Lower respiratory tract infections in rheumatic diseases

Белов, Б. С.; Буханова, Д. В.; Тарасова, Г. М.

doi:10.14412/1996-7012-2018-1-47-54

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…Длительное (более 3 недель) применение системных глюкокортикостероидов в дозе более 0,3 мг /кг массы тела (в перерасчете на преднизолон) является фактором риска развития оппортунистической инфекции, в том числе ИМ [9]. Высокая текущая доза сГКС была идентифицирована как один наиболее значимый фактор риска развития ИМ [1,3,6,10,11,14,15]. Fang et al провели систематический анализ публикаций о криптококкозе у взрослых пациентов с СКВ с 1966 по 2015 г. Исследование показало, что летальность была выше у пациентов, принимавших до развития криптококкоза преднизолон ≥30 мг/день [6].…”

Section: результаты и обсуждениеunclassified

“…Проблема инвазивных микозов (ИМ) у детей с ревматическими заболеваниями изучена недостаточно, в отечественной литературе ей посвящены единичные публикации [1,2]. Поздняя диагностика и неадекватная терапия способствуют высокой летальности при ИМ в этой группе пациентов [1,3,[4][5][6][7][8].…”

Section: Introductionunclassified

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Invasive fungal infections in children with rheumatic diseases

Козлова

Kostik²,

Кузнецова

et al. 2021

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Introduction. In children with rheumatic diseases, severe fungal infections (invasive mycoses – IM) are not well understood.Objectives. To analyze risk factors, disease course of IM in children with systemic rheumatic diseases.Materials and methods. For diagnosis of IM were used criteria EORTC/MSGERC, 2019. We reviewed the literature over the past 15 years on IM in children with rheumatic diseases from the international databases Pubmed and Web of Science.Results. In retrospective multicenter study were included 8 children with IM and systemic rheumatic diseases: ANCA-associated vasculitis (n=4), systemic lupus erythematosus (n=3), juvenile rheumatoid arthritis (n=1). Median age was 13,5 (8-17) y., boys – 67%. Invasive aspergillosis was diagnosed in 5 patients and invasive candidiasis – 3. The risk factors of invasive mycoses were high rheumatic disease activity (100%), corticosteroids (prednisolone ≥ 0,3 mg/kg/d) use for ≥21 d (87,5%), immunosuppressive therapy (87,5%), recent (≤ 2 weeks) pulse steroid therapy (75%), hemophagocytic lymphohistiocytosis (62,5%), prolonged (≥ 10 days) severe neutropenia (≤ 0,5х109/l) (62,5%), and prolonged (≥10 days lymphopenia (≤ 1,0х109/l) (37,5%). In patients with invasive aspergillosis the involved organ was the lung, in patients with invasive candidiasis a candidemia was diagnoses. All patients received antifungal therapy. The overall 30 days survival rate was 37,5%.Сonclusions. Children with high rheumatic diseases activity and intensive treatment with immunosuppressive agents should be considered as patients with a high risk of invasive mycoses with a high mortality.

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Section: результаты и обсуждениеunclassified

Section: Introductionunclassified

Invasive fungal infections in children with rheumatic diseases

Козлова

Kostik²,

Кузнецова

et al. 2021

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COVID-19 and Rheumatology: so far, so close

Белов¹,

Муравьева²,

Тарасова³

2020

Medicinskij sovet

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The disease caused by the new coronavirus COVID-19 is considered by the world community as an emergency of internationalimportance. Along with the huge social importance, the COVID-19 pandemic has highlighted a number of principally new clinical and fundamental problems of immunopathology of human diseases. This problem is extremely urgent for patients suffering from immune-inflammatory rheumatic diseases (IIRD) due to their higher exposure to infectious complications. Achieving and maintaining control over the activity of IIRD plays an important role in reducing the incidence of comorbid infections in these patients. It has been shown that patients with IIRD undergoing active anti-rheumatic therapy are most likely not characterized by increased risk of respiratory or other life-threatening complications within COVID-19 compared to the general population. Given the need for continued monitoring of patients receiving these therapy, unjustified “prophylactic” cancellation should nevertheless be avoided, thereby increasing the risk of relapse of major IIRD. The article also discusses the issues related to the use of basic anti-rheumatic drugs in COVID-19. Currently there is no evidence to support the therapeutic and prophylactic efficacy of chloroquine or hydroxychloroquine in COVID-19. Tocilizumab can be considered as “lifesaving therapy” for patients with acute respiratory distress syndrome in COVID-19, if other treatments have failed or are unavailable. The use of baricitinib in hospitalized pneumonia patients as part of COVID-19 should be considered with extreme caution. The need for further research to assess the potential role of baricitinib for these patients is highlighted. In the absence of a COVID-19 vaccine in a continuing pandemic, vaccination against influenza and pneumococcal infection should be strongly recommended to the absolute majority of patients with IIRD. This is associated with a high risk of fatal respiratory infection in rheumatological patients, especially given the high respiratory tract involvement in COVID-19.

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The frequency and structure of comorbid infections in patients with spondyloarthritis (preliminary own data)

2021

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Introduction. Data on the frequency of comorbid infections (CI) in patients with spondyloarthritis (SpA) are few and contradictory. Objective. The aim of the study was to study the frequency and structure of CI in the inpatient population of SpA patients in the course of a one-moment retrospective study.Subjects and methods. The study included 205 patients with SPA: 119 men, 86 women, the age of patients was 39.02 ± 12.2 years, the duration of the disease was 129.3 ± 104.3 months. Ankylosing spondylitis was diagnosed in 133 patients, psoriatic arthritis in 55, spondyloarthritis associated with Crohn’s disease – in 1, undifferentiated spondyloarthritis – in 16. Most patients, along with nonsteroidal anti-inflammatory drugs, received glucocorticoids, basic anti-inflammatory drugs, and biological drugs. Patients were interviewed by a research doctor with the completion of a unified questionnaire, additional data were obtained from medical documentation.Results. 20% of patients reported more frequent CI development after the SpA debut. 28.7% of patients reported a more severe course of previously observed CI. Temporary discontinuation of therapy due to the development of CI occurred in 25.4% of patients. Exacerbation of SpA after CI was diagnosed in 40% of patients. In general, the leading place in the structure of CI was occupied by infections of the respiratory tract and ENT-organs, the second place belonged to herpes-viral infections. Serious CI accounted for 6.8% of all cases of CI. In SpA patients receiving immunosuppressive therapy, there was an increase in the frequency of acute nasopharyngitis, sinusitis, acute bronchitis, pneumonia and herpes-viral infections. However, cases of CI have also been reported in patients who have never received immuno-suppressive drugs.Conclusion. The data obtained indicate the important of the problem of CI in SpA. Further studies are needed on large samples of patients in order to find significant risk factors for CI, study their relationship with clinical characteristics and influence on the course of SpA.

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Lower respiratory tract infections in rheumatic diseases

Cited by 3 publications

References 33 publications

Invasive fungal infections in children with rheumatic diseases

Invasive fungal infections in children with rheumatic diseases

COVID-19 and Rheumatology: so far, so close

The frequency and structure of comorbid infections in patients with spondyloarthritis (preliminary own data)

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