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Recommendations for the management of pulmonary fungal infections in patients with rheumatoid arthritis

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34

  1. Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy. massimo.galli@unimi.it
  2. Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy.
  3. IRCCS Galeazzi Orthopedic Institute, Milan, Italy.
  4. Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy.
  5. Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy.
  6. Department of Medical Sciences, UOC of Rheumatology, Santa Anna University Hospital, Ferrara, Italy.
  7. Institute of Biomedical Technologies, National Research Council, Milan, Italy.
  8. Department of Medical and Biological Sciences, Rheumatology Clinic, Santa Maria della Misericordia University Hospital, Udine, Italy.
  9. Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, University of Modena and Reggio Emilia, Modena, Italy.
  10. Rheumatology, Allergology and Clinical Immunology Service, Spedali Civili and University, Brescia, Italy.
  11. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
  12. Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Italy.
  13. Clinica Malattie Infettive, IRCCS AOU San Martino-IST, Università di Genova, Italy.
  14. Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, University of Modena and Reggio Emilia, Modena, Italy.
  15. Rheumatology Unit, Department of Medicine, University of Verona, Italy.
  16. Infectious Disease Unit, Amedeo di Savoia Hospital, University of Turin, Italy.
  17. G. Pini Orthopaedic Institute, Milan, Italy.
  18. Infectious Diseases Unit, San Salvatore Hospital, Pesaro, Italy.
  19. Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
  20. Department of Medical Sciences, UOC of Rheumatology, Santa Anna University Hospital, Ferrara, Italy.
  21. Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy.
  22. Rheumatology Unit, Sapienza University, Rome, Italy.
  23. Infectious Disease Unit, University of Rome Tor Vergata, Rome, Italy.
  24. Infectious Disease Unit, Vita e Salute University, Milan, Italy.
  25. Rheumatology Unit, Polytechnic University of Marche, C. Urbani Hospital, Jesi, Italy.
  26. Infectious Disease Unit, Sapienza University, Polo Pontino, ASL Latina, Italy.
  27. Azienda Ospedaliera Universitaria, Seconda Università di Napoli, Italy.
  28. Division of Rheumatology, Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
  29. Research Laboratory and Division of Clinical Rheumatology, University of Genova, Italy.
  30. Department of Medical and Biological Sciences, Rheumatology Clinic, Santa Maria della Misericordia University Hospital, Udine, Italy.
  31. Rheumatology Unit, University of Bari, Italy.
  32. Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence, Italy.
  33. Infectious Diseases Unit, Belcolle Hospital, Viterbo, Italy.
  34. Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.

CER10179 Submission on line
2017 Vol.35, N°6 - PI 1018, PF 1028
Review

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Rheumatology Article

 

Abstract

Often life-threatening pulmonary fungal infections (PFIs) can occur in patients with rheumatoid arthritis (RA) receiving disease-modifying anti-rheumatic drugs (DMARDs). Most of the data concerning PFIs in RA patients come from case reports and retrospective case series. Of the ve most widely described PFIs, Pneumocystis jirovecii pneumonia (PJP) has rarely been seen outside Japan, pulmonary cryptococcosis has been diagnosed in only a small number of patients worldwide, pulmonary coccidioidomycosis has almost only been observed in endemic areas, the limited number of cases of pulmonary histoplasmosis have mainly occurred in the USA, and the rare cases of invasive pulmonary aspergillosis have only been encountered in leukopenic patients. Many aspects of the prophylaxis, diagnosis and treatment of PFIs in RA patients remain to be defined, as does the role of each DMARD in increasing the risk of infection, and the possibility of resuming biological and non-biological DMARD treatment after the infection has been cured. The recommendations for the management of PFIs described in this paper are the product of a consensus procedure promoted by the Italian group for the Study and Management of Infections in Patients with Rheumatic Diseases (the ISMIR group).

PMID: 29185961 [PubMed]

Received: 13/12/2016 - Accepted : 19/02/2017 - In Press: 28/11/2017 - Published: 12/12/2017