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Pneumonia in myasthenia gravis: Microbial etiology and clinical management
Manqiqige Su1,2, Shan Jin3, Kexin Jiao1,2
1Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
Introduction:
Patients with myasthenia gravis (MG) are prone to the development of pneumonia due to the long-term immunotherapies they receive and a tendency for aspiration. Pneumonia remains a risk factor for MG worsening and is the most prevalent cause of mortality in MG patients. Classification of the pathogens involved and exploration of the risk factors for mechanical ventilation (MV) could aid in improving clinical outcomes.
Methods:
Between January 2013 and October 2022, we performed an inpatient database review for MG patients with pneumonia concurrence in a tertiary research center specializing in neuromuscular disorders. The clinical and microbiological characteristics of 116 MG patients with pneumonia were retrospectively analyzed.
Results:
In our cohort, 90.32% (112/124) of organisms were bacteria and 42.86% (48/112) of pathogenic bacteria were carbapenem-resistant. A high abundance of Epstein-Barr virus (EBV) was detected using next-generation sequencing (NGS) in 12 patients, while cytomegalovirus (CMV) was detected in 8 patients. Non-fermentative Gram-negative bacilli were the most prevalent microorganisms, in which ampicillin, sulfamethoxazole-trimethoprim (SMZ-TMP), piperacillin, cefoperazone, ceftazidime, and cefepime may have an anti-infectious effect. Moreover, peripheral lymphocyte percentage [odds ratio (OR) 0.88, 95% CI 0.75-0.96, p = 0.02] and serum globulin (OR 1.16, 95% CI 1.02-1.35, p = 0.03) were significantly associated with the risk of MV demand.
Discussion:
Our identification of the microbial etiology of pneumonia in MG patients may provide future perspectives on accurate antibiotic options and enable early interventions when risk factors are present.
Insights
Pneumonia in myasthenia gravis (MG) patients is often caused by carbapenem-resistant bacteria and viruses like EBV and CMV. Peripheral lymphocyte percentage and serum globulin levels are risk factors for mechanical ventilation in these patients.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Myasthenia gravis (MG) patients face high pneumonia risk due to immunotherapy and aspiration.
- Pneumonia is a significant factor in MG exacerbation and a leading cause of mortality.
- Understanding pneumonia pathogens and mechanical ventilation (MV) risk factors is crucial for improving outcomes.
Purpose of the Study:
- To classify pathogens causing pneumonia in MG patients.
- To identify risk factors associated with the need for mechanical ventilation (MV) in MG patients with pneumonia.
Main Methods:
- Retrospective analysis of 116 MG patients with pneumonia from January 2013 to October 2022.
- Inpatient database review at a tertiary neuromuscular disorder center.
- Clinical and microbiological characteristics were analyzed, including next-generation sequencing (NGS) for viral detection.
Main Results:
- Bacteria constituted 90.32% of identified organisms, with 42.86% being carbapenem-resistant.
- Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were detected in 12 and 8 patients, respectively.
- Peripheral lymphocyte percentage and serum globulin levels were significantly associated with MV risk (p=0.02 and p=0.03, respectively).
Conclusions:
- Identification of microbial etiology aids in selecting appropriate antibiotics for pneumonia in MG patients.
- Early intervention strategies can be developed based on identified risk factors for MV.
- This study provides insights into the complex interplay of MG, pneumonia, and critical care needs.
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