title: Systemic and localized infection by Candida species in patients with rheumatic diseases receiving anti-TNF therapy.
abstract: 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.
  
  
  
  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.
  
  
  
  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 immunosuppressant 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.
  
  
  
  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.affiliation: Universidade São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil; Universidade São Paulo, Faculdade de Medicina, Disciplina de Reumatologia, São Paulo, SP, Brazil. Electronic address: nadia.aikawa@gmail.com.
authors.forename: Nadia E
authors.initials: NE
authors.lastname: Aikawa
authors.affiliation: Universidade São Paulo, Faculdade de Medicina, Laboratório de Micologia Médica (LIM 53), São Paulo, SP, Brazil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brazil.
authors.forename: Daniela T A
authors.initials: DT
authors.lastname: Rosa
authors.affiliation: Universidade São Paulo, Faculdade de Medicina, Laboratório de Micologia Médica (LIM 53), São Paulo, SP, Brazil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brazil.
authors.forename: Gilda M B
authors.initials: GM
authors.lastname: Del Negro
authors.affiliation: Universidade São Paulo, Faculdade de Medicina, Disciplina de Reumatologia, São Paulo, SP, Brazil.
authors.forename: Julio C B
authors.initials: JC
authors.lastname: Moraes
authors.affiliation: Universidade São Paulo, Faculdade de Medicina, Disciplina de Reumatologia, São Paulo, SP, Brazil.
authors.forename: Ana C M
authors.initials: AC
authors.lastname: Ribeiro
authors.affiliation: Universidade São Paulo, Faculdade de Medicina, Disciplina de Reumatologia, São Paulo, SP, Brazil.
authors.forename: Carla Gonçalves
authors.initials: CG
authors.lastname: Saad
authors.affiliation: Universidade São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil; Universidade São Paulo, Faculdade de Medicina, Disciplina de Reumatologia, São Paulo, SP, Brazil.
authors.forename: Clovis A
authors.initials: CA
authors.lastname: Silva
authors.affiliation: Universidade São Paulo, Faculdade de Medicina, Disciplina de Reumatologia, São Paulo, SP, Brazil.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfá
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Ankylosing spondylitis; Anti-TNF; Artrite reumatoide; Candida spp.; Candidíase sistêmica; Espondilite anquilosante; Rheumatoid arthritis; Systemic candidiasis