Strategy of Infection Control in Immunosuppressive Therapy for ANCA-Associated Vasculitis

Yoshida, Masaharu

doi:10.3400/avd.ra.12.00092

Cited by 3 publications

(3 citation statements)

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“…In the reported studies, corticosteroids contributed to 89% of infections of patients with AAV, and the infection rate decreased when the corticosteroids were tapered [ 1 – 4 ]. Corticosteroid treatment leads to an immunocompromised status in patients by inhibiting cytokines, neutrophils, and immunologic response and by exerting anti-inflammatory and immunosuppressive effects [ 22 ]. Infection is suspected when fever (≥37.3 °C) persists for no less than three days and C-reactive protein increases after remission of AAV [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Corticosteroid treatment leads to an immunocompromised status in patients by inhibiting cytokines, neutrophils, and immunologic response and by exerting anti-inflammatory and immunosuppressive effects [ 22 ]. Infection is suspected when fever (≥37.3 °C) persists for no less than three days and C-reactive protein increases after remission of AAV [ 22 ]. The evaluation of infection is based on the presence of organ manifestations.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for infectious complications of ANCA-associated vasculitis: a cohort study

et al. 2018

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BackgroundSevere infections are common complications of immunosuppressive treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with renal involvement. We investigated the clinical characteristics and risk factors of severe infection in Chinese patients with AAV after immunosuppressive therapy.MethodsA total of 248 patients with a new diagnosis of ANCA-associated vasculitis were included in this study. The incidence, time, site, and risk factors of severe infection by the induction therapies were analysed. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CI).ResultsA total of 103 episodes of severe infection were identified in 86 (34.7%, 86/248) patients during a median follow-up of 15 months. The incidence of infection during induction therapy was 38.5% for corticosteroids (CS), 39.0% for CS+ intravenous cyclophosphamide (IV-CYC), 33.8% for CS+ mycophenolate mofetil and 22.5% for CS + tripterygium glycosides, 76 (73.8%) infection episodes occurred within 6 months, while 66 (64.1%) occurred within 3 months. Pneumonia (71.8%, 74/103) was the most frequent type of infection, and the main pathogenic spectrum included bacteria (78.6%), fungi (12.6%), and viruses (8.7%). The risk factors associated with infection were age at the time of diagnosis (HR = 1.003, 95% CI = 1.000–1.006), smoking (HR = 2.338, 95% CI = 1.236–4.424), baseline secrum creatinine (SCr) ≥5.74 mg/dl (HR = 2.153, 95% CI = 1.323–3.502), CD4+ T cell< 281 μl (HR = 1.813, 95% CI = 1.133–2.900), and intravenous cyclophosphamide regimen (HR = 1.951, 95% CI =1.520–2.740). Twelve (13.9%) patients died of severe pneumonia.ConclusionThe infection rate during induction therapy was high in patients with AAV. Bacterial pneumonia was the main type of infection encountered. Age at the time of diagnosis, smoking, baseline SCr ≥5.74 mg/dl, CD4+ T cell< 281 μl, and IV-CYC therapy were identified as risk factors for infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for infectious complications of ANCA-associated vasculitis: a cohort study

et al. 2018

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“…Pulmonary capillaritis is often observed in systemic lupus erythematosus but is also seen in MPA [6]. Patients with MPA tend to suffer from various infectious diseases such as miosis, pneumocystis jirovecii, or cytomegalovirus [6,7,8,9]. In general, clinicians should consider capillaritis due to MPA if the disease state of MPA is active.…”

Section: Discussionmentioning

confidence: 99%

Various patterns of acute alveolar haemorrhage in patients with microscopic polyangiitis: a clinicopathological study of four cases

Yorita¹,

Sakamoto²,

Tsuji³

2018

pjp

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It is well known that acute alveolar haemorrhage (AAH) is attributed to capillaritis in most cases with microscopic polyangiitis (MPA). In this article, we explore the cause of alveolar haemorrhage in MPA patients. In the present study, we extracted four autopsy cases of MPA with AAH. Patient's sex and age, cause of alveolar haemorrhage, therapy, follow-up duration, and cause of death were investigated. As a result, alveolar haemorrhage was caused by diffuse alveolar damage (DAD) due to candidiasis or influenza virus infection, haemorrhagic infarct due to aspergillosis, capillaritis due to MPA, vasculitis due to cytomegalovirus (CMV), and herpes simplex virus (HSV) infection. All patients received corticosteroid therapy, and one patient additionally underwent administration of cyclophosphamide. The duration of follow-up ranged from one to 26 months with a mean of eight months. All patients died of respiratory failure. In summary, clinicians and pathologists should recognise some causes of alveolar haemorrhage in MPA patients, which include DAD, haemorrhagic infarct, virus-associated vasculitis, or MPA-associated capillaritis.

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Alveolar haemorrhage in ANCA-associated vasculitis: Long-term outcome and mortality predictors

Quartuccio

Bond

Isola

et al. 2020

Journal of Autoimmunity

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Strategy of Infection Control in Immunosuppressive Therapy for ANCA-Associated Vasculitis

Cited by 3 publications

References 8 publications

Risk factors for infectious complications of ANCA-associated vasculitis: a cohort study

Risk factors for infectious complications of ANCA-associated vasculitis: a cohort study

Various patterns of acute alveolar haemorrhage in patients with microscopic polyangiitis: a clinicopathological study of four cases

Alveolar haemorrhage in ANCA-associated vasculitis: Long-term outcome and mortality predictors

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