title: Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor alpha antagonists.
abstract: OBJECTIVE
  To describe a group of patients who were treated with tumor necrosis factor alpha (TNF alpha) antagonists and who developed coccidioidomycosis, and to test the hypothesis that patients with inflammatory arthritis receiving TNF alpha antagonist therapy are at higher risk for developing symptomatic coccidioidomycosis.
  
  
  METHODS
  Cases of coccidioidomycosis were identified and reviewed from among patients receiving TNF alpha antagonist therapy from May 1998 through February 2003 in 5 practices within the areas endemic for coccidioidomycosis (Arizona, California, and Nevada). In addition, the relative risk of developing symptomatic coccidioidomycosis was calculated in patients with inflammatory arthritis who were receiving treatment with infliximab, in comparison with patients with inflammatory arthritis who were not receiving infliximab, from January 2000 to February 2003 in a single medical center.
  
  
  RESULTS
  Thirteen cases of documented coccidioidomycosis were associated with TNF alpha antagonist therapy. Twelve cases were associated with the use of infliximab and 1 case with etanercept. Among the cohort of patients from a single medical center, 7 of the 247 patients receiving infliximab and 4 of the 738 patients receiving other therapies developed symptomatic coccidioidomycosis (relative risk 5.23, 95% confidence interval 1.54-17.71; P < 0.01).
  
  
  CONCLUSIONS
  Patients with inflammatory arthritis who are undergoing treatment with infliximab appear to be at higher risk for developing symptomatic coccidioidomycosis as compared with those not receiving infliximab.
authors.affiliation: University of Arizona, Tucson, 85724, USA. laurieb@arthritis.arizona.edu
authors.forename: Laurie
authors.initials: L
authors.lastname: Bergstrom
authors.forename: David E
authors.initials: DE
authors.lastname: Yocum
authors.forename: Neil M
authors.initials: NM
authors.lastname: Ampel
authors.forename: Isidro
authors.initials: I
authors.lastname: Villanueva
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lisse
authors.forename: Oscar
authors.initials: O
authors.lastname: Gluck
authors.forename: John
authors.initials: J
authors.lastname: Tesser
authors.forename: James
authors.initials: J
authors.lastname: Posever
authors.forename: Margaret
authors.initials: M
authors.lastname: Miller
authors.forename: Julio
authors.initials: J
authors.lastname: Araujo
authors.forename: Dana M
authors.initials: DM
authors.lastname: Kageyama
authors.forename: Martin
authors.initials: M
authors.lastname: Berry
authors.forename: Linda
authors.initials: L
authors.lastname: Karl
authors.forename: Christianne M
authors.initials: CM
authors.lastname: Yung
mesh_terms: D000208:Acute Disease; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology*; D003047:Coccidioidomycosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab