title: Brief report: incidence of selected opportunistic infections among children with juvenile idiopathic arthritis.
abstract: OBJECTIVE
  To compare incidence rates of selected opportunistic infections among children with and children without juvenile idiopathic arthritis (JIA).
  
  
  METHODS
  Using U.S. national Medicaid administrative claims data from 2000 through 2005, we identified a cohort of children with JIA based on physician diagnosis codes and dispensed medications. We also identified a non-JIA comparator cohort of children diagnosed as having attention deficit hyperactivity disorder (ADHD). We defined 15 types of opportunistic infection using physician diagnosis or hospital discharge codes; criteria for 7 of these types also included evidence of treatment with specific antimicrobial agents. We calculated infection incidence rates. The rates in the ADHD comparator cohort were standardized to the age, sex, and race distribution of the JIA cohort. We calculated incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs) to compare infection rates.
  
  
  RESULTS
  The JIA cohort included 8,503 children with 13,990 person-years of followup. The ADHD comparator cohort included 360,362 children with 477,050 person-years of followup. When all opportunistic infections were considered together as a single outcome, there were 42 infections in the JIA cohort (incidence rate 300 per 100,000 person-years; IRR 2.4 [95% CI 1.7-3.3] versus ADHD). The most common opportunistic infections among children with JIA were 3 cases of Coccidioides (incidence rate 21 per 100,000 person-years; IRR 101 [95% CI 8.1-5,319] versus ADHD), 5 cases of Salmonella (incidence rate 35 per 100,000 person-years; IRR 3.8 [95% CI 1.2-9.5]), and 32 cases of herpes zoster (incidence rate 225 per 100,000 person-years; IRR 2.1 [95% CI 1.4-3.0]).
  
  
  CONCLUSIONS
  Opportunistic infections are rare among children with JIA. Nevertheless, children with JIA had a higher rate of opportunistic infections, including an increased rate of Coccidioides, Salmonella, and herpes zoster compared to children with ADHD.
authors: University of Alabama at Birmingham, Division of Pediatric Rheumatology, Birmingham, AL 35233-1711, USA. tbeukelman@peds.uab.edu
authors: Timothy
authors: T
authors: Beukelman
authors: Fenglong
authors: F
authors: Xie
authors: John W
authors: JW
authors: Baddley
authors: Lang
authors: L
authors: Chen
authors: Elizabeth
authors: E
authors: Delzell
authors: Carlos G
authors: CG
authors: Grijalva
authors: Melissa L
authors: ML
authors: Mannion
authors: Nivedita M
authors: NM
authors: Patkar
authors: Kenneth G
authors: KG
authors: Saag
authors: Kevin L
authors: KL
authors: Winthrop
authors: Jeffrey R
authors: JR
authors: Curtis
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000009:adverse effects; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D003048:Coccidiosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012480:Salmonella Infections / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents