title: Severe infections in patients with autoimmune diseases treated with cyclophosphamide.
abstract: BACKGROUND
  Infectious diseases are a significant cause of morbidity and mortality in patients with connective tissue diseases. Corticosteroids and immunosuppressive drugs, such as cyclophosphamide (CYC), increases the risk of infections. The objective of this study was to estimate the incidence rates of severe infections in patients who received treatment with CYC.
  
  
  METHODS
  The records of 60 patients with systemic autoimmune diseases who received treatment with CYC were retrospectively reviewed. We evaluated the rate of severe infections that occurred during CYC therapy and the 3 subsequent months.
  
  
  RESULTS
  Systemic lupus erythematosus was the most common disease, and diffuse proliferative glomerulonephritis the most frequent indication. Severe infection occurred in 9 patients (15%). Community acquired pneumonia was the most frequent infection with 3 cases (33%) followed by Herpes Zoster with 2 reports (22%). The cumulative dose of corticosteroid was the only significant risk factor for infection 32.8±16.7 vs. 20.1±15.3 P=.007.
  
  
  CONCLUSIONS
  The use of lower doses of corticosteroids and an aggressive management of infectious complications, allows for an acceptable safety profile in patients treated with CYC.
authors.affiliation: Sección Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital J.B. Iturraspe, Santa Fe, Argentina. Electronic address: jcavallasca@yahoo.com.ar.
authors.forename: Javier A
authors.initials: JA
authors.lastname: Cavallasca
authors.affiliation: Sección Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital J.B. Iturraspe, Santa Fe, Argentina.
authors.forename: Cecilia A
authors.initials: CA
authors.lastname: Costa
authors.affiliation: Sección Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital J.B. Iturraspe, Santa Fe, Argentina.
authors.forename: Maria Del Rosario
authors.initials: Mdel R
authors.lastname: Maliandi
authors.affiliation: Sección Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital J.B. Iturraspe, Santa Fe, Argentina.
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Contini
authors.affiliation: Sección Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital J.B. Iturraspe, Santa Fe, Argentina.
authors.forename: Elena
authors.initials: E
authors.lastname: Fernandez de Carrera
authors.affiliation: Sección Reumatología y Enfermedades Autoinmunes Sistémicas, Hospital J.B. Iturraspe, Santa Fe, Argentina.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Musuruana
mesh_terms: D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000188:drug therapy*; D003240:Connective Tissue Diseases / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: Ciclofosfamida; Connective tissue diseases; Corticoides; Corticosteroids; Cyclophosphamide; Enfermedades autoinmunes sistémicas; Infecciones; Infections, Immunosuppressive drugs; Inmunosupresores