title: Clinical aspects and management of cutaneous leishmaniasis in rheumatoid patients treated with TNF-α antagonists.
abstract: Patients under immunosuppressive therapy with tumor necrosis factor alpha (TNF-α) antagonists are vulnerable to various opportunistic infections including leishmaniasis. We present a case series of 8 travellers developing cutaneous leishmaniasis whilst on TNF-α antagonist treatment and review the literature on aspects of cutaneous leishmaniasis developing in patients treated with TNF-α antagonists. We make interim recommendations regarding the drug therapy used to maintain remission in travellers with rheumatoid disease travelling to leishmania prone areas. Despite having a medical condition requiring continued rheumatological review the interval to diagnosis appears not to be reduced compared to that described in non-rheumatoid patients. Rheumatologists and family doctors should be aware of the need for post-travel surveillance for leishmaniasis in rheumatoid patients on TNF-alpha antagonist treatment.
authors: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Petersplatz 1, 4033 Basel, Switzerland. Electronic address: andreas.neumayr@unibas.ch.
authors: Andreas L C
authors: AL
authors: Neumayr
authors: Gloria
authors: G
authors: Morizot
authors: Leo G
authors: LG
authors: Visser
authors: Diana N J
authors: DN
authors: Lockwood
authors: Bernhard R
authors: BR
authors: Beck
authors: Stefan
authors: S
authors: Schneider
authors: Guillaume
authors: G
authors: Bellaud
authors: Florence
authors: F
authors: Cordoliani
authors: Françoise
authors: F
authors: Foulet
authors: Emmanuel A
authors: EA
authors: Laffitte
authors: Pierre
authors: P
authors: Buffet
authors: Johannes A
authors: JA
authors: Blum
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000469:parasitology*; D005260:Female; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D000981:Antiprotozoal Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Cutaneous leishmaniasis; Immunosuppression; Rheumatology; TNF-alpha antagonists; Treatment