Association of serious infections with pemphigus and pemphigoid: analysis of the Nationwide Inpatient Sample

Abstract

Adults with pemphigus or pemphigoid had increased cutaneous, respiratory, multi-organ and systemic infections, which were associated with considerable inpatient mortality and cost burden. Moreover, there were significant clinical and healthcare disparities with respect to infections in patients with pemphigus or pemphigoid.

Assessment of serious infections in pemphigus and pemphigoid by a national registry

“…In this issue of the Journal, Ren Z. and colleagues investigated the occurrence of serious infections in pemphigus and pemphigoid patients, based on a 10‐year analysis of the Nationwide Inpatient Sample, a US database including a 20% representative sample of all US hospital inpatient admissions occurring each year. Compared with a control group, consisting of all hospitalized patients with unrelated diagnoses, patients with pemphigus or pemphigoid showed a higher incidence of infectious comorbidities including cutaneous and systemic fungal infection, viral infections, in particular herpes simplex and herpes virus, and bacterial infections of skin, bones, respiratory, gastrointestinal, genitourinary tract and central nervous system, septicaemia and antibiotic‐resistant infections . As expected, the co‐existence of comorbidities, such as diabetes and malignancies, as well as of other autoimmune diseases, significantly increased that risk .…”

“…As expected, the co‐existence of comorbidities, such as diabetes and malignancies, as well as of other autoimmune diseases, significantly increased that risk . The authors point out that their findings may be biased as the here documented inpatients with pemphigus and pemphigoid may have a more severe disease course than patients with AIBD seen as outpatients …”

“…Compared with a control group, consisting of all hospitalized patients with unrelated diagnoses, patients with pemphigus or pemphigoid showed a higher incidence of infectious comorbidities including cutaneous and systemic fungal infection, viral infections, in particular herpes simplex and herpes virus, and bacterial infections of skin, bones, respiratory, gastrointestinal, genitourinary tract and central nervous system, septicaemia and antibiotic‐resistant infections . As expected, the co‐existence of comorbidities, such as diabetes and malignancies, as well as of other autoimmune diseases, significantly increased that risk . The authors point out that their findings may be biased as the here documented inpatients with pemphigus and pemphigoid may have a more severe disease course than patients with AIBD seen as outpatients …”

“…In spite of a slightly different profile of associated infections, Clostridium difficile enterocolitis, endocarditis and septicaemia were common causes of infection‐related deaths in both groups …”

“…Of note, patients with pemphigus, but not pemphigoid, were found at higher risk of opportunistic infections, including aspergillosis and Pneumocystis carinii pneumonia . This may be related to the more profound immune suppression needed for initial clinical disease control of pemphigus compared with pemphigoid.…”