Fungal infections following treatment with monoclonal antibodies and other immunomodulatory therapies

Candel, Francisco Javier; Peñuelas, Marina; Tabares, Carolina Serrano; García-Vidal, Carolina; Matesanz, Mayra; Salavert, Miguel; Rivas, Pilar Cebollero; Pemán, Javier

doi:10.1016/j.riam.2019.09.001

Cited by 14 publications

(6 citation statements)

References 65 publications

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“…The contribution of diabetes mellitus per se to the development of rhino-orbital-cerebral mucormycosis was the most common underlying comorbidity in 340 of 851 (40%) patients who were included in a meta-analysis, with an odds ratio (OR) of 2.49 (95% CI 1.77–3.54) compared to the next possible factor of having hematological malignancies with an OR of 0.76 (0.44–1.26) [ 19 ]. The role of Interleukin 6 blockers as a risk factor for mucormycosis is not clear [ 39 ]. Whether the combined use of steroids and interleukin 6 blockers will increase the risk of mucormycosis compared to the use of steroids alone needs more studies.…”

Section: Risk Factorsmentioning

confidence: 99%

COVID-19 and mucormycosis superinfection: the perfect storm

et al. 2021

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Background The recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports of fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated with steroids. The recent surge in cases of COVID-19 in India during the second wave of the pandemic had been associated with increased reporting of invasive mucormycosis post COVID-19. There are multiple case reports and case series describing mucormycosis in COVID-19. Purpose In this review, we included most recent reported case reports and case-series of mucormycosis among patients with COVID-19 and describe the clinical features and outcome. Results Many of the mucormycosis reports were eported from India, especially in COVID-19 patients who were treated and recovered patients. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis. Those patients were diabetic and had corticosteroids therapy for controlling the severity of COVID-19, leading to a higher fatality in such cases and complicating the pandemic scenario. The triad of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use and uncontrolled diabetes mellitus have been evident for significant increase in the incidence of angioinvasive maxillofacial mucormycosis. In addition, the presence of spores and other factors might play a role as well. Conclusion With the ongoing COVID-19 pandemic and increasing number of critically ill patients infected with SARS-CoV-2, it is important to develop a risk-based approach for patients at risk of mucormycosis based on the epidemiological burden of mucormycosis, prevalence of diabetes mellitus, COVID-19 disease severity and use of immune modulating agents including the combined use of corticosteroids and immunosuppressive agents in patients with cancer and transplants.

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Section: Risk Factorsmentioning

confidence: 99%

COVID-19 and mucormycosis superinfection: the perfect storm

et al. 2021

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“…Studies have also linked the use of Natalizumab with some severe viral or fungal infections such as herpes simplex, varicella-zoster, mycobacteria, JC virus or Candida. These adverse reactions are common among the patients treated with monoclonal antibodies and a thorough investigation of the patients' immune status is highly recommended [19].…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Adverse Reactions Associated with Monoclonal Antibodies Treatment in Multiple Sclerosis: Case Reports and Short Literature Review

Sîrbu¹,

Ivan²,

Vasile

et al. 2022

JCM

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Background and aims. Multiple sclerosis is a disease of the central nervous system, whose treatment often involves the use of monoclonal antibodies. This can lead to a series of complications that the clinician should pay attention to and accordingly adjust the therapy. We aim to emphasize real-life experiences with adverse cutaneous reactions to monoclonal antibodies by presenting a series of two cases from our clinic. Methods. In the first case, a female patient was treated with natalizumab for eight years and developed relapsing-remitting cutaneous lesions following the monthly administration of the treatment. The second case is of a male patient treated with ocrelizumab, who developed plaque-like lesions following the fifth administration. We analyzed the biological parameters and performed investigations, dermatological evaluation and skin biopsies. Results. The result of the skin biopsy for the natalizumab patient showed a chronic spongiotic dermatitis, with the anti-natalizumab antibodies being negative. The patient who received ocrelizumab developed nummular eczema, disseminated on his trunk and limbs. Conclusions. Given the fact that these therapies are frequently used in multiple sclerosis patients, and their skin adverse reactions are known, we described some particularities and a brief review of the literature with practical implications. Further studies need to be conducted to establish a firm association between monoclonal antibodies therapy and adverse cutaneous reactions, but the clinician should be aware of their existence.

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“…Asymptomatic lung colonization may be diagnosed in non-HIV/AIDS or non-immunosuppressed patients, who may become reservoirs for dissemination to immunocompromised patients since Pneumocystis can be transmitted from person to person by airborne route (reviewed in [226,227]). Furthermore, even when the infection resolves, P. jirovecii can persist colonization in the host for months [19].…”

Section: Pneumocystis Sppmentioning

confidence: 99%

“…Corticosteroids, typically used to suppress inflammation, do not significantly benefit PjP patients [228][229][230][231][232]. Moreover, patients undergoing immunomodulatory therapies with monoclonal antibodies, including TNF-alpha antagonists, CD52 antagonists, CD20 receptor blockers and many cytokine inhibitors have been associated with the development of P. jirovecii infections [19].…”

Section: Pneumocystis Sppmentioning

confidence: 99%

“…Individuals at high-risk of developing invasive of invasive fungal diseases include genetically immunocompromised persons, such as those with chronic or persistent autoimmune inflammatory diseases (e.g., rheumatic, dermatological, gastrointestinal, and neurological disorders), and individuals with hemato-oncological syndromes. Patients with acquired immune-related conditions, such as people undergoing immunomodulatory treatments, including cancer chemotherapy, organ/stem cell transplantation, corticosteroid or monoclonal antibody-induced immune suppression are likewise at high risk [2,19]. Invasive surgical interventions, intensive care (e.g., intubation and invasive catheters), and parenteral nutrition [1,2,[20][21][22][23] heighten risk for invasive mycoses.…”

Section: Introductionmentioning

confidence: 99%

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Immunotherapy against Systemic Fungal Infections Based on Monoclonal Antibodies

Boniche

Rossi

Kischkel

et al. 2020

JoF

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The increasing incidence in systemic fungal infections in humans has increased focus for the development of fungal vaccines and use of monoclonal antibodies. Invasive mycoses are generally difficult to treat, as most occur in vulnerable individuals, with compromised innate and adaptive immune responses. Mortality rates in the setting of our current antifungal drugs remain excessively high. Moreover, systemic mycoses require prolonged durations of antifungal treatment and side effects frequently occur, particularly drug-induced liver and/or kidney injury. The use of monoclonal antibodies with or without concomitant administration of antifungal drugs emerges as a potentially efficient treatment modality to improve outcomes and reduce chemotherapy toxicities. In this review, we focus on the use of monoclonal antibodies with experimental evidence on the reduction of fungal burden and prolongation of survival in in vivo disease models. Presently, there are no licensed monoclonal antibodies for use in the treatment of systemic mycoses, although the potential of such a vaccine is very high as indicated by the substantial promising results from several experimental models.

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Fungal infections following treatment with monoclonal antibodies and other immunomodulatory therapies

Cited by 14 publications

References 65 publications

COVID-19 and mucormycosis superinfection: the perfect storm

COVID-19 and mucormycosis superinfection: the perfect storm

Cutaneous Adverse Reactions Associated with Monoclonal Antibodies Treatment in Multiple Sclerosis: Case Reports and Short Literature Review

Immunotherapy against Systemic Fungal Infections Based on Monoclonal Antibodies

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