[Infections in polymyositis and in dermatomyositis].
Infections result in increased mortality rates in patients with polymyositis/dermatomyositis, leading to death in 9 to 30% of cases. The following parameters can be considered of predictive value for infection onset in polymyositis/dermatomyositis: age, lymphopenia, esophageal dysfunction, ventilatory insufficiency, interstitial lung disease, calcinosis cutis, as well as higher mean daily doses of steroids. A great variety of microorganisms may be responsible for pyogenic and opportunistic infections in polymyositis/dermatomyositis. Opportunistic infections are more often due to mycobacteria and fungi (Pneumocystis jiroveci, Candidasp.). Because a great variety of microorganisms may be responsible for opportunistic infections, it seems difficult to initiate primary prophylaxis in patients with polymyositis/dermatomyositis who exhibit risk factors for opportunistic infections. Primary prophylaxis of Pneumocystis jirovecipneumonia should be given in the group of patients exhibiting CD4-cell count lower than 250/mm(3). Vaccination should be performed in patients with polymyositis/dermatomyositis, prior to immunosuppressive therapy institution.
Marie
Isabelle
I
Département de Médecine Interne, CHU Rouen, F-76031 Rouen Cedex, France. isabelle.marie@chu-rouen.fr
D003882:Dermatomyositis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007239:Infections / Q000453:epidemiology* / Q000401:mortality; D009164:Mycobacterium Infections / Q000453:epidemiology; D009181:Mycoses / Q000453:epidemiology; D009894:Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology; D017285:Polymyositis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011237:Predictive Value of Tests; D014611:Vaccination / Q000379:methods; D014612:Vaccines / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D014612:Vaccines