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[Collagen diseases with opportunistic infections]
Katsuhiko Takabayashi1, Hideki Hanaoka
1Department of Medical Informatics and Management, Chiba University Hospital.
Summary
Prophylaxis with isoniazid (INH) and sulfamethoxazole/trimethoprim (ST) effectively prevents opportunistic infections like tuberculosis and Pneumocystis pneumonia in patients receiving high-dose corticosteroids. Careful patient selection and prophylaxis are crucial for managing these risks.
Area of Science:
- Immunology
- Infectious Diseases
- Rheumatology
Context:
- Collagen diseases often require immunosuppressive therapy, increasing the risk of opportunistic infections.
- Lung tuberculosis, Pneumocystis carinii pneumonia, and fungal infections are significant opportunistic threats.
- Effective prophylactic strategies are available but require careful consideration of adverse effects.
Purpose:
- To evaluate the long-term efficacy of isoniazid (INH) and sulfamethoxazole/trimethoprim (ST) prophylaxis against opportunistic infections in patients with collagen diseases.
- To assess the role of prophylaxis in mitigating tuberculosis and Pneumocystis carinii pneumonia risks associated with high-dose corticosteroid and infliximab therapy.
Summary:
- A 15-year study demonstrated successful prophylaxis against tuberculosis and Pneumocystis carinii pneumonia using INH and ST in patients treated with >60 mg/day of prednisolone, tapering to <30 mg/day.
- Despite concerns about infliximab inducing tuberculosis, particularly in Japan, few cases were observed, potentially due to patient selection and proactive prophylaxis.
Impact:
- This study highlights the critical importance of targeted prophylaxis in managing opportunistic infections in immunocompromised patients.
- The findings support the routine use of INH and ST for preventing serious infections in patients undergoing long-term, high-dose corticosteroid therapy.