Risk of Nocardial Infections With Anti-tumor Necrosis Factor Therapy

Ali, Tauseef; Chakraburtty, Amarsha; Mahmood, Sultan; Bronze, Michael S.

doi:10.1097/maj.0b013e3182883708

Cited by 23 publications

(11 citation statements)

References 17 publications

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“…Newer immunosuppressive therapies such as monoclonal antibodies may also be a risk factor for infection and several cases of CNS nocardiosis have been reported in the setting of monoclonal antibodies. [25–28] The concomitant use of multiple agents and corticosteroids in particular makes direct attribution of risk difficult. However, given the increasing number of individuals being placed on novel agents, this is an area which warrants further scrutiny.…”

Section: Discussionmentioning

confidence: 99%

Central nervous system nocardiosis in Queensland

et al. 2016

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Nocardia infection of the central nervous system (CNS) is an uncommon but clinically important disease, often occurring in immunocompromised individuals and carrying a high mortality rate. We present 20 cases of microbiologically proven CNS nocardiosis diagnosed in Queensland from 1997 to 2015 and review the literature from 1997 to 2016.Over 50% of cases occurred in immunocompromised individuals, with corticosteroid use posing a particularly significant risk factor. Nine (45%) patients were immunocompetent and 3 had no comorbidities at time of diagnosis. Nocardia farcinica was the most frequently isolated species (8/20) and resistance to trimethoprim–sulfamethoxazole (TMP-SMX) was found in 2 isolates. Overall, 35% of our patients died within 1 year, with the majority of deaths occurring in the first month following diagnosis. Interestingly, of the 7 deaths occurring at 1 year, 6 were attributed to N farcinica with the seventh isolate being unspeciated, suggesting the virulence of the N farcinica strain.

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Section: Discussionmentioning

confidence: 99%

Central nervous system nocardiosis in Queensland

et al. 2016

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“…2018;9(2):68-72 therapy. As reviewed, there are 10 cases described in literature, all under anti-TNF therapy [22][23][24][25][26][27][28][29][30][31]. To our knowledge, this is the first described case of nocardiosis in a patient under TCZ.…”

Section: Discussionmentioning

confidence: 91%

Cerebral Nocardiosis in a Patient With Rheumatoid Arthritis Under Treatment With Tocilizumab

et al. 2018

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The use of biological therapy has revolutionized the treatment of various autoimmune diseases. Tocilizumab (TCZ) is a recombinant humanized antiinterleukin-6 (IL-6) receptor monoclonal antibody approved for the treatment of patients with rheumatoid arthritis, as monotherapy or in combination with other disease-modifying antirheumatic drugs (DMARDs). Clinical and post-marketing surveillance studies of TCZ indicate that infections are the most frequent adverse events. Most of the serious infections described are bacterial and viral, with no uncommon pathogens. The authors report a case of a patient with destructive rheumatoid arthritis under TCZ that presented with neurological symptoms and a right cerebellar lesion with marked diffusion restriction suggestive of cerebellar abscess. The microbiologic studies from aspirative cerebral biopsy revealed Nocardia farcinica. With adequate antibiotics, the patient evolved with resolution of all symptoms and brain abscess at 5 months of followup. According to published reports, this is the first case of nocardial infection in patients under TCZ. The case highlights the importance of being aware of risk infection in these patients and need of an early diagnosis allowing a prompt treatment.

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“…In addition, we further identified that individuals receiving immunosuppressive therapy are at greater risk of acquiring Nocardia infections. In fact, the increased clinical use of immunosuppressive therapy has been associated with increased rates of opportunistic infections such as tuberculosis and histoplasmosis [21, 22]. Hence, it is necessary to screen patients for opportunistic infections before administering immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 99%

Nontuberculous mycobacterial and Nocardia infections mimicking pulmonary tuberculosis: a retrospective study of a general hospital patient population in China

Dong

Chu

Guo

et al. 2020

Journal of Medical Microbiology

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Purpose. In this study, we differentiated between tuberculosis (TB) and infections caused by nontuberculous mycobacteria (NTM) or Nocardia in a tertiary general hospital in China. Differences in clinical manifestations and factors between respiratory infections associated with these organisms were also investigated. Methodology. A retrospective analysis was conducted for suspected pulmonary TB patients with positive bacterial culture results under treatment at Wangjing Hospital, a tertiary general hospital, between January 2014 and June 2017. Sputum samples were submitted for liquid culture and species identification by mass spectrometry. Results. Between January 2014 and June 2017, a total of 3981 suspected TB cases were analysed, of which 151 (3.8 %) exhibited positive mycobacterial culture results. Using mass spectrometry, the 151 isolates were classified into three groups: Mycobacterium tuberculosis (MTB) (n=112; 74.2 %), NTM (n=21 13.9 %) and Nocardia (n=18; 11.9 %). The NTM and Nocardia prevalence rates were significantly higher amongst elderly patients [aged ≥65 years; odds ratio (95 % confidence interval): 3.89 (1.05–14.38) for NTM; odds ratio (95 % confidence interval): 5.10 (1.09–23.91) for Nocardia ]. In addition, treatment with immunosuppressive therapy [odds ratio (95 % confidence interval): 3.92 (1.16–13.27)] was identified as a risk factor for Nocardia infection in these patients. Conclusion. Our results demonstrated that a quarter of culture-positive ‘suspected TB patients’ harboured NTM or Nocardia infections. Notably, nearly all patients with non-TB infections presented with clinical syndromes mimicking pulmonary TB. Individuals receiving immunosuppressive therapy were at greater risk of acquiring Nocardia infections.

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Risk of Nocardial Infections With Anti-tumor Necrosis Factor Therapy

Cited by 23 publications

References 17 publications

Central nervous system nocardiosis in Queensland

Central nervous system nocardiosis in Queensland

Cerebral Nocardiosis in a Patient With Rheumatoid Arthritis Under Treatment With Tocilizumab

Nontuberculous mycobacterial and Nocardia infections mimicking pulmonary tuberculosis: a retrospective study of a general hospital patient population in China

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