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Published on: June 16, 2020
Considerations and clinical management of infections in sarcoidosis
Edward S Chen1, Karen C Patterson2
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University, 5501 Hopkins Bayview Circle, Baltimore, Maryland 21224, USA.
Purpose Of Review:
To summarize data from recent reports about risks and outcomes of the infections most often reported in patients with sarcoidosis.
Recent Findings:
Rates of fungal infections and other severe infections are higher in patients with sarcoidosis compared to controls. Immunosuppression further increases the risk for an infection requiring hospitalization. In contrast, outcomes of coronavirus disease 2019 (COVID-19) are not worse unless lung impairment or other comorbidities are present.
Summary:
Tuberculosis, fungal infections, and other severe infections requiring hospital admission are, fortunately, relatively rare in patients with sarcoidosis who live in nonendemic regions. However, ongoing vigilance is required when the course of sarcoidosis is atypical or inexplicably progressive, as costs are high when these infections are missed. In contrast, COVID-19 and other respiratory viral illnesses are common, including among patients with sarcoidosis. When organ impairment is minimal, an underlying diagnosis of sarcoidosis does not appear to increase the risk of severe COVID-19, but patients may have higher risks due to comorbidities, which are important factors to address in routine sarcoidosis care. The burden from respiratory viral events, including impacts on quality of life and life functionality including work capacity, is unknown and is important to measure.
Insights
Patients with sarcoidosis face higher risks of severe infections, particularly fungal infections, especially when on immunosuppression. However, outcomes for COVID-19 are generally not worse unless comorbidities are present.
Area of Science:
- Infectious disease epidemiology
- Pulmonary medicine
- Immunology
Background:
- Sarcoidosis patients exhibit elevated risks for severe infections, including fungal infections, compared to the general population.
- Immunosuppressive therapies commonly used in sarcoidosis management further exacerbate infection risks, potentially leading to hospitalization.
- While severe outcomes from COVID-19 are not inherently higher in sarcoidosis patients, pre-existing lung impairment and comorbidities significantly increase this risk.
Approach:
- This review synthesizes recent data on infection risks and outcomes in sarcoidosis.
- Analysis focuses on common infections such as tuberculosis, fungal infections, and viral illnesses like COVID-19.
- The impact of immunosuppression and comorbidities on infection severity is evaluated.
Key Points:
- Fungal and other severe infections are more prevalent in sarcoidosis patients, necessitating vigilance, especially with atypical disease progression.
- Immunosuppression is a significant risk factor for infections requiring hospitalization in this population.
- COVID-19 outcomes in sarcoidosis patients are generally favorable unless complicated by lung impairment or comorbidities.
Conclusions:
- While severe infections are relatively rare in non-endemic areas, they pose a considerable burden when missed, underscoring the need for careful monitoring.
- Sarcoidosis itself does not appear to worsen COVID-19 prognosis in the absence of organ impairment, but comorbidities are critical factors.
- Further research is needed to quantify the impact of respiratory viral illnesses on sarcoidosis patients' quality of life and functional capacity.
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