REVIEW - Fungal infections complicating TNF-alpha blockade therapy

[Guest guest]

Mayo Clinic Proceedings

Feb 2008

Fungal Infections Complicating Tumor Necrosis Factor á Blockade Therapy

Sotirios Tsiodras, MD, MSc, ScD, Samonis, MD, Dimitrios T.

Boumpas, MD and Dimitrios P. Kontoyiannis, MD, MSc, ScD

From the 4th Academic Department of Internal Medicine and Infectious

Diseases, Attikon University General Hospital, University of Athens

Medical School, Athens, Greece (S.T.), Department of Internal

Medicine, University of Crete Medical School, Heraklion, Greece (G.S.,

D.T.B.), and Department of Infectious Diseases, Infection Control and

Employee Health, The University of Texas M.D. Cancer Center,

Houston (D.P.K.).

Abstract

Tumor necrosis factor á (TNF-á) blockade has emerged as a useful

therapy for collagen vascular diseases or graft-vs-host disease.

Fungal infections complicating such therapy have been reported

sporadically. MEDLINE and PubMed databases (from January 1, 1966, to

June 1, 2007) were searched for reports of invasive fungal infections

(IFIs) associated with the 3 available anti-TNF-á agents, ie,

infliximab, etanercept, and adalimumab.

Of the 281 cases of IFI associated with TNF-á inhibition, 226 (80%)

were associated with infliximab, 44 (16%) with etanercept, and 11 (4%)

with adalimumab. Fungal infections associated with infliximab occurred

a median of 55 days (interquartile range [iQR], 15-140 days) after

initiation of therapy and 3 infusions of the medication (IQR, 2-5),

whereas those associated with etanercept occurred a median of 144 days

(IQR, 46-240 days) after initiation of therapy. The median age of

patients was 58 years (IQR, 44-68 years), and 62% were male. Use of at

least 1 other immunosuppressant medication, typically a systemic

corticosteroid, was reported during the course of the fungal infection

in 102 (98%) of the 104 patients for whom data were available.

The most prevalent IFIs were histoplasmosis (n=84 [30%]), candidiasis

(n=64 [23%]), and aspergillosis (n=64 [23%]). Pneumonia was the most

common pattern of infection. Of the 90 (32%) of 281 cases for which

outcome information was available, 29 fatalities (32%) were recorded.

Tumor necrosis factor á blockade is associated with IFI across a range

of host groups. A high index of suspicion in patients treated with

TNF-á antagonists is recommended because the course of such infections

can be serious or fulminant, and rapid access to health care should be

provided. Surveillance of IFIs complicating TNF-á blockade and other

biologic therapies is warranted through well-organized prospective

patient registries.

********************************************************

Read the full article here:

http://www.mayoclinicproceedings.com/content/83/2/181.long

Not an MD

[Guest guest]

, I think I'll save this article and take it to my rheumy. Once

when I told him that I had had candidiasis (yeast infection), he said

they usually don't count that kind of infection. Then the last time

after I had had a conbination of vaginal Strep B and yeast infection,

I told him that I thought an infection was an infection.

I am on just Enbrel and acetaminophen, no corticosteroid or other

immunosuppressant.

Sue

On Oct 2, 2010, at 5:54 PM, wrote:

>

> Abstract

>

> Tumor necrosis factor α (TNF-α) blockade has emerged as a useful

> therapy for collagen vascular diseases or graft-vs-host disease.

> Fungal infections complicating such therapy have been reported

> sporadically. MEDLINE and PubMed databases (from January 1, 1966, to

> June 1, 2007) were searched for reports of invasive fungal infections

> (IFIs) associated with the 3 available anti-TNF-α agents, ie,

> infliximab, etanercept, and adalimumab.

>

> Of the 281 cases of IFI associated with TNF-α inhibition, 226 (80%)

> were associated with infliximab, 44 (16%) with etanercept, and 11 (4%)

> with adalimumab. Fungal infections associated with infliximab occurred

> a median of 55 days (interquartile range [iQR], 15-140 days) after

> initiation of therapy and 3 infusions of the medication (IQR, 2-5),

> whereas those associated with etanercept occurred a median of 144 days

> (IQR, 46-240 days) after initiation of therapy. The median age of

> patients was 58 years (IQR, 44-68 years), and 62% were male. Use of at

> least 1 other immunosuppressant medication, typically a systemic

> corticosteroid, was reported during the course of the fungal infection

> in 102 (98%) of the 104 patients for whom data were available.

>

> The most prevalent IFIs were histoplasmosis (n=84 [30%]), candidiasis

> (n=64 [23%]), and aspergillosis (n=64 [23%]). Pneumonia was the most

> common pattern of infection. Of the 90 (32%) of 281 cases for which

> outcome information was available, 29 fatalities (32%) were recorded.

>

> Tumor necrosis factor α blockade is associated with IFI across a

> range

> of host groups. A high index of suspicion in patients treated with

> TNF-α antagonists is recommended because the course of such

> infections

> can be serious or fulminant, and rapid access to health care should be

> provided. Surveillance of IFIs complicating TNF-α blockade and other

> biologic therapies is warranted through well-organized prospective

> patient registries.

>

> ********************************************************

> Read the full article here:

>

> http://www.mayoclinicproceedings.com/content/83/2/181.long

>

>

>

>

> Not an MD

>

>

> ------------------------------------

>

>

[Guest guest]

Good idea, Sue. Let us know what he says.

Not an MD

On Sat, Oct 2, 2010 at 7:37 PM, marysue <marysue@...> wrote:

> , I think I'll save this article and take it to my rheumy. Once

> when I told him that I had had candidiasis (yeast infection), he said

> they usually don't count that kind of infection. Then the last time

> after I had had a conbination of vaginal Strep B and yeast infection,

> I told him that I thought an infection was an infection.

>

> I am on just Enbrel and acetaminophen, no corticosteroid or other

> immunosuppressant.

>

> Sue

[Guest guest]

OK, now dont laugh at me my fellow groupies:

After I read this article I began to wonder. I always get my feet manicured,

its my one luxury. So about 3 months ago, I noticed my big toe nail turning

dark, and it turns out its a nail fungus. So I went to the doc, she offered me

to take fungus pills for a long time, or to use a tincture to paint on, I chose

the tinture, cause to take these fungus pills for weeks, I am afraid the RA

would flare without my RA meds (it takes long).

So here I am painting the tincture on faithfully for one month already and its

still not getting better. The podiatrist said it might take up to a

year.....ugh.

Is this minor fungal infection because of the Enbrel? ??(not an MD but

should have been/BE one - L0L:))

Thanks

OKD

[Guest guest]

I've read that a common way to get toenail fungus is from pedicares.

Here is an article about it:

http://www.squidoo.com/toe-fungus-pedicures

Sue

On Oct 4, 2010, at 10:39 AM, OKD wrote:

> OK, now dont laugh at me my fellow groupies:

>

> After I read this article I began to wonder. I always get my feet

> manicured, its my one luxury. So about 3 months ago, I noticed my

> big toe nail turning dark, and it turns out its a nail fungus. So I

> went to the doc, she offered me to take fungus pills for a long

> time, or to use a tincture to paint on, I chose the tinture, cause

> to take these fungus pills for weeks, I am afraid the RA would flare

> without my RA meds (it takes long).

>

> So here I am painting the tincture on faithfully for one month

> already and its still not getting better. The podiatrist said it

> might take up to a year.....ugh.

>

> Is this minor fungal infection because of the Enbrel? ??(not

> an MD but should have been/BE one - L0L:))

>

[Guest guest]

Sad to say, I got it that way in one nail. I treated it over the counter for a

year, but gave up. The Lamisil tabs seem to helping and my NP ordered liver

tests every month. Kate f

Sent from my iPhone

On Oct 4, 2010, at 3:47 PM, marysue <marysue@...> wrote:

> I've read that a common way to get toenail fungus is from pedicares.

> Here is an article about it:

>

> http://www.squidoo.com/toe-fungus-pedicures

>

> Sue

>

> On Oct 4, 2010, at 10:39 AM, OKD wrote:

>

> > OK, now dont laugh at me my fellow groupies:

> >

> > After I read this article I began to wonder. I always get my feet

> > manicured, its my one luxury. So about 3 months ago, I noticed my

> > big toe nail turning dark, and it turns out its a nail fungus. So I

> > went to the doc, she offered me to take fungus pills for a long

> > time, or to use a tincture to paint on, I chose the tinture, cause

> > to take these fungus pills for weeks, I am afraid the RA would flare

> > without my RA meds (it takes long).

> >

> > So here I am painting the tincture on faithfully for one month

> > already and its still not getting better. The podiatrist said it

> > might take up to a year.....ugh.

> >

> > Is this minor fungal infection because of the Enbrel? ??(not

> > an MD but should have been/BE one - L0L:))

> >

>

>

[Guest guest]

LOL, OKD.

So sorry about your toe. Since that sort of fungal infection is so

common, it's difficult to know whether Enbrel had anything to do with

it.

Not an MD

On Mon, Oct 4, 2010 at 9:39 AM, OKD <Cofade_2000@...> wrote:

> OK, now dont laugh at me my fellow groupies:

>

> After I read this article I began to wonder.  I always get my feet manicured,

its my one luxury.  So about 3 months ago, I noticed my big toe nail turning

dark, and it turns out its a nail fungus.  So I went to the doc, she offered me

to take fungus pills for a long time, or to use a tincture to paint on, I chose

the tinture, cause to take these fungus pills for weeks, I am afraid the RA

would flare without my RA meds (it takes long).

>

> So here I am painting the tincture on faithfully for one month already and its

still not getting better.  The podiatrist said it might take up to a

year.....ugh.

>

> Is this minor fungal infection because of the Enbrel?   ??(not an MD but

should have been/BE one - L0L:))

>

>

> Thanks

>

> OKD

[Guest guest]

You don't say whether you are on Methotrexate, but I regularly have problems

with fungal problems in my mouth (Thrush) for which I have to take meds, even

though I take folic acid to help.

from CaliforniA

> > OK, now dont laugh at me my fellow groupies:

> >

> > After I read this article I began to wonder.  I always get my feet

manicured, its my one luxury.  So about 3 months ago, I noticed my big toe nail

turning dark, and it turns out its a nail fungus.  So I went to the doc, she

offered me to take fungus pills for a long time, or to use a tincture to paint

on, I chose the tinture, cause to take these fungus pills for weeks, I am afraid

the RA would flare without my RA meds (it takes long).

> >

> > So here I am painting the tincture on faithfully for one month already and

its still not getting better.  The podiatrist said it might take up to a

year.....ugh.

> >

> > Is this minor fungal infection because of the Enbrel?   ??(not an MD but

should have been/BE one - L0L:))

> >

> >

> > Thanks

> >

> > OKD

>