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Published on: June 14, 2024
Opportunistic infections in patients with idiopathic inflammatory myopathies
Ada Redondo-Benito1, Adrian Curran2, Ana Villar-Gomez3
1Internal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.
Aim:
To describe the prevalence, clinical characteristics and risk factors of opportunistic infection (OI) in a cohort of patients with inflammatory myopathies, and compare mortality rates between those with and without OIs.
Methods:
In total, 204 patients from our myositis cohort were reviewed to identify patients who had experienced an OI during the period 1986-2014. The patients' clinical characteristics, treatments received, and outcomes were systematically recorded. Disease activity at the OI diagnosis and the cumulative doses of immunosuppressive drugs were analyzed, as well as the specific pathogens involved and affected organs.
Results:
The prevalence of OI in the total cohort was 6.4%: viruses, 44.4% (varicella-zoster virus, cytomegalovirus); bacteria, 22.2% (Salmonella sp., Mycobacterium tuberculosis, M. chelonae); fungi, 16.7% (Candida albicans, Pneumocystis jirovecii); and parasites, 16.7% (Toxoplasmosis gondii, Leishmania spp.). Lung and skin/soft tissues were the organs most commonly affected (27.8%). Overall, 55.6% of OIs developed during the first year after the myositis diagnosis and OI was significantly associated with administration of high-dose glucocorticoids (P = 0.0148). Fever at onset of myositis (P = 0.0317), biological therapy (P < 0.001) and sequential administration of four or more immunosuppressive agents during myositis evolution (P = 0.0032) were significantly associated with OI. All-cause mortality in the OI group was 3.69 deaths per 100 patients/year versus 3.40 in the remainder of the cohort (P = 0.996).
Conclusions:
The prevalence of OI was 6.4% in our myositis cohort, higher than the rest of the inpatients of our hospital (1.7%; P < 0.01). High-dose glucocorticoids at disease onset and severe immunosuppression are the main factors implicated.
Insights
Opportunistic infections (OIs) affect 6.4% of patients with inflammatory myopathies, often occurring within the first year. High-dose glucocorticoids and severe immunosuppression are key risk factors for OIs in myositis patients.
Area of Science:
- Rheumatology
- Infectious Diseases
- Immunology
Background:
- Inflammatory myopathies (IM) are chronic autoimmune diseases requiring immunosuppressive therapy.
- Opportunistic infections (OIs) are a significant concern in immunocompromised patients, including those with IM.
- Understanding OI prevalence and risk factors in IM is crucial for patient management.
Purpose of the Study:
- To determine the prevalence and clinical characteristics of OIs in a cohort of patients with inflammatory myopathies.
- To identify risk factors associated with OI development in this patient population.
- To compare mortality rates between IM patients with and without OIs.
Main Methods:
- A retrospective review of 204 patients with inflammatory myopathies diagnosed between 1986 and 2014 was conducted.
- Data collected included patient demographics, clinical characteristics, treatments, OI details (pathogen, affected organs), and outcomes.
- Statistical analysis identified factors associated with OI development and compared mortality rates.
Main Results:
- The prevalence of OI in the myositis cohort was 6.4%, significantly higher than the general hospital inpatient population (1.7%).
- Common OIs included viral (44.4%), bacterial (22.2%), fungal (16.7%), and parasitic (16.7%) infections, primarily affecting the lungs and skin.
- High-dose glucocorticoids, biological therapy, and use of multiple immunosuppressive agents were significantly associated with increased OI risk.
Conclusions:
- Opportunistic infections are a notable complication in patients with inflammatory myopathies, with a prevalence of 6.4%.
- Key risk factors include high-dose glucocorticoid therapy at disease onset and extensive use of immunosuppressive agents.
- While OIs were more common in this cohort, all-cause mortality did not significantly differ between patients with and without OIs.
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