title: T. asahii pulmonary infection as a complication of TNF-inhibitor and steroids: posaconazole pharmacotherapy and risk analysis.
abstract: We report the first documented Trichosporon asahii infection in a patient with connective tissue disease treated with a Tumor Necrosis Factor (TNF) inhibitor and describe an institutional root cause analysis for TNF inhibitor-associated infections. Fourteen patients with incident fungal infections during TNF inhibitor treatment were identified. They were matched with uncomplicated patients receiving TNF inhibitors or with rheumatoid arthritis (RA) patients managed without TNF inhibitors. We found that patients acquiring fungal infections were more likely to have graft versus host disease (GVHD) (p<0.05). Furthermore, infected patients were more likely (OR=24.4) to have multiple immunosuppressive therapies over the controls as well as several risk factors identified by the Infectious Disease Society ofAmerica (IDSA). The 3 patient deaths in our study were associated with GVHD and infliximab. Trichosporon was isolated in 1 patient receiving adalimumab. Our results suggest that these high risk patients be monitored closely for fungal infection.
authors.affiliation: Department of Medicine, School Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, USA.
authors.forename: Somjade
authors.initials: S
authors.lastname: Songcharoen
authors.forename: John D
authors.initials: JD
authors.lastname: Cleary
authors.forename: John
authors.initials: J
authors.lastname: Jenkins
authors.forename: Matthew
authors.initials: M
authors.lastname: DeShazo
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000935:Antifungal Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D000069285:Infliximab; D008172:Lung Diseases, Fungal / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D060891:Root Cause Analysis; D014230:Triazoles / Q000627:therapeutic use; D060586:Trichosporonosis / Q000139:chemically induced* / Q000188:drug therapy; D000079424:Tumor Necrosis Factor Inhibitors; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000935:Antifungal Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014230:Triazoles; D000079424:Tumor Necrosis Factor Inhibitors; C101425:posaconazole; D000069285:Infliximab; D000068879:Adalimumab