Invasive pulmonary fungal infections in patients with connective tissue disease: a retrospective study from northern China

Abstract

Invasive pulmonary fungal infection (IPFI) is a potentially fatal complication in patients with connective tissue disease (CTD). The current study aimed to uncover the clinical characteristics and risk factors of patients with IPFI-CTD. The files of 2186 CTD patients admitted to a single center in northern China between January 2011 and December 2013 were retrospectively reviewed. A total of 47 CTD patients with IPFI were enrolled into this study and assigned to the CTD-IPFI group, while 47 uninfected CTD patients were assigned to the control group. Clinical manifestations were recorded, and risk factors of IPFI were calculated by stepwise logistical regression analysis. Forty-seven (2.15%) CTD patients developed IPFI. Systemic lupus erythematosus patients were responsible for the highest proportion (36.17%) of cases with IPFI. Candida albicans (72.3%) accounted for the most common fungal species. CTD-IPFI patients had significantly elevated white blood cell count, erythrocyte sedimentation rate, C-reactive protein and fasting glucose values compared to controls (P<0.05). Cough, sputum and blood in phlegm were the most common symptoms. Risk factors of IPFI in CTD included maximum prednisone dose ≥30 mg/day within 3 months prior to infection, anti-microbial drug therapy, and interstitial pneumonia. CTD patients who have underlying interstitial pneumonia, prior prednisone or multiple antibiotics, were more likely to develop IPFI.

Invasive Fungal Infection as the Initial Presentation of Systemic Lupus Erythematosus

“…In lupus patients not receiving corticosteroids, like our case, high disease activity is associated with a significant risk factor for IFI [3,6,7]. Multiple antibiotics were also confirmed to be risk factors for interstitial pneumonia fungal infection (IPFI) in lupus patients [5]. In addition, underlying interstitial pneumonia is a risk factor for developing IPFI in lupus patients.…”

“…Patients with underlying lung diseases such as interstitial pneumonia tend to have secondary infections, which precipitate respiratory failure and even death. It is noteworthy that the widespread use of glucocorticoid therapy in the treatment of interstitial pneumonia also promotes secondary fungal infections [5]. Due to its relatively insidious onset, rapid progression and the difficulties of accurate laboratory diagnosis, IPFI represents a true challenge for clinicians to make prompt and appropriate decisions about patient management [4,5].…”

“…It is noteworthy that the widespread use of glucocorticoid therapy in the treatment of interstitial pneumonia also promotes secondary fungal infections [5]. Due to its relatively insidious onset, rapid progression and the difficulties of accurate laboratory diagnosis, IPFI represents a true challenge for clinicians to make prompt and appropriate decisions about patient management [4,5]. The diagnosis may also be complicated by the overlap of clinical characteristics with active SLE [2].…”

“…In fact, all known opportunistic infections have been documented in SLE, special attention has been paid to IFI due to their high mortality and severe morbidity [6,7]. Relatively few cases of IPFI which have evolved well under specific treatment have been described in SLE, and the risk factors remain incompletely explored [5]. The authors report another case of this condition in a 24-year-old man presenting with IPFI revealing SLE.…”

“…The lung is the most frequently involved organ in IFI. Deterioration caused by invasive pulmonary fungal infections (IPFI) is a potentially fatal complication in patients with SLE and usually the direct cause of death in SLE [5]. In fact, all known opportunistic infections have been documented in SLE, special attention has been paid to IFI due to their high mortality and severe morbidity [6,7].…”