Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for opportunistic infections in infliximab-treated patients: the importance of screening in prevention

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

We sought to determine factors associated with opportunistic infections (OI) in infliximab-treated patients. A retrospective study cohort (1999–2004) was examined. Nine OI were diagnosed in 94 infliximab-treated patients: tuberculosis (four), visceral leishmaniasis (one), pyogenic muscular abscess (one Salmonella spp. and one Streptococcus pneumoniae), and two viral infections (hepatitis B virus [HBV] and zoster ophthalmicus). The risk for OI was significantly higher in the first year of treatment (odds ratio [OR] 8; 95% confidence interval [CI] 2–50). Previous treatment with more than two immunosuppressive drugs was the only factor related to OI (OR 8.686; 95% CI 1.889–39.943). We identified the subset of patients treated with infliximab who had a higher risk for OI. The screening of latent infections is key to diminishing the incidence of these infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Wallis RS, Broder MS, Wong JY (2004) Granulomatous infectious diseases associated with tumor necrosis factor antagonists. Clin Infect Dis 38:1261–1265. doi:10.1086/383317

    Article  PubMed  CAS  Google Scholar 

  2. Keane J, Gershon S, Wise RP et al (2001) Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 345:1098–1104. doi:10.1056/NEJMoa011110

    Article  PubMed  CAS  Google Scholar 

  3. Crum NF, Lederman ER, Wallace MR (2005) Infections associated with tumor necrosis factor-alpha antagonists. Medicine (Baltimore) 84:291–302. doi:10.1097/01.md.0000180044.19285.9a

    Article  CAS  Google Scholar 

  4. Doran MF, Crowson CS, Pond GR et al (2002) Predictors of infection in rheumatoid arthritis. Arthritis Rheum 46:2294–2300. doi:10.1002/art.10529

    Article  PubMed  Google Scholar 

  5. Greenberg SB (2002) Infections in the immunocompromised rheumatologic patient. Crit Care Clin 18:931–956. doi:10.1016/S0749-0704(02)00022-2

    Article  PubMed  Google Scholar 

  6. Cunnane G, Doran M, Bresnihan B (2003) Infections and biological therapy in rheumatoid arthritis. Best Pract Res Clin Rheumatol 17:345–363. doi:10.1016/S1521-6942(02)00107-9

    Article  PubMed  Google Scholar 

  7. Garcia-Vidal C, Salavert M (2007) Artritis reumatoide y el tropismo infeccioso. Seminarios Fundacion Esp Reumatologia 8:68–87

    Article  Google Scholar 

  8. Elkayam O, Caspi D, Reitblatt T et al (2004) The effect of tumor necrosis factor blockade on the response to pneumococcal vaccination in patients with rheumatoid arthritis and ankylosing spondylitis. Semin Arthritis Rheum 33:283–288. doi:10.1053/j.semarthrit.2003.10.003

    Article  PubMed  CAS  Google Scholar 

  9. Fomin I, Caspi D, Lavy V et al (2006) Vaccination against influenza in rheumatoid arthritis: the effect of disease modifying drugs, including TNF alpha blockers. Ann Rheum Dis 65:191–194. doi:10.1136/ard.2005.036434

    Article  PubMed  CAS  Google Scholar 

  10. Visvanathan S, Keenan GF, Baker DG et al (2007) Response to pneumococcal vaccine in patients with early rheumatoid arthritis receiving Infliximab plus methotrexate or methotrexate alone. J Rheumatol 34:952–957

    PubMed  CAS  Google Scholar 

  11. Gelinck LB, van der Bijl AE, Visser LG et al (2008) Synergistic immunosuppressive effect of anti-TNF combined with methotrexate on antibody responses to the 23 valent pneumococcal polysaccharide vaccine. Vaccine 26:3528–3533. doi:10.1016/j.vaccine.2008.04.028

    Article  PubMed  CAS  Google Scholar 

  12. Bergstrom L, Yocum DE, Ampel NM et al (2004) Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor alpha antagonists. Arthritis Rheum 50:1959–1966. doi:10.1002/art.20454

    Article  PubMed  CAS  Google Scholar 

  13. Gardam MA, Keystone EC, Menzies R et al (2003) Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis 3:148–155. doi:10.1016/S1473-3099(03)00545-0

    Article  PubMed  CAS  Google Scholar 

  14. Mow WS, Abreu-Martin MT, Papadakis KA et al (2004) High incidence of anergy in inflammatory bowel disease patients limits the usefulness of PPD screening before infliximab therapy. Clin Gastroenterol Hepatol 2:309–313. doi:10.1016/S1542-3565(04)00060-6

    Article  PubMed  Google Scholar 

  15. Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V et al (2005) Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum 52:1766–1772. doi:10.1002/art.21043

    Article  PubMed  CAS  Google Scholar 

  16. Sellam J, Hamdi H, Roy C et al (2007) Comparison of in vitro-specific blood tests with tuberculin skin test for diagnosis of latent tuberculosis before anti-TNF therapy. Ann Rheum Dis 66:1610–1615. doi:10.1136/ard.2007.069799

    Article  PubMed  Google Scholar 

  17. Mazurek GH, Weis SE, Moonan PK et al (2007) Prospective comparison of the tuberculin skin test and 2 whole-blood interferon-gamma release assays in persons with suspected tuberculosis. Clin Infect Dis 45:837–845. doi:10.1086/521107

    Article  PubMed  CAS  Google Scholar 

  18. Mazurek GH, Zajdowicz MJ, Hankinson AL et al (2007) Detection of Mycobacterium tuberculosis infection in United States navy recruits using the tuberculin skin test or whole-blood interferon-gamma release assays. Clin Infect Dis 45:826–836. doi:10.1086/521106

    Article  PubMed  CAS  Google Scholar 

  19. Esteve M, Saro C, González-Huix F et al (2004) Chronic hepatitis B reactivation following infliximab therapy in Crohn’s disease patients: need for primary prophylaxis. Gut 53:1363–1365. doi:10.1136/gut.2004.040675

    Article  PubMed  CAS  Google Scholar 

  20. Esteve M, Loras C, González-Huix F (2007) Lamivudine resistance and exacerbation of hepatitis B in infliximab-treated Crohn’s disease patient. Inflamm Bowel Dis 13:1450–1451. doi:10.1002/ibd.20202

    Article  PubMed  Google Scholar 

  21. Garcia Vidal C, Rodríguez Fernández S, Martínez Lacasa J et al (2005) Paradoxical response to antituberculous therapy in infliximab-treated patients with disseminated tuberculosis. Clin Infect Dis 40:756–759. doi:10.1086/427941

    Article  PubMed  Google Scholar 

  22. Tubach F, Ravaud P, Salmon-Céron D et al (2006) Emergence of Legionella pneumophila pneumonia in patients receiving tumor necrosis factor-alpha antagonist. Clin Infect Dis 43:e95–e100. doi:10.1086/508538

    Article  PubMed  CAS  Google Scholar 

  23. Dixon WG, Watson K, Lunt M et al (2006) Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 54:2368–2376. doi:10.1002/art.21978

    Article  PubMed  CAS  Google Scholar 

  24. Hine RJ, Everson MP, Hardin JM et al (1990) Methotrexate therapy in rheumatoid arthritis patients diminishes lectin-induced mononuclear cell proliferation. Rheumatol Int 10:165–169. doi:10.1007/BF02274842

    Article  PubMed  CAS  Google Scholar 

  25. Lionakis MS, Kontoyiannis DP (2003) Glucocorticoids and invasive fungal infections. Lancet 362:1828–1838. doi:10.1016/S0140-6736(03)14904-5

    Article  PubMed  CAS  Google Scholar 

  26. McCune WJ, Golbus J, Zeldes W et al (1988) Clinical and immunologic effects of monthly administration of intravenous cyclophosphamide in severe systemic lupus erythematosus. N Engl J Med 318:1423–1431

    PubMed  CAS  Google Scholar 

  27. Schreiber SL, Crabtree GR (1992) The mechanism of action of cyclosporin A and FK506. Immunol Today 13:136–142. doi:10.1016/0167-5699(92)90111-J

    Article  PubMed  CAS  Google Scholar 

  28. Jick SS, Lieberman ES, Rahman MU et al (2006) Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum 55:19–26. doi:10.1002/art.21705

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Part of these results have been presented previously at the 46th Interscience Conference on Antimicrobial Agents and Chemotherapy, 27–30 September 2006, San Francisco, CA. We thank David García-Cortés for his value technical assistance.

Author information

Authors and Affiliations

  1. Service of Internal Medicine, Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain

    C. Garcia-Vidal, S. Rodríguez-Fernández, S. Teijón, M. Rodríguez-Carballeira, J. M. Lacasa & J. Garau

  2. Service of Gastroenterology, Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain

    M. Esteve

  3. Service of Rheumatology, Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain

    G. Salvador

  4. Infectious Disease Service, Hospital Universitari de Bellvitge, Feixa Llarga sn 08907 L’Hospitalet, Barcelona, Spain

    C. Garcia-Vidal

Authors
  1. C. Garcia-Vidal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Rodríguez-Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Teijón
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Esteve
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Rodríguez-Carballeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. M. Lacasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Salvador
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Garau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Garcia-Vidal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garcia-Vidal, C., Rodríguez-Fernández, S., Teijón, S. et al. Risk factors for opportunistic infections in infliximab-treated patients: the importance of screening in prevention. Eur J Clin Microbiol Infect Dis 28, 331–337 (2009). https://doi.org/10.1007/s10096-008-0628-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-008-0628-x

Keywords

Search

Navigation