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Preventing and treating biologic-associated opportunistic infections

Abstract

A variety of opportunistic pathogens have been reported to infect patients receiving tumor necrosis factor (TNF) antagonists for the treatment of autoimmune diseases. These pathogens are numerous, and include coccidioides, histoplasma, nontuberculous mycobacteria, Mycobacteria tuberculosis, and others of public health concern. Accordingly, TNF antagonists should be used with caution in patients at risk for tuberculosis, and screening for latent tuberculosis infection should be undertaken before anti-TNF therapy is initiated. Although screening and prevention efforts have decreased the risk of tuberculosis in this setting, optimal screening methods represent an area of evolving controversy. This article discusses the latest developments in screening methodologies for latent tuberculosis infection, as well as potential preventive and therapeutic considerations for opportunistic infections associated with anti-TNF agents and other biologic therapies.

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Figure 1: Proposed schemata for TB screening in patients administered or scheduled to receive TNF antagonists.
Figure 2: Known endemic areas for three endemic mycoses in North and South America.

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Acknowledgements

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. K. L. Winthrop's work on this manuscript was funded by an Agency for Healthcare Research and Quality (AHRQ) grant (1K08HS017552-01).

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Correspondence to Kevin L. Winthrop.

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K. L. Winthrop declares he has received grant support from UCB, and has acted as a consultant for Genentech and Amgen. T. Chiller declares no competing interests.

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Winthrop, K., Chiller, T. Preventing and treating biologic-associated opportunistic infections. Nat Rev Rheumatol 5, 405–410 (2009). https://doi.org/10.1038/nrrheum.2009.105

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