Protocolo de Prevenção e Tratamento de Infeções Associadas à Terapêutica Imunossupressora de Doenças Autoimunes

Abstract

We propose a guideline about the risk, prevention and treatment of infection in the patient under immunomodulatory or immunosuppressive therapy in the context of autoimmune or autoinflammatory disease. It is divided into three sections: drugs and associated risk of infection; immunizations; risk, prevention, and treatment of specific infections. The treatment of autoimmune diseases involves the use of immunosuppressive or immunomodulatory therapies, with an increasing number of new drugs being used. It is associated with an increased risk of infection, which may be present globally or only for specific agents, varying widely depending on the pharmacological class and even within the same class. The prevention strategy and clinical management need to be individually tailored and there are several key factors: characterization of the disease that prompts the immunosuppression, understanding of the mechanism of action of the immunosuppressive drug, knowledge of previous infections, recognition of risk factors, laboratory test results, vaccine administration, monitoring of clinical signs and symptoms and patient education.

Cerebral Tuberculosis After Therapy With Adalimumab for Hidradenitis Suppurativa: A Rare Case

“…This is because even under these conditions, the infection is rare within her age group. A higher frequency is observed in patients over 60 years on anti-TNF-α therapy, although the risk in this age range, compared to the general population, is not universally agreed to be increased [ 7 , 12 , 14 ].…”

“…In regions with low TB prevalence, such as North America and Western Europe, extrapulmonary manifestations of TB are primarily observed in adults with reactivated disease, with CNS TB, particularly in the form of meningitis, being the predominant presentation [ 15 ]. Following the inhalation of aerosol droplets containing M. tuberculosis , the host may either immediately eliminate the organism, develop primary active disease, remain with LTBI, or progress to active disease after a period of latent infection [ 12 , 14 ]. Among individuals with LTBI and no underlying medical conditions, reactivation disease occurs in approximately 5% to 10% of cases [ 15 ].…”

“…The screening process involves, first and foremost, ruling out active disease through symptom inquiry, assessment of signs consistent with TB disease, and chest radiography. Subsequently, it involves the exclusion of LTBI by inquiring about past TB and/or potential high-risk contacts [ 12 , 14 , 16 ]. There is no gold standard analytical method for diagnosing LTBI [ 14 , 16 ].…”

“…Subsequently, it involves the exclusion of LTBI by inquiring about past TB and/or potential high-risk contacts [ 12 , 14 , 16 ]. There is no gold standard analytical method for diagnosing LTBI [ 14 , 16 ]. These tests, in addition to relying on an intact immune system, which may compromise their interpretation in patients under immunosuppressive therapy, are imperfect in assessing the risk of progression to TB disease.…”

“…These tests, in addition to relying on an intact immune system, which may compromise their interpretation in patients under immunosuppressive therapy, are imperfect in assessing the risk of progression to TB disease. Among the available tests, IGRA exhibits higher sensitivity compared to the tuberculin skin test (TST) [ 12 , 14 , 16 ]. In the absence of past TB treatment, a previously positive IGRA before the initiation of therapy is an indication for LTBI treatment, typically involving monotherapy for four to nine months [ 14 ].…”