other mold-active triazoles against non-Aspergillus molds.
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Zhao J, Weng W, Chen C, Zhang J. The prevalence and mortality of cryptococcal meningitis in patients with autoimmune diseases: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2021; 40:2515-2523. [PMID: 34258688 DOI: 10.1007/s10096-021-04293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022]
Abstract
Growing evidence suggests that autoimmune diseases (AIDs) are risk factors for cryptococcal meningitis (CM). Therefore, understanding the epidemiological and clinical profile of CM in patients with AIDs is important. This meta-analysis assessed the prevalence, clinical profiles, and clinical outcomes of CM in AIDs. Studies on CM in patients with AIDs were searched for in PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure, and meta-analyses were performed using the statistical program of R. Nineteen studies with 36,631 patients with AIDs were analyzed. The overall pooled CM prevalence was 0.4% (95% confidence interval [CI], 0.3-0.6%), 90.7% of which occurred in female patients. Thirteen studies with 77 patients with AIDs diagnosed with CM were analyzed, and the mortality rate was 26.7% (95% CI, 9.5-47.2%). Of patients with systemic lupus erythematosus, 30.1% of CM cases were initially misdiagnosed (95% CI, 0-65.6%). The primary symptom of CM with AIDs was headache (99.4%; 95% CI, 92.1-100%), followed by fever (93.7%; 95% CI, 82.8-100%) and vomiting (37.2%; 95% CI, 13.2-61.2%). The prevalence of CM infections among patients with AIDs should not be underestimated despite non-specific clinical presentations as there were fatal outcomes. Our results suggest that more research is needed to understand the relationship between AIDs and CM, and clinical trials are necessary to improve treatment strategies.
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Affiliation(s)
- Jing Zhao
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Weipin Weng
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chunli Chen
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jie Zhang
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China.
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Suwatanapongched T, Visoottiviseth Y, Watcharananan SP, Kanoksil W, Muntham D, Pornsuriyasak P. Clinical characteristics and CT manifestations of invasive pulmonary aspergillosis in hospitalised patients with systemic lupus erythematosus. Clin Radiol 2021; 76:548.e13-548.e23. [PMID: 33610288 DOI: 10.1016/j.crad.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/13/2021] [Indexed: 11/17/2022]
Abstract
AIM To investigate clinical and computed tomography (CT) findings of invasive pulmonary aspergillosis (IPA) in patients with systemic lupus erythematosus (SLE) and to explore the relationships of CT findings with clinical characteristics and outcomes. MATERIALS AND METHODS Clinical and CT findings of 14 SLE patients with proven (n=4) and probable (n=10) IPA between January 2006 and April 2013 were reviewed retrospectively and related to patients' outcomes. RESULTS All patients (mean age, 42.3 ± 15.1 years; 11 women, three men) had active SLE, prior corticosteroid, and/or immunosuppressive therapy. Dominant CT findings performed within 10 days of the clinical onset consisted of nodules/masses (100%, 14/14), consolidations (92.9%, 13/14), and ground-glass opacity (85.7%, 12/14). Bilateral, multilobar, and upper-lobe involvement was common. Regardless of dominant patterns, the halo, reversed halo, air-crescent, hypodense, and feeding vessel signs were found in 12 (85.7%), one (7.1%), three (21.3%), seven (50%), and seven (50%) patients, respectively. There was no significant difference in CT findings between the IPA alone (n=5) and co-infection (n=9) groups and between survived (n=4) and non-survived (n=10) patients. The IPA-alone group more frequently had alcohol consumption (p=0.018), haemoptysis (p=0.023), and disseminated aspergillosis (p=0.027) than did the co-infection group. Non-survived patients tended to be older and have a history of recent hospitalisation. CONCLUSIONS IPA is a rare, life-threatening disease affecting SLE patients in the early course of disease with high disease activity requiring corticosteroid and/or immunosuppressive therapy. Dominant CT findings are characteristics of angio-invasive form with a high frequency of the halo sign and bilateral, multilobar, and upper-lobe involvement.
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Affiliation(s)
- T Suwatanapongched
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Y Visoottiviseth
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S P Watcharananan
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W Kanoksil
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - D Muntham
- Section for Mathematics, Faculty of Science and Technology, Rajamangala University of Technology, Phranakhon Si Ayutthaya Province, Thailand
| | - P Pornsuriyasak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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6
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Lao M, Gong Y, Shen C, Wang C, Liang L, Zhan Z, Chen D. Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study. Clin Rheumatol 2020; 39:3071-3081. [PMID: 32246239 DOI: 10.1007/s10067-020-05068-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/26/2020] [Accepted: 03/23/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore the clinical features and associated factors of cryptococcosis in patients with connective tissue disease (CTD) from Southern China. METHODS Demographic and clinical data were collected between 2007 and 2018. Associated factors were analyzed by logistic regression analysis. RESULTS A total of 6809 inpatients with CTD were included. Cryptococcosis was diagnosed in 30 patients (prevalence, 0.4%). Cryptococcosis was predominant in patients with ANCA-associated vasculitis (AAV) (prevalence, 6/530, 1.1%). Lung was commonly involved (18/30, 60.0%), followed by meninges (6/30, 20.0%), blood stream (5/30, 16.7%), and disseminated cryptococcosis (involved blood stream and meninges) (1/30, 3.3%). Infiltrates (10/18, 55.6%) and small nodules (8/18, 44.4%) were the main radiographic manifestation of pulmonary cryptococcosis (PC). The positive rate of serum cryptococcal antigen (CrAg) in patients with PC was 88.2%. Cryptococcus spp. were found in 75% (3/4) patients who underwent lung biopsy. Most of the patients with cryptococcal meningitis (CM) had elevated cerebrospinal fluid (CSF) opening pressure (6/7, 85.7%) and decreased CSF glucose level (5/7, 71.4%). Positive blood culture confirmed the diagnosis of cryptococcal sepsis (CS). Three patients died (10.0%), including one with CM and two with PC. Multivariate logistic regression analysis showed that accumulated dose of glucocorticoid (GC) [odds ratio (OR) = 1.42, 95% confidence interval (CI) 1.04-1.93, P = 0.03] was associated with cryptococcosis in patients with CTD. CONCLUSIONS Cryptococcosis develops in various organs. Typical radiological manifestation accompanied with positive serum CrAg provides helpful clues for the diagnosis. Lumbar puncture is a critical diagnostic method to distinguish CM. The accumulated dose of GC is associated with cryptococcosis in patients with CTD. Key Points • Pulmonary cryptococcosis is suspected if pulmonary nodules adjacent to the pleura are present, with serum CrAg positive. • Cryptococcal meningitis has insidious onset and the diagnosis mainly depends on lumber puncture. • Cryptococcal sepsis is not rare and needs timely blood culture in suspected patients.
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Affiliation(s)
- Minxi Lao
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.,Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingying Gong
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chuyu Shen
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Cuicui Wang
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Liuqin Liang
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Zhongping Zhan
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Dongying Chen
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
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Candida bloodstream infection in patients with systemic autoimmune diseases. Med Mal Infect 2020; 50:372-376. [PMID: 32113868 DOI: 10.1016/j.medmal.2020.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/09/2019] [Accepted: 01/29/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the epidemiological, clinical and microbiological characteristics and mortality of patients with Candida bloodstream infection and systemic autoimmune diseases. METHODS We performed a retrospective multicenter study of candidemia in adults with systemic autoimmune diseases between 2010 and 2016. RESULTS Among 1040 patients with candidemia, 36 (3.5%) had a systemic autoimmune disease. The most common systemic autoimmune disease was rheumatoid arthritis (27.8%). The most common species was Candida albicans (66.7%). Twenty-two (61.1%) patients received a corticosteroid therapy and nine (25%) received an immunosuppressive therapy at the time of candidemia. The mortality rate was 27.8%. CONCLUSIONS Systemic autoimmune diseases are not common in patients with candidemia. The unadjusted mortality rate was comparable to other candidemia studies in the general population.
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8
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Rotjanapan P, Chen YC, Chakrabarti A, Li RY, Rudramurthy SM, Yu J, Kung HC, Watcharananan S, Tan AL, Saffari SE, Tan BH. Epidemiology and clinical characteristics of invasive mould infections: A multicenter, retrospective analysis in five Asian countries. Med Mycol 2018; 56:186-196. [PMID: 28525619 DOI: 10.1093/mmy/myx029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 04/03/2017] [Indexed: 12/12/2022] Open
Abstract
Formal, large-scale, multicenter studies of invasive mould infection (IMI) in Asia are rare. This 1-year, retrospective study was designed to assess the incidence and clinical determinants of IMI in centers in five countries (Thailand, Taiwan, Singapore, China, India). Patients treated in a single year (2012) were identified through discharge diagnoses, microbiology, and histopathology logs, and entered based on published definitions of IMI. A total of 155 cases were included (median age 54 years; 47.7% male). Of these, 47.7% had proven disease; the remainder had probable IMI. The most frequent host factors were prolonged steroid use (39.4%) and recent neutropenia (38.7%). Common underlying conditions included diabetes mellitus (DM; 30.9%), acute myeloid leukemia (19.4%), and rheumatologic conditions (11.6%). DM was more common in patients with no recent history of neutropenia or prolonged steroid use (P = .006). The lung was the most frequently involved site (78.7%), demonstrating a range of features on computed tomography (CT). Aspergillus was the most common mould cultured (71.6%), primarily A. fumigatus and A. flavus, although proportions varied in different centers. The most often used antifungal for empiric therapy was conventional amphotericin. Ninety-day mortality was 32.9%. This is the first multicenter Asian study of IMI not limited to specific patient groups or diagnostic methods. It suggests that DM and rheumatologic conditions be considered as risk factors for IMI and demonstrates that IMI should not be ruled out in patients whose chest features on CT do not fit the conventional criteria.
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Affiliation(s)
- P Rotjanapan
- Division of Infectious Diseases, Ramathibodi Hospital, Bangkok, Thailand
| | - Y C Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Y Li
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - S M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J Yu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - H C Kung
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - S Watcharananan
- Division of Infectious Diseases, Ramathibodi Hospital, Bangkok, Thailand
| | - A L Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - S E Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - B H Tan
- Department of Infectious Disease, Singapore General Hospital, Singapore, Singapore
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9
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Santamaría-Alza Y, Sánchez-Bautista J, Fajardo-Rivero JF, Figueroa CL. Invasive fungal infections in Colombian patients with systemic lupus erythematosus. Lupus 2018. [PMID: 29536803 DOI: 10.1177/0961203318763743] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction Systemic lupus erythematosus is an autoimmune disease with multi-organ involvement. Complications, such as invasive fungal infections usually occur in patients with a greater severity of the disease. Objective The objective of this study was to determine the prevalence and risk variables associated with invasive fungal infections in a Colombian systemic lupus erythematosus population. Materials and methods A cross-sectional, retrospective study that evaluated patients with systemic lupus erythematosus for six years. The primary outcome was invasive fungal infection. Descriptive, group comparison and bivariate analysis was performed using Stata 12.0 software. Results Two hundred patients were included in this study; 84.5% of the patients were women and the median age was 36 years; 68% of the subjects had haematological complications; 53.3% had nephropathy; 45% had pneumopathy and 28% had pericardial impairment; 7.5% of patients had invasive fungal infections and the most frequently isolated fungus was Candida albicans. Pericardial disease, cyclophosphamide use, high disease activity, elevated ESR, C3 hypocomplementemia, anaemia and lymphopenia had a significant association with invasive fungal infection ( P < 0.05). Conclusions We describe for the first time the prevalence of invasive fungal infection in a Colombian population with systemic lupus erythematosus, which was higher than that reported in other latitudes. In this population the increase in disease activity, the presence of pericardial impairment and laboratory alterations (anaemia, lymphopenia, increased ESR and C3 hypocomplementemia) are associated with a greater possibility of invasive fungal infections. Regarding the use of drugs, unlike other studies, in the Colombian population an association was found only with the previous administration of cyclophosphamide. In addition, patients with invasive fungal infections and systemic lupus erythematosus had a higher prevalence of mortality and hospital readmission compared with patients with systemic lupus erythematosus without invasive fungal infection.
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Affiliation(s)
- Y Santamaría-Alza
- 1 Internal Medicine Department, Industrial University of Santander, Bucaramanga, Colombia
| | - J Sánchez-Bautista
- 2 Centre for Infection and Inflammation Imaging Research, 1466 Johns Hopkins University , Baltimore, USA
| | - J F Fajardo-Rivero
- 3 Pulmonology Department, University Hospital of Santander, Bucaramanga, Colombia
| | - C L Figueroa
- 1 Internal Medicine Department, Industrial University of Santander, Bucaramanga, Colombia
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10
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Ge HF, Liu XQ, Zhu YQ, Chen HQ, Chen GZ. Invasive pulmonary fungal infections in patients with connective tissue disease: a retrospective study from northern China. Braz J Med Biol Res 2016; 49:e5531. [PMID: 27683823 PMCID: PMC5044799 DOI: 10.1590/1414-431x20165531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/25/2016] [Indexed: 11/21/2022] Open
Abstract
Invasive pulmonary fungal infection (IPFI) is a potentially fatal complication in patients with connective tissue disease (CTD). The current study aimed to uncover the clinical characteristics and risk factors of patients with IPFI-CTD. The files of 2186 CTD patients admitted to a single center in northern China between January 2011 and December 2013 were retrospectively reviewed. A total of 47 CTD patients with IPFI were enrolled into this study and assigned to the CTD-IPFI group, while 47 uninfected CTD patients were assigned to the control group. Clinical manifestations were recorded, and risk factors of IPFI were calculated by stepwise logistical regression analysis. Forty-seven (2.15%) CTD patients developed IPFI. Systemic lupus erythematosus patients were responsible for the highest proportion (36.17%) of cases with IPFI. Candida albicans (72.3%) accounted for the most common fungal species. CTD-IPFI patients had significantly elevated white blood cell count, erythrocyte sedimentation rate, C-reactive protein and fasting glucose values compared to controls (P<0.05). Cough, sputum and blood in phlegm were the most common symptoms. Risk factors of IPFI in CTD included maximum prednisone dose ≥30 mg/day within 3 months prior to infection, anti-microbial drug therapy, and interstitial pneumonia. CTD patients who have underlying interstitial pneumonia, prior prednisone or multiple antibiotics, were more likely to develop IPFI.
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Affiliation(s)
- H F Ge
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China
| | - X Q Liu
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China
| | - Y Q Zhu
- Laboratory Department, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China
| | - H Q Chen
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China
| | - G Z Chen
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China
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Silva MF, Ferriani MP, Terreri MT, Pereira RM, Magalhães CS, Bonfá E, Campos LM, Okuda EM, Appenzeller S, Ferriani VP, Barbosa CM, Ramos VC, Lotufo S, Silva CA. A Multicenter Study of Invasive Fungal Infections in Patients with Childhood-onset Systemic Lupus Erythematosus. J Rheumatol 2016; 42:2296-303. [PMID: 26568586 DOI: 10.3899/jrheum.150142] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To study the prevalence, risk factors, and mortality of invasive fungal infections (IFI) in patients with childhood-onset systemic lupus erythematosus (cSLE). METHODS A retrospective multicenter cohort study was performed in 852 patients with cSLE from 10 pediatric rheumatology services. An investigator meeting was held and all participants received database training. IFI were diagnosed according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria (proven, probable, and possible). Also evaluated were demographic, clinical, and laboratory data, and disease activity [SLE Disease Activity Index 2000 (SLEDAI-2K)], cumulative damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), treatment, and outcomes. RESULTS IFI were observed in 33/852 patients (3.9%) with cSLE. Proven IFI was diagnosed in 22 patients with cSLE, probable IFI in 5, and possible IFI in 6. Types of IFI were candidiasis (20), aspergillosis (9), cryptococcosis (2), and 1 each disseminated histoplasmosis and paracoccidioidomycosis. The median of disease duration was lower (1.0 vs 4.7 yrs, p < 0.0001) with a higher current SLEDAI-2K [19.5 (0-44) vs 2 (0-45), p < 0.0001] and current prednisone (PRED) dose [50 (10-60) vs 10 (2-90) mg/day, p < 0.0001] in patients with IFI compared with those without IFI. The frequency of death was higher in the former group (51% vs 6%, p < 0.0001). Logistic regression analysis revealed that SLEDAI-2K (OR 1.108, 95% CI 1.057-1.163, p < 0.0001), current PRED dose (OR 1.046, 95% CI 1.021-1.071, p < 0.0001), and disease duration (OR 0.984, 95% CI 0.969-0.998, p = 0.030) were independent risk factors for IFI (R(2) Nagelkerke 0.425). CONCLUSION To our knowledge, this is the first study to characterize IFI in patients with cSLE. We identified that disease activity and current glucocorticoid use were the main risk factors for these life-threatening infections, mainly in the first years of disease course, with a high rate of fatal outcome.
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Affiliation(s)
- Marco F Silva
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Mariana P Ferriani
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Maria T Terreri
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Rosa M Pereira
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Claudia S Magalhães
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Eloisa Bonfá
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Lucia M Campos
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Eunice M Okuda
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Simone Appenzeller
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Virgínia P Ferriani
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Cássia M Barbosa
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Valéria C Ramos
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Simone Lotufo
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Clovis A Silva
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo.
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Chen D, Xie J, Chen H, Yang Y, Zhan Z, Liang L, Yang X. Infection in Southern Chinese Patients with Systemic Lupus Erythematosus: Spectrum, Drug Resistance, Outcomes, and Risk Factors. J Rheumatol 2016; 43:1650-6. [DOI: 10.3899/jrheum.151523] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the spectrum, antibiotic-resistant pattern, risk factors, and outcomes of infection in patients hospitalized with systemic lupus erythematosus (SLE).Methods.We collected the clinical and microbiological data from hospitalized patients with SLE with infection between June 2005 and June 2015, and then conducted retrospective analyses.Results.Among our sample of 3815 hospitalized patients, 1321 (34.6%) were diagnosed with infection. The majority (78.3%) of infection occurred within 5 years of SLE onset. Bacterial infection was predominant (50.6%), followed by viral infection (36.4%) and fungal infection (12.5%). The lungs (33.7%) and upper respiratory tracts (26.3%) were most commonly affected. Gram-negative bacteria (GNB) were predominant over gram-positive bacteria (178 isolates vs 90 isolates). The most frequently isolated bacteria were Escherichia coli (24.6%), followed by Acinetobacter baumannii (13.4%) and coagulase-negative Staphylococcus (13.4%). Multidrug-resistant (MDR) strains were detected in 26.9% of bacterial isolates. The most common fungus was Candida spp. (99 episodes), followed by Aspergillus (24 episodes) and Cryptococcus neoformans (13 episodes). The overall mortality rate for this cohort was 2.2%; 48 patients died of infection. Factors associated with bacterial and viral infection were higher Systemic Lupus Erythematosus Disease Activity Index, renal involvement, thrombocytopenia, accumulated dose of glucocorticoids (GC), and treatment with cyclophosphamide (CYC). Renal involvement, accumulated dose of GC, and treatment with CYC were associated with fungal infection.Conclusion.Infection was the leading cause of mortality in patients hospitalized with SLE. There were some notable features of infection in Chinese patients including early onset, higher proportion of respiratory tract involvement, predominance of GNB with emergence of MDR isolates, and a variety of pathogens.
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Ramos-Casals M, Brito-Zerón P, Kostov B, Sisó-Almirall A, Bosch X, Buss D, Trilla A, Stone JH, Khamashta MA, Shoenfeld Y. Google-driven search for big data in autoimmune geoepidemiology: analysis of 394,827 patients with systemic autoimmune diseases. Autoimmun Rev 2015; 14:670-9. [PMID: 25842074 DOI: 10.1016/j.autrev.2015.03.008] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/30/2015] [Indexed: 01/08/2023]
Abstract
Systemic autoimmune diseases (SADs) are a significant cause of morbidity and mortality worldwide, although their epidemiological profile varies significantly country by country. We explored the potential of the Google search engine to collect and merge large series (>1000 patients) of SADs reported in the Pubmed library, with the aim of obtaining a high-definition geoepidemiological picture of each disease. We collected data from 394,827 patients with SADs. Analysis showed a predominance of medical vs. administrative databases (74% vs. 26%), public health system vs. health insurance resources (88% vs. 12%) and patient-based vs. population-based designs (82% vs. 18%). The most unbalanced gender ratio was found in primary Sjögren syndrome (pSS), with nearly 10 females affected per 1 male, followed by systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and antiphospholipid syndrome (APS) (ratio of nearly 5:1). Each disease predominantly affects a specific age group: children (Kawasaki disease, primary immunodeficiencies and Schonlein-Henoch disease), young people (SLE Behçet disease and sarcoidosis), middle-aged people (SSc, vasculitis and pSS) and the elderly (amyloidosis, polymyalgia rheumatica, and giant cell arteritis). We found significant differences in the geographical distribution of studies for each disease, and a higher frequency of the three SADs with available data (SLE, inflammatory myopathies and Kawasaki disease) in African-American patients. Using a "big data" approach enabled hitherto unseen connections in SADs to emerge.
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Affiliation(s)
- Manuel Ramos-Casals
- Josep Font Laboratory of Autoimmune Diseases, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
| | - Pilar Brito-Zerón
- Josep Font Laboratory of Autoimmune Diseases, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Belchin Kostov
- Primary Care Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Primary Care Centre Les Corts, CAPSE, Barcelona, Spain
| | - Antoni Sisó-Almirall
- Primary Care Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Primary Care Centre Les Corts, CAPSE, Barcelona, Spain
| | - Xavier Bosch
- Department of Internal Medicine, ICMiD, Hospital Clínic, Barcelona, Spain
| | - David Buss
- Josep Font Laboratory of Autoimmune Diseases, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Antoni Trilla
- Preventive Medicine and Epidemiology Unit, Hospital Clínic-Universitat de Barcelona, Barcelona Centre for International Health Research, Barcelona, Catalonia, Spain
| | - John H Stone
- Harvard Medical School, Boston, MA 02114, USA; Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College University, London, UK
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Invasive fungal disease in systemic lupus erythematosus: A systematic review of disease characteristics, risk factors, and prognosis. Semin Arthritis Rheum 2014; 44:325-30. [DOI: 10.1016/j.semarthrit.2014.06.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/11/2014] [Accepted: 06/22/2014] [Indexed: 11/20/2022]
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Faksri K, Kaewkes W, Chaicumpar K, Chaimanee P, Wongwajana S. Epidemiology and identification of potential fungal pathogens causing invasive fungal infections in a tertiary care hospital in northeast Thailand. Med Mycol 2014; 52:810-8. [PMID: 25231771 DOI: 10.1093/mmy/myu052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Invasive fungal infections (IFIs) are life threatening and associated with a high mortality rate. Here, we describe the distribution of pathogens, host risk factors, and significance of fungi isolated from patients with IFIs. The study included 861 fungal isolates recovered between 2006 and 2011 from 802 patients at Srinagarind Hospital, Thailand. Based on the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group 2008 criteria, 28.5% (245/861 isolates) of the fungal isolates were considered to be causative agents of IFIs. The most common fungus was Candida albicans (46%, 396/861 isolates). However, the most common yeast causing IFIs was Cryptococcus neoformans (34.7%, 85/245 isolates), while the most common mould was Penicillium marneffei (10.6%, 26/245 isolates). Cryptococcosis was significantly associated with human immunodeficiency virus infections (P < 0.001). Trend analysis revealed that there was no significant increase in IFI cases (P = 0.34) from 2006 to 2011 or from 2007 to 2011 (P = 0.05), but there was a trend toward significant increases in candidiasis (P = 0.04). The fungal isolates were categorized according to the positive predictive value of their recovery in cultures as being true (>95%), moderate (5%-95%), and rare (<5%) pathogens. This classification system could facilitate the prediction of the likelihood of diseases caused by the isolated fungi.
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Affiliation(s)
- Kiatichai Faksri
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Thailand
| | - Wanlop Kaewkes
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand
| | - Kunyaluk Chaicumpar
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand
| | - Prajuab Chaimanee
- Clinical Microbiology Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
| | - Suwin Wongwajana
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand
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Kourbeti IS, Mylonakis E. Fungal central nervous system infections: prevalence and diagnosis. Expert Rev Anti Infect Ther 2014; 12:265-73. [PMID: 24392732 DOI: 10.1586/14787210.2014.874282] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fungal infections of the central nervous system (CNS) are rare but they pose a significant challenge. Their prevalence spans a wide array of hosts including immunosuppressed and immunocompetent individuals, patients undergoing neurosurgical procedures and those carrying implantable CNS devices. Cryptococcus neoformans and Aspergillus spp. remain the most common pathogens. Magnetic resonance imaging can help localize the lesions, but diagnosis is challenging since invasive procedures may be needed for the retrieval of tissue, especially in cases of fungal abscesses. Antigen and antibody tests are available and approved for use in the cerebrospinal fluid (CSF). PCR-based techniques are promising but they are not validated for use in the CSF. This review provides an overview on the differential diagnosis of the fungal CNS disease based on the host and the clinical syndrome and suggests the optimal use of diagnostic techniques. It also summarizes the emergence of Cryptococcus gatti and an unanticipated outbreak caused by Exserohilum rostratum.
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Affiliation(s)
- Irene S Kourbeti
- Infectious Disease Division, Alpert Medical School and Brown University, Rhode Island Hospital, RI, USA
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Kim D, Cho SK, Sung YK. The Present and Future of Clinical Research for Korean Lupus Patients. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Dam Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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18
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Fei Y, Shi X, Gan F, Li X, Zhang W, Li M, Hou Y, Zhang X, Zhao Y, Zeng X, Zhang F. Death causes and pathogens analysis of systemic lupus erythematosus during the past 26 years. Clin Rheumatol 2013; 33:57-63. [PMID: 24046218 DOI: 10.1007/s10067-013-2383-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 07/23/2013] [Accepted: 08/26/2013] [Indexed: 11/24/2022]
Abstract
Different causes of mortality have been described over different decades followed by description of pathogens identified from infective episodes that led to death. A retrospective review was performed in 3,831 hospitalized systemic lupus erythematosus (SLE) patients in Peking Union Medical College Hospital from January 1986 to April 2012. The primary causes of death were identified, and the constituent ratio of specific death causes during different periods was compared. Among 3,831 hospitalized SLE patients, 268 patients died, accounting for 7.0 %. No significant difference of death rate was found between men and women, P = 0.404. The three most frequent death causes according to decade were as follows: for 1986-1995, renal involvement, lupus encephalopathy, and infections; for 1996-2005, infections, lupus encephalopathy, and renal involvement; and for 2006-2012, infections, lupus encephalopathy, and pulmonary hypertension. Certain types of deaths, primarily related to lupus activity, have decreased over time, whereas infections, often attributed to the use of corticosteroid and immunosuppressant medications, have increased gradually and changed to the most frequent death causes of SLE. Early mortality (<3 years) occurred more commonly in lupus encephalopathy, while late death (>3 years) happened more frequently in renal involvement, pulmonary artery hypertension, cardiovascular events, and cancer. In SLE death cases mainly dying from infection, mixed infections were more frequent than single pathogen infection (60.5 vs. 39.5 %), including common bacteria, fungal infection, and cytomegalovirus. Aspergillus fumigatus and Pneumocystis carinii were the two most commonly infected pathogens, and Cytomegalovirus was a frequent pathogen of mixed infection. Aggressive therapy has effectively reduced the mortality related to disease activity but also was associated with life-threatening infections. Mixed and fungal infection should be considered when SLE patients have severe infection.
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Affiliation(s)
- Yunyun Fei
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Robinett KS, Weiler B, Verceles AC. Invasive aspergillosis masquerading as catastrophic antiphospholipid syndrome. Am J Crit Care 2013; 22:448-51. [PMID: 23996427 DOI: 10.4037/ajcc2013659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
A 25-year-old woman with a history of systemic lupus erythematosus who was taking steroids came to the hospital because of vague signs and symptoms of weight loss, constipation, and oral ulcers. Multiorgan dysfunction developed, and catastrophic antiphospholipid syndrome was suspected. She was treated with an intravenous infusion of heparin, but she experienced a subdural hemorrhage and died on day 10 of the hospitalization. An autopsy revealed disseminated invasive aspergillosis. This case illustrates that invasive aspergillosis is a frequently missed diagnosis and should be part of the differential diagnosis for any patient who is immunosuppressed, including patients with autoimmune diseases such as systemic lupus erythematosus.
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Affiliation(s)
- Kathryn S. Robinett
- Kathryn S. Robinett and Avelino C. Verceles are assistant professors of medicine, Department of Medicine, Division of Pulmonary and Critical Care, and Bethany Weiler is a resident in internal medicine at the University of Maryland Medical Center, Baltimore, Maryland
| | - Bethany Weiler
- Kathryn S. Robinett and Avelino C. Verceles are assistant professors of medicine, Department of Medicine, Division of Pulmonary and Critical Care, and Bethany Weiler is a resident in internal medicine at the University of Maryland Medical Center, Baltimore, Maryland
| | - Avelino C. Verceles
- Kathryn S. Robinett and Avelino C. Verceles are assistant professors of medicine, Department of Medicine, Division of Pulmonary and Critical Care, and Bethany Weiler is a resident in internal medicine at the University of Maryland Medical Center, Baltimore, Maryland
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20
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Vinicki JP, Pellet SC, Pappalardo C, Cruzat VC, Spinetto MA, Dubinsky D, Tiraboschi IN, Laborde HA, Nasswetter G. Invasive fungal infections in Argentine patients with systemic lupus erythematosus. Lupus 2013; 22:892-8. [DOI: 10.1177/0961203313496342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Infections are the leading cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Invasive fungal infections (IFI) comprise a group of diseases caused by Cryptococcus, Histoplasma, Aspergillus and Candida. Few studies of IFI have been published in patients with SLE and associated factors have not been completely defined. Objectives The objectives of this paper are to estimate the frequency of IFI in admitted patients with SLE in our hospital, to determine the risk factors associated with IFI in our patients with SLE, and to compare IFI group with a control group (SLE without IFI). Methods The medical charts of patients with IFI (EORTC/MSG, 2008) and SLE (ACR, 1997) admitted to our hospital from June 2001 until June 2012 were reviewed. To identify factors associated with IFI, we developed a case-control study (SLE + IFI vs SLE alone) in a one to three ratio adjusted for sex and age and hospitalization for other reasons. Comparison was made of demographic characteristics, duration of disease and disease activity previous to IFI diagnosis, especially three months before fungal infection. We defined severe activity as SLEDAI ≥ 8. Infection by fungi of the genus Candida was considered only in its disseminated form. Results Ten cases of IFI were identified in 208 patients with SLE admitted between June 2001 and June 2012. We included 40 patients with SLE (10 with IFI and 30 controls). Of the SLE-IFI patients, eight were women and the average age was 27.5 years (range, 19–42 years). Fungal isolation: eight Cryptococcus neoformans, one Histoplasma capsulatum and one Candida albicans. Sites affected: five in peripheral blood, five in central nervous system (CNS), four in skin/soft tissue and one in pleura. Mortality was 40% ( p = 0.002), with Cryptococcus neoformans being the most common fungus. The SLE disease activity was severe in 70% of infected patients and no significant difference with the control group was found ( p = 0.195). We also found no association with leukopenia, lymphopenia, hypocomplementemia, hypogammaglobulinemia or anti-DNA positivity; neither with meprednisone doses >20 mg/day or intravenous methylprednisolone pulse therapy before fungal infection. The use of immunosuppressive therapy with azathioprine showed a significant association ( p = 0.017). Cyclophosphamide ( p = 0.100) or mycophenolate mofetil ( p = 0.256) did not show similar results. Conclusion The frequency of IFI in hospitalized SLE patients in our hospital was 4.8%. Cryptococcus neoformans was the most common etiologic agent and was primarily responsible for the deaths in this cohort. These data are consistent with publications in East Asia rather than North America where Candida spp. is more common. Unlike other publications, previous immunosuppression with azathioprine was the only risk factor associated with the development of the infection. Invasive fungal infection should be suspected in hospitalized patients with SLE and immunosuppression with CNS or atypical cutaneous manifestation of SLE in order to start appropriate treatment early and obtain better outcome.
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Affiliation(s)
| | | | | | | | | | | | - IN Tiraboschi
- División Infectología, Hospital de Clínicas, Universidad de Buenos Aires, Argentina
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21
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Strauß R. [Pulmonary and other aspergilloses in patients in the intensive care unit]. Mycoses 2013; 55 Suppl 2:25-9. [PMID: 22519629 DOI: 10.1111/j.1439-0507.2012.02180.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Strauß
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Erlangen, Deutschland.
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22
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Herbrecht R, Bories P, Moulin JC, Ledoux MP, Letscher-Bru V. Risk stratification for invasive aspergillosis in immunocompromised patients. Ann N Y Acad Sci 2012; 1272:23-30. [DOI: 10.1111/j.1749-6632.2012.06829.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Fulminant antiphospholipid antibody syndrome complicated by Aspergillus tracheobronchitis. Med Mycol Case Rep 2012; 1:99-102. [PMID: 24371751 DOI: 10.1016/j.mmcr.2012.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/09/2012] [Accepted: 10/09/2012] [Indexed: 11/22/2022] Open
Abstract
Aspergillus fumigatus is a filamentous mold that causes infections in patients who are inmmunocompromised. We report a case of Aspergillus tracheobronchitis in fulminant systemic lupus erythematosus case. Diagnosis with more invasive diagnostic procedures & aggressive antifungal therapy is indicated at early stage.
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Fan YC, Li WG, Zheng MH, Gao W, Zhang YY, Song LJ. Invasive fungal infection in patients with systemic lupus erythematosus: Experience from a single institute of Northern China. Gene 2012; 506:184-7. [PMID: 22750799 DOI: 10.1016/j.gene.2012.06.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 06/19/2012] [Indexed: 11/28/2022]
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Fernández-Ruiz M, Silva JT, San-Juan R, de Dios B, García-Luján R, López-Medrano F, Lizasoain M, Aguado JM. Aspergillus tracheobronchitis: report of 8 cases and review of the literature. Medicine (Baltimore) 2012; 91:261-273. [PMID: 22932790 DOI: 10.1097/md.0b013e31826c2ccf] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aspergillus tracheobronchitis (AT) is an infrequent but severe form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We reviewed 8 cases of AT diagnosed in our tertiary care center during an 18-year period, as well as 148 cases previously reported in the English literature from 1985 to July 2011. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression. Solid organ transplantation (SOT) (44.2%), hematologic malignancy (21.2%), neutropenia (18.7%), and chronic obstructive pulmonary disease (15.4%) were the most common underlying conditions reported. Most cases occurred in patients receiving long-term corticosteroid treatment (71.8%) or chemotherapy (25.0%). Fever and respiratory complaints (cough, dyspnea, stridor, or wheezing) were the most frequent symptoms; one-third of patients developed acute respiratory distress at presentation, and 15.1% were asymptomatic at the time of diagnosis. Initial imaging studies were not informative in 47.4% of the cases. Aspergillus fumigatus was the predominant species (74.4%). The pseudomembranous form was the most commonly observed (31.9% of cases) and was more frequent in neutropenic patients (p = 0.007), whereas ulcerative AT (31.2%) was associated with SOT (p = 0.001). The most frequent antifungal monotherapy regimens were amphotericin B deoxycholate (23.1%) and itraconazole (18.6%), whereas combined therapy was administered in 35.9% of the cases. Overall inhospital mortality was 39.1%, with neutropenia (odds ratio [OR], 20.47; p < 0.001) and acute respiratory distress at presentation (OR, 9.54; p = 0.002) as independent prognostic factors. Our pooled analysis of the literature shows that AT remains a rare opportunistic infection with a nonspecific presentation and a variable course depending on the nature of the predisposing factor.
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Affiliation(s)
- Mario Fernández-Ruiz
- From the Unit of Infectious Diseases (MFR, RSJ, BdD, FLM, ML, JMA), Instituto de Investigación Hospital "12 de Octubre" (i+12), and Department of Pneumology (RGL), Hospital Universitario "12 de Octubre," Madrid; and Department of Internal Medicine (JTS), Hospital Infanta Cristina, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
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BARBER CLAIREE, BARNABE CHERYL. Another Consequence of Severe Lupus: Invasive Fungal Disease. J Rheumatol 2012; 39:1772-4. [DOI: 10.3899/jrheum.120707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Martínez-Martínez MU, Herrera-Van Oostdam D, Román-Acosta S, Magaña-Aquino M, Baranda-Cándido L, Abud-Mendoza C. Invasive fungal infections in patients with systemic lupus erythematosus. J Rheumatol 2012; 39:1814-8. [PMID: 22707608 DOI: 10.3899/jrheum.111498] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Invasive fungal infections (IFI) are catastrophic diseases associated with a high mortality. Relatively few cases of IFI have been described in systemic lupus erythematosus (SLE) and their related factors have not been completely explored. We evaluated factors associated with IFI in patients with SLE. METHODS All patients with both IFI and SLE admitted to our hospital in the last 7 years were evaluated and each was compared with 5 hospitalized patients with SLE (controls). Demographic factors, duration of SLE, and treatment in the previous month were compared. RESULTS Sixty patients with SLE were evaluated (10 with IFI and 50 controls). Median age was 29 years. High C-reactive protein levels were associated with IFI, along with other factors such as high disease activity, mechanical ventilation, treatment with antibiotics, hemodialysis, high doses of glucocorticoids (GC), and treatment with mycophenolate mofetil. Mortality was 4 times more frequent in patients with IFI than in SLE patients without the deep fungal infection. CONCLUSION IFI is a rare infection observed in patients with rheumatic diseases. We describe factors associated with IFI in patients with SLE. IFI is associated with elevated morbidity and mortality. Early diagnosis and treatment are desirable.
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Affiliation(s)
- Marco Ulises Martínez-Martínez
- Regional Unit of Rheumatology and Osteoporosis, Central Hospital Dr. Ignacio Morones Prieto, and Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Av. V. Carranza 2395, San Luis Potosí, S.L.P., Mexico, 78240
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Invasive fungal infection in Chinese patients with systemic lupus erythematosus. Clin Rheumatol 2012; 31:1087-91. [DOI: 10.1007/s10067-012-1980-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 03/13/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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Silva MF, Ribeiro AS, Fiorot FJ, Aikawa NE, Lotito AP, Campos LM, Mauad T, Silva CA. Invasive aspergillosis: a severe infection in juvenile systemic lupus erythematosus patients. Lupus 2012; 21:1011-6. [PMID: 22451602 DOI: 10.1177/0961203312442752] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infections are an important cause of morbidity and mortality in juvenile systemic lupus erythematosus (JSLE). Among them, invasive aspergillosis (IA), which is usually related to immunosuppressed patients, has been rarely reported in JSLE. From 1983 to 2011, 5604 patients were followed at our institution and 283 (5%) met the American College of Rheumatology (ACR) classification criteria for SLE. Six (2.1%) of our JSLE patients had IA. One of them was previously reported and five will be described herein. Four of them were female. The median age at JSLE diagnosis was 12 years (8–16) and the median interval between diagnosis of JSLE and IA was 6 months (1–38). All had pulmonary involvement and three of them had systemic involvement. The median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was 19 (7–22). Diagnosis of IA was performed by isolation of Aspergillus spp., two in bronchoalveolar lavage culture and by way of autopsy in the others. All of them were treated with corticosteroids and/or immunosuppressive drugs at IA diagnosis (azathioprine and/or intravenous cyclophosphamide). They all required treatment in the pediatric intensive care unit with mechanical ventilation and antifungal therapy (fluconazole, amphotericin B, itraconazole and/or voriconazole); nonetheless, none of them survived. In conclusion, this was the first report that evaluated the prevalence of IA in a large population of JSLE patients from a tertiary pediatric hospital, and clearly showed the severity of the outcome, especially in patients with active disease and treated with immunosuppressive agents. This study reinforces the importance of early diagnosis and treatment with certain antifungals, especially in critically ill patients.
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Affiliation(s)
- MF Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - AS Ribeiro
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - FJ Fiorot
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - NE Aikawa
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
- Division of Rheumatology, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - AP Lotito
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - LM Campos
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - T Mauad
- Department of Pathology, Faculdade de Medicina da Universidade São Paulo, Brazil
| | - CA Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo, Brazil
- Division of Rheumatology, Faculdade de Medicina da Universidade São Paulo, Brazil
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Ritchie J, Smyth A, Tower C, Helbert M, Venning M, Garovic V. Maternal deaths in women with lupus nephritis: a review of published evidence. Lupus 2012; 21:534-41. [PMID: 22311940 DOI: 10.1177/0961203311434939] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Pregnancies in women with systemic lupus erythematosus (SLE) and lupus nephritis are considered high-risk due to high rates of maternal and fetal complications. However, there has not been a formal analysis addressing the issue of maternal deaths in these women. The aim of this study was to perform a literature review of the maternal deaths in women with SLE and lupus nephritis to: (1) identify the main causes of death and (2) discuss possible reasons for these causes, and strategies that may improve patient care and outcomes. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENT: We performed an extensive electronic literature search from 1962 to 2009 using online databases (PubMed, Embase, Lilacs, Cochrane Controlled Trials Register, Medline, and Science Citation Index). Studies were included if they reported pregnancies in patients with SLE and lupus nephritis with at least one reported maternal death. RESULTS We identified 13 studies that reported a total of 17 deaths in the 6 week post-partum period that were attributable to SLE and lupus nephritis. In all cases, death occurred in the setting of active disease, and was attributed either to infection in 41.2% (n = 7), or disease activity in 29.4% (n = 5). The remaining deaths were due to pulmonary embolus in 11.8% (n = 2), pregnancy-associated cardiomyopathy in 5.9% (n = 1), adrenal failure due to abrupt steroid withdrawal in 5.9% (n = 1), and undefined in 5.9% (n = 1). CONCLUSIONS All maternal deaths in patients with SLE and lupus nephritis occurred in those with active disease, with disease activity/complications and infections (mainly opportunistic) being the two major causes. The presented evidence further supports timing of pregnancy relative to SLE activity, and the judicious use of immunosuppressive agents in pregnant patients.
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Affiliation(s)
- J Ritchie
- Vascular Research Group, Manchester Academic Health Science Centre, University of Manchester, Salford Royal Hospital, UK
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Slavin MA, Chakrabarti A. Opportunistic fungal infections in the Asia-Pacific region. Med Mycol 2012; 50:18-25. [DOI: 10.3109/13693786.2011.602989] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Hsiue HC, Wu TH, Chang TC, Hsiue YC, Huang YT, Lee PI, Hsueh PR. Culture-positive invasive aspergillosis in a medical center in Taiwan, 2000–2009. Eur J Clin Microbiol Infect Dis 2011; 31:1319-26. [DOI: 10.1007/s10096-011-1445-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 10/01/2011] [Indexed: 10/16/2022]
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Matsumura M, Kawamura R, Inoue R, Yamada K, Kawano M, Yamagishi M. Concurrent presentation of cryptococcal meningoencephalitis and systemic lupus erythematosus. Mod Rheumatol 2010; 21:305-8. [PMID: 21188455 PMCID: PMC3110276 DOI: 10.1007/s10165-010-0383-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 11/01/2010] [Indexed: 11/02/2022]
Abstract
Cryptococcal meningitis is a recognized complication of systemic lupus erythematosus (SLE), with high mortality rates, particularly in those treated with immunosuppressive agents. We describe a patient diagnosed simultaneously with cryptococcal meningoencephalitis and SLE and reviewed four similar cases reported in the literature. In our case, profound low CD4 lymphocyte count and low complement levels were observed. The patient was treated with prednisolone, fluconazole, and 5-flucytosine and evinced good clinical improvement. This case suggests that intrinsic immunological abnormality related to SLE predisposed to opportunistic infections.
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Affiliation(s)
- Masami Matsumura
- Research Center for Medical Education, Kanazawa University Graduate School of Medicine, Takara-machi 13-1, Kanazawa, Ishikawa 920-8641, Japan.
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Pagano L, Akova M, Dimopoulos G, Herbrecht R, Drgona L, Blijlevens N. Risk assessment and prognostic factors for mould-related diseases in immunocompromised patients. J Antimicrob Chemother 2010; 66 Suppl 1:i5-14. [DOI: 10.1093/jac/dkq437] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Weng CT, Lee NY, Liu MF, Weng MY, Wu AB, Chang TW, Lin TS, Wang JY, Chang HY, Wang CR. A retrospective study of catastrophic invasive fungal infections in patients with systemic lupus erythematosus from southern Taiwan. Lupus 2010; 19:1204-9. [PMID: 20515999 DOI: 10.1177/0961203310368969] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As very few large scale publications of invasive fungal infection (IFI) have been reported in lupus patients from individual medical centers, a retrospective study was performed from 1988 to 2009 in southern Taiwan. Demographic characteristics, clinical and laboratory data, and mycological examinations were analyzed. Twenty cases with IFI were identified in 2397 patients (0.83% incidence). There were 19 females and one male with an average age of 31.8 +/- 12.6. Involved sites included eight disseminated cases, six central nervous system, four lungs, one abdomen and one soft tissue. IFI contributed to a high mortality with 10 deaths (50%), and there were no survivors for the disseminated cases and Candida-infected patients. High activity (Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) > 8) was noted in 50% of IFI episodes. The survival from IFI diagnosis to death was only 7.7 +/- 4.2 days, all in a rapid course. No statistical difference was found between survivors and non-survivors when comparing their SLEDAI. Eighty-five percent of IFI episodes under high dosages of corticosteroids therapy and 95% of patients had lupus nephritis. There was an increased risk of IFI in the lupus patients receiving high daily dosage of prednisolone therapy. Critical information from analyses of the present large series could be applied into clinical practices to reduce the morbidity and mortality in such patients.
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Affiliation(s)
- C-T Weng
- Section of Rheumatology and Immunology, National Cheng Kung University Hospital and Dou-Liou Branch, Tainan, Taiwan, Republic of China
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