Infectious Complications of Immunosuppressive Therapy in Patients with Rheumatic Diseases

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Infectious Complications of Immunosuppressive Therapy in Patients with

Rheumatic Diseases

Infection is a major complication in patients who have a rheumatic disease

and the failure to recognize infection can have life-threatening effects.

Some rheumatic diseases are associated with immune system abnormalities and

require the use of immunosuppressive therapy. Recognizing and treating

infections in these populations are difficult for many reasons. The symptoms

of infection can be identical to the underlying disease making it difficult

to see the signs and symptoms of infection. The effects of the therapy used

in treating problems with the immune system may mask the characteristics of

infection such as fever and inflammation. These matters make the treatment

more complicated since the spectrum of potential pathogens is so broad.

Although fever is a common characteristic of many rheumatic diseases, it

could also be a cardinal sign of an infection. In many cases the

anti-inflammatory agents can hide fever, making infection difficult to

recognize. Fever in a patient who is getting immunosuppressive therapy

demands prompt attention. In assessment a complete history and physical

should be done, chest x-ray and appropriate lab work should be obtained, and

the activity of the underlying disease should be examined. Any abnormalities

should be pursued immediately.

Pneumonia is perhaps the most frequent and potentially life-threatening

infections with patients with rheumatic diseases. Symptoms can include

fever, evidence on x-ray, and on cough which can be productive. Treatment of

pneumonia depends on what kind of pathogen is present. Cultures, lab work,

and obtaining blood cultures enable the physician to discover what is

causing the pneumonia and to treat it effectively.

Occasionally, it is indicated that a patient undergoing immunosuppressive

therapy be started on antibiotics prophylactically to protect against

infection.

Although infection continues to be a great concern for patients with

rheumatic diseases, early diagnosis and proper treatment is crucial to the

successful management of these patients. Because symptoms of infection vary

between patients, the physician must always think about the possibility of

infection.