Opportunistic infections in patients with idiopathic inflammatory myopathies

Redondo-Benito, Ada; Curran, Adrían; Villar-Gomez, Ana; Trallero-Araguás, Ernesto; Fernández‐Codina, Andreu; Pinal‐Fernandez, Iago; Pendás, J.A. Rodrigo; Selva-O’Callaghan, Albert

doi:10.1111/1756-185x.13255

Cited by 33 publications

(27 citation statements)

References 33 publications

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“…Occurrence of opportunistic infections in IM-related ILD is significant and could be at least associated with the disease itself and its treatments (86). Thus, preventive treatment of pneumocystis jirovecii with trimethoprime + sulfamethoxazole or in case of contraindication with atovaquone, should be prescribed as soon as patients received steroids >20 mg/d during >4 weeks and especially for the most severe patients (87).…”

Section: Treatments Adjuvant Therapiesmentioning

confidence: 99%

Inflammatory Myopathy-Related Interstitial Lung Disease: From Pathophysiology to Treatment

Hervier

Uzunhan

2020

Front. Med.

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Inflammatory myopathies (IM) are auto-immune connective tissue diseases characterized by muscle involvement and by extramuscular manifestations. As such, pulmonary manifestations, which mainly include interstitial lung disease (ILD), often darken two out of four distinct IM, namely dermatomyositis and overlapping myositis. Being the initiation site of the disease and being the leading cause of morbidity and mortality, ILD is of major importance in this context. ILD has a heterogeneous expression among the patients, with various onset mode, various radiological pattern, various severity and finally with different prognoses, which are particularly difficult to predict at the time of IM diagnosis. Therefore, ILD is a challenging issue. Treatments are based on steroids and immunosuppressive or targeted therapies. Their respective place is yet poorly codified however and remains often based on clinician expertise. Dedicated clinical trials are lacking to date and are also difficult to build, due to difficulty of constituting large and homogeneous patient groups and to rigorously evaluate disease outcomes. Indeed, pulmonary function tests alone are being regularly defeated in IM, in which respiratory muscles are often involved. Composite scores, bringing together several lung parameters, should thus be developed and validated in the future, to better assess the disease response to treatment. This review aims to describe the current knowledge of IM immuno-pathogenesis, the clinical features associated with IM related-ILD, focusing of both severity and prognosis, and the actual therapeutic approaches.

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Section: Treatments Adjuvant Therapiesmentioning

confidence: 99%

Inflammatory Myopathy-Related Interstitial Lung Disease: From Pathophysiology to Treatment

Hervier

Uzunhan

2020

Front. Med.

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“…50 Immunocompromised patients with IIM are particularly prone to develop opportunistic infections with an estimated prevalence of 6% in a recent retrospective series of 204 patients. 118 Long-term administration of CS, biological therapies, and sequential administration of four or more immunosuppressive therapies during the course of disease were reported as significant risk factors. Interestingly, 56% of opportunistic infections occurred during the first year after the diagnosis, when the immunosuppression drug dosage was the highest.…”

Section: Indirect Pulmonary Complications Infectionsmentioning

confidence: 99%

Lung Diseases in Inflammatory Myopathies

Barba

Mainbourg

Nasser

et al. 2019

Semin Respir Crit Care Med

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Lung involvement is the leading cause of mortality in inflammatory myopathy. A careful assessment of clinical and serologic manifestations especially myositis-associated autoantibodies allows precise classification of the different phenotypes of inflammatory myopathy and stratification of the risk of lung involvement. About three out of four patients with inflammatory myopathy develop interstitial lung disease (ILD), which represents the main cause of morbidity and mortality. In patients with a confirmed diagnosis of inflammatory myopathy, the approach to the diagnosis of ILD includes assessment of clinical and functional severity, evaluation of the high-resolution computed tomography pattern of disease, which often suggests nonspecific interstitial pneumonia or organizing pneumonia. Bronchoalveolar lavage to rule out infection is often performed; however, video-assisted thoracoscopic lung biopsy is now generally discouraged, unless malignancy is suspected. The so-called antisynthetase syndrome characterized by the combination of mechanics' hands, Raynaud' phenomenon, myositis often mild or absent, and presence of one of the anti-tRNA synthetase antibodies is associated with a 70% risk of ILD, especially in subjects with antibodies other than anti-Jo1 antibodies (i.e., anti-PL7 or -PL12 antibodies). Treatment depends on both severity and progression of ILD, often including a combination of corticosteroids and immunosuppressive therapy. Rituximab-based regimen has showed promising results in retrospective studies for the management of refractory or rapidly progressive forms of ILD. Clinical trials are ongoing to evaluate the actual efficacy of this strategy on mortality related to lung disease. Secondary pulmonary complications of inflammatory myopathy include opportunistic infections, aspiration pneumonia, pneumomediastinum, ventilatory failure due to diaphragmatic muscular weakness, drug-induced pneumonitis, and rarely pulmonary hypertension.

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“…An underestimation of the realistic effect of this interaction is possible, considering the lower adherence rates of males to pharmacotherapy in general 30 , and to immunomodulatory therapy in particular 31 . However, previous reports on the susceptibility to opportunistic infections in the setting of corticosteroid therapy did not show a difference between the sexes 32,33 . As corticosteroid use may reflect the severity of the underlying disease, the susceptibility of corticosteroid-treated males to nocardiosis may merely be a surrogate for their poorer physical condition, exposing them to nocardiosis.…”

Section: Discussionmentioning

confidence: 70%

Clinical correlates of nocardiosis

Margalit

Goldberg

Ari

et al. 2020

Sci Rep

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Nocardia is an opportunistic pathogen that most frequently affects the lungs. Evidence is limited regarding the risk factors for nocardiosis. The current study assessed clinical correlates of nocardiosis. A retrospective study was conducted based on medical records of consecutive adult patients (N = 60) with nocardiosis hospitalized during 2007-2018 at a tertiary hospital in central Israel. A matched comparison group of 120 patients was randomly selected among hospitalized patients with community-acquired pneumonia. Multivariable conditional logistic regression models were fitted. Immunosuppressive pharmacotherapy was positively associated with nocardiosis (matched odds ratio [OR] 4.40, 95% confidence interval [CI] 2.25-8.62, p < 0.001), particularly corticosteroid therapy (matched OR 4.69, 95% CI 2.45-8.99, p < 0.001). Systemic corticosteroid therapy was strongly associated with pulmonary nocardiosis (matched OR 5.90, 95% CI 2.75-12.66, p < 0.001). The positive association between solid organ transplantation and nocardiosis was attenuated following adjustment for systemic corticosteroids in a multivariable model. The association between corticosteroid therapy and nocardiosis appeared stronger in patients with chronic pulmonary disease (OR 5.74, 95% CI 2.75-12.66, p < 0.001) than in the pooled analysis of all nocardiosis cases. In conclusion, corticosteroid therapy was strongly correlated with nocardiosis, particularly among individuals with chronic pulmonary disease and in pulmonary nocardiosis. Nocardiosis is an opportunistic infection that typically occurs in individuals with a history of solid organ transplantation (SOT) 1 , malignancy 2 , human immunodeficiency virus infection 3 or chronic pulmonary diseases 4. Evidence on the independent contribution of each of these conditions to nocardiosis risk remains limited, since most studies were case-series and lacked a comparison group. It is also unclear if the likelihood of nocardiosis is related to the underlying disease itself or to the immunosuppression therapy administered against it. Corticosteroid therapy is prevalent amongst individuals diagnosed with nocardiosis 5,6. A European multicenter case-control study conducted among SOT recipients (SOTR) showed that corticosteroid dosage was related to the risk of nocardiosis (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.03-1.22 for each milligram increase in corticosteroid dose), and a strong positive association was found between high calcineurin inhibitor and nocardiosis (OR 6.11, 95% CI 2.58-14.51) 1. As corticosteroid therapy is the standard of care for many conditions that might be also associated with nocardiosis, such as SOT, chronic pulmonary diseases and cancer, the independent role of each factor, warrant further investigation. As Nocardia is mostly transmitted by inhalation or aspiration 7 , the lungs are the primary site of infection in more than two-thirds of the nocardiosis cases 3. However, evidence on the risk factors for nocardiosis, beyond the general propensity to develop bacterial pne...

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Opportunistic infections in patients with idiopathic inflammatory myopathies

Abstract: The prevalence of OI was 6.4% in our myositis cohort, higher than the rest of the inpatients of our hospital (1.7%; P < 0.01). High-dose glucocorticoids at disease onset and severe immunosuppression are the main factors implicated.

Cited by 33 publications

References 33 publications

Inflammatory Myopathy-Related Interstitial Lung Disease: From Pathophysiology to Treatment

Inflammatory Myopathy-Related Interstitial Lung Disease: From Pathophysiology to Treatment

Lung Diseases in Inflammatory Myopathies

Clinical correlates of nocardiosis

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