Infections and vasculitis

Thomas, Konstantinos; Vassilopoulos, Dimitrios

doi:10.1097/bor.0000000000000348

Cited by 20 publications

(8 citation statements)

References 38 publications

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“…The maintenance regimens consist of low-dose glucocorticoids and chronic immunosuppressive drugs (161). On the one hand this management reduces chronic inflammation and allows good outcomes and survival (162), on the other hand it can lead to sarcopenia, bone loss, higher risk of infection (163) and frailty development in the long-term.…”

Section: Anca-associated Vasculitismentioning

confidence: 99%

Frailty in Rheumatic Diseases

2020

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Frailty is a syndrome characterized by the decline in the physiologic reserve and function of several systems, leading to increased vulnerability and adverse health outcomes. While common in the elderly, recent studies have underlined the higher prevalence of frailty in chronic diseases, independent of age. The pathophysiological mechanisms that contribute to frailty have not been completely understood, although significant progresses have recently been made. In this context, chronic inflammation is likely to play a pivotal role, both directly and indirectly through other systems, such as the musculoskeletal, endocrine, and neurological systems. Rheumatic diseases are characterized by chronic inflammation and accumulation of deficits during time. Therefore, studies have recently started to explore the link between frailty and rheumatic diseases, and in this review, we report what has been described so far. Frailty is dynamic and potentially reversible with 8.3%-17.9% of older adults spontaneously improving their frailty status over time. Muscle strength is likely the most significant influencing factor which could be improved with training thus pointing at the need to maintain physical activity. Not surprisingly, frailty is more prevalent in patients affected by rheumatic diseases than in healthy controls, regardless of age and is associated with high disease activity to affect the clinical outcomes, largely due to chronic inflammation. More importantly, the treatment of the underlying condition may prevent frailty. Scales to assess frailty in patients affected by rheumatic diseases have been proposed, but larger casuistries are needed to validate disease-specific indexes, which could allow more accurate prognostic estimates than demographic and diseaserelated variables alone. Frail patients can be more vulnerable and more difficult to treat, due to the risk of side effects, therefore frailty should be taken into account in clinical decisions. Clinical trials addressing frailty could identify patients who are less likely to tolerate potentially toxic medications and might benefit from more conservative regimens. In conclusion, the implementation of the concept of frailty in rheumatology will allow a better understanding of the patient global health, a finest risk stratification and a more individualized management strategy.

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Section: Anca-associated Vasculitismentioning

confidence: 99%

Frailty in Rheumatic Diseases

2020

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“…Many glomerular diseases are immunologically mediated disorders [1,[5][6][7][8], and immunosuppressive medications put glomerular disease patients at a high risk of various infections, such as pneumonia, Mycobacterium tuberculosis and hepatitis B virus reactivation, which contribute to the progression of disease per se and mortality [9][10][11][12][13][14]. In recent years, accumulating data have shown an increased rate of opportunistic infections in glomerular disease patients with longterm use of glucocorticoids and (or) immunosuppressive agents, especially in nephrotic syndrome, IgA nephropathy, lupus nephritis and vasculitis patients [14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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Background Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.

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“…The interest in infection-related vasculitides has been boosted over the last 2 decades by the development of new molecular techniques and the proof of true associations between viral infections and systemic vasculitis [82]. The aggressive treatment of vasculitis incurs a variety of adverse effects, among which infection is the most common and prevailed as a major complication in every stage of vasculitis.…”

Section: Infections In Immunosuppressed Patients With Vasculitismentioning

confidence: 99%

Overview of infections as an etiologic factor and complication in patients with vasculitides

et al. 2022

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Vasculitides, a form of inflammatory autoimmune disease targeting the vessels, constitute an entity with significant morbidity and mortality. Infections have long been associated with vasculitides as a result of the incident immunosuppression following treatment induction and maintenance. Several microbial pathogens have been described as etiologic factors of infections in this patient population according to the type of vessels affected. Intense research has also been recently conducted in the interplay between vasculitides and certain viral infections, namely human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2. Of note, a plethora of scientific evidence is available regarding the role of infections as triggering factors for vasculitides. Among the main mechanisms implicated in this direction are the activation of B and T cells, the direct endothelial insult, the immune complex-mediated vascular injury, and the cell-mediated, type IV hypersensitivity vessel damage. Therefore, this review aims to summarize all the available evidence concerning this bidirectional interplay between infections and vasculitides.

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Infections and vasculitis

Abstract: Infections continue to be one of the main causes of mortality in patients with systemic vasculitides, emphasizing the need for safer immunosuppressive therapies and appropriate prophylaxis.

Cited by 20 publications

References 38 publications

Frailty in Rheumatic Diseases

Frailty in Rheumatic Diseases

Nocardiosis in glomerular disease patients with immunosuppressive therapy

Overview of infections as an etiologic factor and complication in patients with vasculitides

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