Clinical infection with <i>Strongyloides sterocoralis</i> following etanercept use for rheumatoid arthritis

Boatright, M. David; Wang, Benjamin W. E.

doi:10.1002/art.20882

Cited by 31 publications

(8 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In fact, patients with rheumatic diseases who are taking disease-modifying anti-rheumatic drugs (DMARD) and anti-tumor necrosis factor (TNF) therapy have a high risk for general infections,5-7 including intestinal pathogenic parasite infestations such as Strongyloides stercoralis 8,9. However, to our knowledge, there are no data regarding the risk of microsporidiosis in these patients 10-13…”

Section: Introductionmentioning

confidence: 99%

Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs?

Aikawa

Twardowsky

Carvalho

et al. 2011

Clinics

View full text Add to dashboard Cite

OBJECTIVE:Immunosuppressed patients are at risk of microsporidiosis, and this parasitosis has an increased rate of dissemination in this population. Our objective was to evaluate the presence of microsporidiosis and other intestinal parasites in rheumatic disease patients undergoing anti-tumor necrosis factor/disease-modifying anti-rheumatic drug treatment.METHODS:Ninety-eight patients (47 with rheumatoid arthritis, 31 with ankylosing spondylitis and 11 with psoriatic arthritis) and 92 healthy control patients were enrolled in the study. Three stool samples and cultures were collected from each subject.RESULTS:The frequency of microsporidia was significantly higher in rheumatic disease patients than in control subjects (36 vs. 4%, respectively; p<0.0001), as well as in those with rheumatic diseases (32 vs. 4%, respectively; p<0.0001), ankylosing spondylitis (45 vs. 4%, respectively; p<0.0001) and psoriatic arthritis (40 vs. 4%, respectively; p<0.0001), despite a similar social-economic class distribution in both the patient and control groups (p = 0.1153). Of note, concomitant fecal leukocytes were observed in the majority of the microsporidia-positive patients (79.5%). Approximately 80% of the patients had gastrointestinal symptoms, such as diarrhea (26%), abdominal pain (31%) and weight loss (5%), although the frequencies of these symptoms were comparable in patients with and without this infection (p>0.05). Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis disease activity parameters were comparable in both groups (p>0.05). The duration of anti-tumor necrosis factor/disease-modifying anti-rheumatic drugs and glucocorticoid use were also similar in both groups.CONCLUSION:We have documented that microsporidiosis with intestinal mucosa disruption is frequent in patients undergoing concomitant anti-tumor necrosis factor/disease-modifying anti-rheumatic drug therapy. Impaired host defenses due to the combination of the underlying disease and the immunosuppressive therapy is the most likely explanation for this finding, and this increased susceptibility reinforces the need for the investigation of microsporidia and implementation of treatment strategies in this population.

show abstract

Section: Introductionmentioning

confidence: 99%

Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs?

Aikawa

Twardowsky

Carvalho

et al. 2011

Clinics

View full text Add to dashboard Cite

show abstract

“…The risks increase when these patients are on immunobiological drugs. We highlight the letter published by Boatright and Wang,85 where they report the role of prednisone combination with the biologic drug etanercept in the occurrence of a case of strongyloidiasis.…”

Section: Immunosuppression Interference In the Progression Of Intestimentioning

confidence: 92%

Recommendations from the Brazilian Society of Rheumatology on the diagnosis and treatment of intestinal parasitic infections in patients with autoimmune rheumatic disorders

Braz

Andrade

Mota

et al. 2015

Revista Brasileira de Reumatologia (English Edition)

View full text Add to dashboard Cite

RBRE-177; No. of Pages 13 r e v b r a s r e u m a t o l . 2 0 1 5;x x x(x x):xxx-xxx w w w . r e u m a t o l o g i a . c o m . b r a b s t r a c t Intestinal parasites -helminths and protozoa -are cosmopolitan diseases which are most prevalent in tropical regions. Patients with diagnoses of autoimmune rheumatic diseases have, due to the underlying disease or its treatment, an increased risk of occurrence of severe manifestations of intestinal parasites. Although the prevalence of these parasitic infections is very high in our environment, not always is the rheumatologist attentive to the need for investigation and treatment of helminthiasis and protozooses before the use of immunomodulatory, immunosuppressive therapies, and of biological drugs that are modifiers of the course of the disease. In this document, the Brazilian Society of Rheumatology establishes general recommendations on the diagnosis and treatment of intestinal parasitic infections in Brazil in patients with autoimmune rheumatic diseases, highlighting rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritis. Recomendações da Sociedade Brasileira de Reumatologia sobre diagnóstico e tratamento das parasitoses intestinais em pacientes com doenças reumáticas autoimunes Palavras-chave:Enteropatias parasitárias r e s u m o As parasitoses intestinais -helmintíases e protozooses -são doenças cosmopolitas com maior prevalência em regiões tropicais. Pacientes com diagnóstico de doenças No. of Pages 13 2 r e v b r a s r e u m a t o l . 2 0 1 5;x x x(x x):xxx-xxx Diagnóstico Terapêutica Doenças autoimunes Doenças reumáticas reumáticas autoimunes apresentam, em função da própria doença de base ou de seu tratamento, um maior risco de ocorrência de manifestaç ões graves das parasitoses intestinais. Embora a prevalência dessas parasitoses seja bastante elevada em nosso meio, nem sempre o reumatologista está atento à necessidade de investigação e tratamento das helmintíases e protozooses antes do uso de terapias imunomoduladoras, imunossupressoras e dos medicamentos biológicos modificadores do curso da doença. Neste documento, a Sociedade Brasileira de Reumatologia estabelece recomendaç ões gerais sobre o diagnóstico e tratamento das parasitoses intestinais no Brasil em pacientes com doenças reumáticas autoimunes, com destaque para a artrite reumatoide, o lúpus eritematoso sistêmico e as espondiloartrites.

show abstract

“…Failure to clear the infection can lead to chronic infection characterized by a low parasite load that maintains survival in the host via a well-regulated autoinfection cycle. Immunosuppressive states induced by corticosteroids and TNF- α inhibitors or conditions such as lymphoma, HTLV infection, bone marrow allografts, rheumatoid arthritis, alcoholism, malnutrition, leprosy, tuberculosis, and chemotherapeutic drugs can lead to disseminated hyperinfection syndrome [ 11 – 14 ]. TNF- α inhibitors along with glucocorticoids can modify the Th2 response which has a role in controlling many helminthic infestations resulting in exacerbation of asymptomatic carrier state to symptomatic infection or hyperinfection [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Immunosuppression with Antitumour Necrosis Factor Therapy Leading to Strongyloides Hyperinfection Syndrome

Khaliq

Ihle

Perry

2018

Case Reports in Infectious Diseases

View full text Add to dashboard Cite

Strongyloides stercoralis is an endemic parasitic infection that can remain asymptomatic for years, but it can cause death in immunosuppressed individuals. Here, we present a case of Strongyloides hyperinfection in a 75-year-old male secondary to sepsis and chronic immunosuppression due to TNF-α inhibitors. Despite aggressive treatment including broad-spectrum antibiotics and antihelminths, his respiratory failure worsened and he died after palliative extubation. S. stercoralis infection remains a diagnostic challenge. Presentation with Strongyloides is often nonspecific, and eosinophilia is absent in hyperinfection. Diagnosis can be delayed, especially in low-prevalence areas where suspicion is low. Strongyloides should be considered in the differential diagnosis in the presence of risk factors including immunosuppressive therapy, and a travel history should be carefully obtained. Patients with recurrent enterobacterial sepsis or respiratory failure with diffuse infiltrates in the setting of eosinophilia should undergo testing for Strongyloides. A multidisciplinary approach can result in earlier diagnosis and favorable outcomes.

show abstract

Clinical infection with Strongyloides sterocoralis following etanercept use for rheumatoid arthritis

Cited by 31 publications

References 6 publications

Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs?

Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs?

Recommendations from the Brazilian Society of Rheumatology on the diagnosis and treatment of intestinal parasitic infections in patients with autoimmune rheumatic disorders

Immunosuppression with Antitumour Necrosis Factor Therapy Leading to Strongyloides Hyperinfection Syndrome

Contact Info

Product

Resources

About