Premium
Pneumocystis jirovecii colonization in patients treated with infliximab
Author(s) -
Wissmann Gustavo,
Morilla Rubén,
MartínGarrido Isabel,
Friaza Vicente,
Respaldiza Nieves,
Povedano Juan,
PraenaFernández Juan M.,
MontesCano Marco A.,
Medrano Francisco J.,
Goldani Luciano Z.,
de la Horra Carmen,
Varela José M.,
Calderón Enrique J.
Publication year - 2011
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2010.02415.x
Subject(s) - pneumocystis jirovecii , infliximab , medicine , rheumatoid arthritis , pneumocystis pneumonia , immunology , colonization , tumor necrosis factor alpha , pneumonia , biology , microbiology and biotechnology
Eur J Clin Invest 2011; 41 (3): 343–348 Abstract Background Infliximab, a chimeric antitumour necrosis factor (TNF) monoclonal antibody, has become an established effective therapy for inflammatory rheumatic disease. However, TNF is a critical factor in host defence, and the suppression of its biological activity may be associated with the increased risk of opportunistic infections. The frequent use of infliximab in clinical practice has identified Pneumocystis jirovecii pneumonia (PcP) as a serious complication. Individuals colonized with Pneumocystis may be at high risk of development of PcP when they have undergone immunosuppression. Hence, we addressed the question of the frequency of Pneumocystis colonization among patients treated with infliximab. Design We examined 125 oropharyngeal washes collected from 78 individuals with rheumatoid arthritis, 30 with ankylosing spondylitis and 17 with psoriatic arthritis, half of them underwent infliximab therapy, using a real‐time polymerase chain reaction assay that employs specific primers from a portion of the mitochondrial large‐subunit rRNA gene of P. jirovecii . Results Pneumocystis jirovecii colonization was detected in 32 (25·6%) patients. In a multivariate regression model, only duration of infliximab treatment for more than 3 years and use of corticosteroid were significantly and independently associated with risk of Pneumocystis colonization. However, the effect of corticosteroid on P. jirovecii colonization rate was not linearly dose dependent as showed other logistic regression analysis. Conclusions There is a high rate of P. jirovecii colonization among patients with rheumatologic diseases treated with infliximab. The identification of patients colonized by P. jirovecii before starting the treatment with infliximab could be a strategy for PcP prevention.