title: Rheumatological patients undergoing immunosuppressive treatments and parasitic diseases: a review of the literature of clinical cases and perspectives to screen and follow-up active and latent chronic infections.
abstract: OBJECTIVE
  Nowadays, several potent immunosuppressive drugs are available for patients with rheumatologic disorders. In general, these treatments are acceptably well tolerated. Nevertheless, in patients with rheumatic diseases, who are taking immunosuppressive drugs, an increased risk of bacterial, viral and fungal, as well as parasitic infections, exists.
  
  
  METHODS
  We have reviewed literature, on PubMed library, on the topic 'parasitic infections in rheumatic disease patients treated with immunosuppressive drugs, including biological therapies'. We used no language or time restrictions. Search was concluded on January 15th 2014. We grouped all parasitic events among rheumatologic, therapeutically immuosuppressed, patients to estimate the magnitude of this risk. Then we gave our viewpoint in the perspective to screen and follow-up for active and latent chronic parasitoses, developing an hypothetical flow-chart.
  
  
  RESULTS
  From data published in the literature the real burden of parasitoses, among patients with rheumatic diseases treated with immunosuppressive treatments, can not be estimated. Nevertheless, a positive trend on publication number exists, probably due to more than one reason: i) the increasing number of patients treated, especially with more than one immunosuppressive treatment, including new biological agents; ii) the increasing number of individuals who move from the north to the south of the world (endemic areas for parasitic infections) and vice versa, due to globalisation, and iii) the fact that more attention is paid for notification/publication of cases.
  
  
  CONCLUSIONS
  Considering parasitic infections as emerging and potentially serious in their evolution, additional strategies for the prevention, careful screening and follow-up, with a high level of suspicion, identification, and pre-emptive therapy are necessary in candidate patients for biological agents.
authors: Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy. fabiani.silvia@libero.it.
authors: Silvia
authors: S
authors: Fabiani
authors: Fabrizio
authors: F
authors: Bruschi
mesh_terms: D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000276:immunology / Q000469:parasitology* / Q000517:prevention & control; D010272:Parasitic Diseases / Q000175:diagnosis / Q000276:immunology / Q000469:parasitology* / Q000517:prevention & control; D018579:Patient Selection; D011379:Prognosis; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents