title: [Systemic and localized infection by Candida species in patients with rheumatic diseases receiving anti-TNF therapy].
abstract: OBJECTIVE
  To evaluate the prevalence of systemic and localized infection by Candida species and its possible association with demographic, clinical and laboratory manifestations and therapy in patients with rheumatic diseases taking TNF blockers.
  
  
  METHODS
  Consecutive patients with rheumatic diseases receiving anti-TNF agents were included. The following risk factors up to four weeks prior to the study were analyzed: use of antibiotics, immunosuppressant drugs, hospitalization and invasive procedures. All subjects were evaluated for clinical complaints, specific blood cultures were obtained for fungi and blood samples were collected for Candida spp. detection by polymerase chain reaction.
  
  
  RESULTS
  194 patients [67 with rheumatoid arthritis (RA), 47 with ankylosing spondylitis (AS), 36 with juvenile idiopathic arthritis (JIA), 28 with psoriatic arthritis and 16 with other conditions] were included. The average age of patients was 42±16 years, with 68 (35%) male and mean disease duration of 15±10 years. Sixty-four (33%) patients were receiving adalimumab, 59 (30%) etanercept and 71 (36%) infliximab. Eighty-one percent of patients were concomitantly taking immunosuppressants drugs. At the time of the study, only one (0.5%) patient had localized fungal infection (vaginal candidiasis). None of the patients included had systemic candidiasis with positive blood cultures for fungi or PCR positive for Candida spp. in peripheral blood sample.
  
  
  CONCLUSIONS
  This was the first study to assess the prevalence of invasive and localized fungal disease by candida in a significant number of patients with rheumatic diseases on anti-TNF therapy, and demonstrated low risk of candidiasis, despite the high prevalence of immunosuppressive drug use.
authors: Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil; Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil. Electronic address: nadia.aikawa@gmail.com.
authors: Nadia E
authors: NE
authors: Aikawa
authors: Laboratório de Micologia Médica (LIM 53), Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil.
authors: Daniela T A
authors: DT
authors: Rosa
authors: Laboratório de Micologia Médica (LIM 53), Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil.
authors: Gilda M B
authors: GM
authors: Del Negro
authors: Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil.
authors: Julio C B
authors: JC
authors: Moraes
authors: Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil.
authors: Ana C M
authors: AC
authors: Ribeiro
authors: Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil.
authors: Carla Gonçalves
authors: CG
authors: Saad
authors: Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil; Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil.
authors: Clovis A
authors: CA
authors: Silva
authors: Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil.
authors: Eloisa
authors: E
authors: Bonfá
keywords: Ankylosing spondylitis; Artrite reumatoide; Candida spp; Candidíase sistêmica; Espondilite anquilosante; Rheumatoid arthritis; Systemic candidiasis; anti‐TNF