[Non tuberculous anti-TNF associated opportunistic infections].
Anti-TNFalpha agents have revolutionized the treatment of patients with rheumatoid arthritis, spondylarthropathies and Crohn's disease. However, their use is associated with an increased risk of infections. Pyogenic infections (involving the lungs, skin and urinary tract) and tuberculosis are the more commonly observed infectious complications in patients receiving anti-TNFalpha agents. However, opportunistic infections have been increasingly reported in anti-TNFalpha-treated patients, and include non tuberculous mycobacteria, fungi (Pneumocystis jiroveci, Candida sp, Aspergillus, Cryptococcus, Histoplasma), opportunistic bacterial (Nocardia), parasitic (Leishmania) and viral (e.g. Cytomegalovirus, human herpes virus 8 [HHV 8]) infections. These infectious complications usually occur within the first months of therapy and are important causes of morbidity and mortality in anti-TNFalpha-treated patients. It is recommended to rule out infections, especially latent or active tuberculosis, before the initiation of anti-TNFalpha therapy. However, it is necessary to follow-up closely these patients to detect the possible occurrence of opportunistic infections.
Marie
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I
Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France. isabelle.marie@chu-rouen.fr
Guglielmino
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E
D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001424:Bacterial Infections / Q000276:immunology; D003424:Crohn Disease / Q000188:drug therapy; D003937:Diagnosis, Differential; D000068800:Etanercept; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000069285:Infliximab; D009181:Mycoses / Q000276:immunology; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D010272:Parasitic Diseases / Q000276:immunology; D018124:Receptors, Tumor Necrosis Factor; D012307:Risk Factors; D025241:Spondylarthritis / Q000188:drug therapy; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014777:Virus Diseases / Q000276:immunology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept