Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor α antagonists

Abstract

Objective. To describe a group of patients who were treated with tumor necrosis factor ␣ (TNF␣) antagonists and who developed coccidioidomycosis, and to test the hypothesis that patients with inflammatory arthritis receiving TNF␣ antagonist therapy are at higher risk for developing symptomatic coccidioidomycosis.Methods Conclusion. Patients with inflammatory arthritis who are undergoing treatment with infliximab appear to be at higher risk for developing symptomatic coccidioidomycosis as compared with those not receiving infliximab.

Efficacy of the Investigational Antifungal VT-1161 in Treating Naturally Occurring Coccidioidomycosis in Dogs

“…ranges from mild, self-limiting symptoms to fulminant and fatal disease (1). Although most patients will recover without medical intervention, people with progressive or chronic disease and populations with various compromises of the immune system require antifungal therapy (2)(3)(4). The most severe consequence of coccidioidal infection is meningitis, which requires lifetime antifungal therapy (5,6).…”

Coccidioides immitis and posadasii; A review of their biology, genomics, pathogenesis, and host immunity

“…Although this has been known for many decades, there is little or no understanding of what drives the immune response toward a TH1 (DTH, IFNγ) pathway in people who do well. Clearly CD4 T cells are required since patients with low CD4 counts because of untreated AIDS are at high risk for disseminated infections [53] Patients treat with tumor necrosis factor inhibitors are also at higher risk [54]. We also know from rare human genetic mutations that inability to make or respond to IFNɣ is a risk for dissemination of infection [55,56].…”

Update on the Epidemiology of Coccidioidomycosis

“…The advent of and increasing use of immunomodulatory agents that target cell-mediated immunity is a trend that warrants increased awareness of healthcare providers on the risks o f c o c c i d i o i d o m y c o s i s i n t h e s e p o p u l a t i o n s . Chemotherapeutic agents and high-dose corticosteroids (equivalent to >20 mg/day prednisone) have traditionally been identified as conferring risk of infection; however, the increasing prevalence of tumor necrosis factor-α (TNF-α) antagonists along with immunosuppression accompanying solid organ or hematopoietic stem cell transplantation recipients is also of rising concern [38][39][40].…”

“…In one retrospective study taking place within several institutions within the Southwest found that of 247 patients with inflammatory arthritis receiving TNF-α treatment in comparison to 738 patients with inflammatory arthritis on other nonbiologic therapy, the relative risk of developing symptomatic coccidioidomycosis to be 5.23 [38]. Patients receiving allogeneic stem cell transplantations in Arizona were also reviewed in another study that noted active coccidioidomycosis after transplantation in 11 of 426 patients (2.6 %) [40].…”