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Pneumocystis jirovecii colonization in patients treated with infliximab

Authors

  • Gustavo Wissmann,

    1. Pneumocystis Study Group, Infectology Unit, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
    2. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    3. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • Rubén Morilla,

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    2. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • Isabel Martín-Garrido,

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
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  • Vicente Friaza,

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    2. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • Nieves Respaldiza,

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    2. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • Juan Povedano,

    1. Service of Rheumatology, Virgen del Rocío Universitary Hospital, Seville, Spain
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  • Juan M. Praena-Fernández,

    1. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • Marco A. Montes-Cano,

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    2. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • Francisco J. Medrano,

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    2. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • Luciano Z. Goldani,

    1. Pneumocystis Study Group, Infectology Unit, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • Carmen de la Horra,

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    2. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • José M. Varela,

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    2. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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  • Enrique J. Calderón

    1. CIBER Epidemiology and Public Health, Service of Internal Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain
    2. Institut of Biomedicine, Virgen del Rocío Universitary Hospital/CSIC/University of Seville, Seville, Spain
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Enrique J. Calderón, MD, PhD, Instituto de Biomedicina de Sevilla. Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain. Tel.: +34 955 01 3284; Fax: +34 955 01 3292; e-mail: ecalderon@ibis-sevilla.es

Abstract

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.

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