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Pneumocystis jirovecii colonization in patients treated with infliximab

AuthorsWissmann, Gustavo; Morilla Romero de la Osa, R.; Friaza Patiño, Vicente; Respaldiza, Nieves; Praena, Juan M.; Montes-Cano, Marco-Antonio; Medrano, Francisco Javier; Horra, Carmen de la; Varela Aguilar, José M.; Calderón, Enrique J.
Issue Date2011
PublisherBlackwell Publishing
CitationEuropean Journal of Clinical Investigation 41(3): 343-348 (2011)
Abstract[Background] Infliximab, a chimeric antitumour necrosis factor (TNF) monoclonal antibody, has become an established effective therapy for inflammatory rheumatic disease. However, TNF is a critical factor in host defence, and the suppression of its biological activity may be associated with the increased risk of opportunistic infections. The frequent use of infliximab in clinical practice has identified Pneumocystis jirovecii pneumonia (PcP) as a serious complication. Individuals colonized with Pneumocystis may be at high risk of development of PcP when they have undergone immunosuppression. Hence, we addressed the question of the frequency of Pneumocystis colonization among patients treated with infliximab.
[Design] We examined 125 oropharyngeal washes collected from 78 individuals with rheumatoid arthritis, 30 with ankylosing spondylitis and 17 with psoriatic arthritis, half of them underwent infliximab therapy, using a real-time polymerase chain reaction assay that employs specific primers from a portion of the mitochondrial large-subunit rRNA gene of P. jirovecii.
[Results] Pneumocystis jirovecii colonization was detected in 32 (25·6%) patients. In a multivariate regression model, only duration of infliximab treatment for more than 3years and use of corticosteroid were significantly and independently associated with risk of Pneumocystis colonization. However, the effect of corticosteroid on P. jirovecii colonization rate was not linearly dose dependent as showed other logistic regression analysis.
[Conclusions] There is a high rate of P. jirovecii colonization among patients with rheumatologic diseases treated with infliximab. The identification of patients colonized by P. jirovecii before starting the treatment with infliximab could be a strategy for PcP prevention. © 2010 The Authors. European Journal of Clinical Investigation © 2010 Stichting European Society for Clinical Investigation Journal Foundation.
DescriptionWissmann, Gustavo et al.
Identifiersdoi: 10.1111/j.1365-2362.2010.02415.x
issn: 0014-2972
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