title: Opportunistic infections in patients with pemphigus.
abstract: BACKGROUND
  Opportunistic infections (OIs) can be defined as infections in immunosuppressed patients that are more frequent or severe because of immunosuppression. The literature on OIs in pemphigus is sparse.
  
  
  OBJECTIVE
  We assessed the incidence, risk factors, and characteristics of OIs in patients with pemphigus.
  
  
  METHODS
  This was a historical prospective study following a cohort of 172 patients with newly diagnosed pemphigus for the development of OIs.
  
  
  RESULTS
  Fourteen patients developed OIs at a mean of 4 months from the time of diagnosis while taking a mean dose of 0.8 mg/kg/day of prednisone, 5 in conjunction with azathioprine. The risk of developing an OI in the first year after the diagnosis of pemphigus was 9.3%, subsequently dropping to 0. Advanced age and possibly diabetes were found to be risk factors for OI development. Infectious agents included Nocardia, cytomegalovirus, Legionella, and Listeria. Two patients died within 2 months of OI diagnosis, and 2 more had neurologic impairment.
  
  
  CONCLUSIONS
  Limitations include the extraction of historical data and the cohort originating from a single geographic region.
  
  
  CONCLUSIONS
  OIs present in a significant number of patients with pemphigus during the first year after the diagnosis of pemphigus, with potential deleterious effects. Older and possibly diabetic patients are at increased risk. Physician vigilance and patient education on limiting pathogen exposure is recommended.
authors.affiliation: Department of Dermatology, Oregon Health and Science University, Portland, Oregon. Electronic address: leshem@ohsu.edu.
authors.forename: Yael A
authors.initials: YA
authors.lastname: Leshem
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; South District Health Office, Ministry of Health, Beer Sheva, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Gdalevich
authors.affiliation: Department of Dermatology, Ha'emek Medical Center, Afula, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Ziv
authors.affiliation: Department of Dermatology, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: David
authors.affiliation: Department of Dermatology, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Emmilia
authors.initials: E
authors.lastname: Hodak
authors.affiliation: Department of Dermatology, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mimouni
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007876:Legionellosis / Q000453:epidemiology; D008088:Listeriosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000453:epidemiology; D009894:Opportunistic Infections / Q000453:epidemiology*; D010392:Pemphigus / Q000188:drug therapy / Q000453:epidemiology*; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone
keywords: corticosteroids; cytomegalovirus; legionella; listeria; nocardia; opportunistic infection; pemphigus