Systemic and localized infection by Candida species in patients with rheumatic diseases receiving anti-TNF therapy

详细信息    查看全文

• 作者：Nadia E. Aikawa^a ; ^b ; ^{nadia.aikawa@gmail.com} ; ^{nadia.aikawa@hc.fm.usp.br} ; Daniela T.A. Rosa^c ; ^d ; Gilda M.B. Del Negro^c ; ^d ; Julio C.B. Moraes^b ; Ana C.M. Ribeiro^b ; Carla Gonç ; alves Saad^b ; Clovis A. Silva^a ; ^b ; Eloisa Bonfá ; ^b
• 关键词：Systemic candidiasis ; Candida spp. ; Anti-TNF ; Rheumatoid arthritis ; Ankylosing spondylitis
• 刊名：Revista Brasileira de Reumatologia (English Edition)
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：56
• 期：6
• 页码：478-482
• 全文大小：477 K
• 卷排序：56

文摘

To evaluate the prevalence of systemic and localized infection by Candida species and its possible association with demographic, clinical and laboratory manifestations and therapy in patients with rheumatic diseases taking TNF blockers.MethodsConsecutive patients with rheumatic diseases receiving anti-TNF agents were included. The following risk factors up to four weeks prior to the study were analyzed: use of antibiotics, immunosuppressant drugs, hospitalization and invasive procedures. All subjects were evaluated for clinical complaints; specific blood cultures were obtained for fungi and blood samples were collected for Candida spp. detection by polymerase chain reaction.Results194 patients [67 with rheumatoid arthritis (RA), 47 with ankylosing spondylitis (AS), 36 with juvenile idiopathic arthritis (JIA), 28 with psoriatic arthritis and 16 with other conditions] were included. The average age of patients was 42 ± 16 years, with 68 (35%) male and mean disease duration of 15 ± 10 years. Sixty-four (33%) patients were receiving adalimumab, 59 (30%) etanercept and 71 (36%) infliximab. Eighty-one percent of patients were concomitantly taking immunosuppressant drugs. At the time of the study, only one (0.5%) patient had localized fungal infection (vaginal candidiasis). None of the patients included had systemic candidiasis with positive blood cultures for fungi or PCR positive for Candida spp. in peripheral blood sample.ConclusionsThis was the first study to assess the prevalence of invasive and localized fungal disease by Candida in a significant number of patients with rheumatic diseases on anti-TNF therapy, and demonstrated low risk of candidiasis, despite the high prevalence of immunosuppressive drug use.