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[Infections in polymyositis and in dermatomyositis]

Isabelle Marie1

  • 1Département de Médecine Interne, CHU Rouen, F-76031 Rouen Cedex, France. isabelle.marie@chu-rouen.fr

Presse Medicale (Paris, France : 1983)
|December 17, 2008
PubMed

Insights

Infections significantly increase mortality in polymyositis/dermatomyositis patients. Risk factors include age, lymphopenia, organ dysfunction, and steroid use, necessitating targeted prevention strategies.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Immunology

Background:

  • Infections are a major cause of mortality in polymyositis/dermatomyositis (PM/DM), accounting for 9-30% of deaths.
  • Patients with PM/DM are susceptible to both pyogenic and opportunistic infections.

Purpose of the Study:

  • To identify predictive factors for infection onset in PM/DM patients.
  • To discuss appropriate prophylactic measures against infections in PM/DM.

Main Methods:

  • Review of clinical parameters associated with infection risk in PM/DM.
  • Analysis of common pathogens causing infections in PM/DM.
  • Evaluation of strategies for infection prevention, including vaccination and primary prophylaxis.

Main Results:

  • Predictive factors for infection include age, lymphopenia, esophageal dysfunction, ventilatory insufficiency, interstitial lung disease, calcinosis cutis, and high steroid doses.
  • Mycobacteria and fungi (e.g., Pneumocystis jiroveci, Candida) are common causes of opportunistic infections.
  • Primary prophylaxis for Pneumocystis jiroveci pneumonia is recommended for patients with CD4 counts below 250/mm³.

Conclusions:

  • Implementing preventative strategies, such as vaccination before immunosuppression and targeted prophylaxis, is crucial for reducing infection-related mortality in PM/DM.
  • Prophylaxis against Pneumocystis jiroveci pneumonia should be considered for immunocompromised PM/DM patients.

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