SEVERE CUTANEOUS
            <i>CANDIDA</i>
            INFECTION DURING NATALIZUMAB THERAPY IN MULTIPLE SCLEROSIS

Gutwinski, Stefan; Erbe, Sebastian; Münch, Christoph; Janke, Otto J.; Müller, Ulrich; Haas, Juergen

doi:10.1212/wnl.0b013e3181cef810

Cited by 24 publications

(7 citation statements)

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“…Severe dermatological fungal infection has previously been described 14 , but no further reports have followed that initial one. The fatal cases observed in our study were particularly different from those reported in the literature, where death was mainly related to later development of PML.…”

Section: Discussionmentioning

confidence: 99%

Natalizumab adverse events are rare in patients with multiple sclerosis

Fragoso

Alves-Leon

Arruda

et al. 2013

Arq. Neuro-Psiquiatr.

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Objective: To assess the prevalence and the profile of adverse events (AE) of natalizumab in patients with multiple sclerosis (MS). Methods: Data collection from neurologists attending to patients with MS at specialized units in Brazil. Results: Data from 103 patients attending the infusion centers of 16 MS units in 9 Brazilian states were included in the study. The total number of infusions was 1,042. Seventy-nine patients (76.7%) did not present any AE. Twenty-four patients (23.3%) presented only mild AE. There were three major AE, including two deaths. These three occurrences, although not necessarily being drug-related, must be taken into consideration. Conclusion: The profile of AEs for natalizumab shows that 97% of patients have none or only mild AE. However, still due to safety worries, the use of this medication should be restricted to MS units under the care of specialized neurologists.Key words: multiple sclerosis, natalizumab, adverse events, antibodies, monoclonal. RESUMOObjetivo: Avaliar a prevalência e o perfil dos eventos adversos (EA) por natalizumabe em pacientes com esclerose múltipla (EM). Métodos: Coleta de dados fornecidos por neurologistas de unidades especializadas em EM no Brasil. Resultados: No estudo, foram incluídos dados de 103 pacientes em tratamento em centros de infusão de 16 unidades de EM em 9 estados brasileiros. O número total de infusões foi 1.042. Setenta e nove pacientes (76,7%) não apresentaram nenhum EA. Vinte e quatro pacientes (23,3%) apresentaram apenas EA leves. Foram relatados três importantes EA, incluindo duas mortes. Embora não necessariamente ligadas à droga, estas EA devem ser levadas em consideração. Conclusão: O perfil de EA para natalizumabe mostrou que em 97% dos pacientes não houve EA ou houve apenas EA leves. No entanto, dadas as preocupações com segurança da droga, o uso deste medicamento deve continuar restrito às unidades de EM sob os cuidados de neurologistas especializados.Palavras-Chave: esclerose múltipla, natalizumabe, eventos adversos, anticorpos monoclonais.

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Section: Discussionmentioning

confidence: 99%

Natalizumab adverse events are rare in patients with multiple sclerosis

Fragoso

Alves-Leon

Arruda

et al. 2013

Arq. Neuro-Psiquiatr.

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“…The mycobiome may also function as a reservoir for opportunistic pathogens in immunocompromised individuals, hence playing a role in diseases not obviously linked to the gut. Specifically, fungi have previously been shown to act as opportunistic pathogens during immune-mediated and antibiotic therapy (Gutwinski et al, 2010; Penkert et al, 2016; Seto et al, 2016). In this context, fungal infections represent a large proportion of infectious diseases in immunocompromised persons (Drgona et al, 2014).…”

Section: Gut Mycobiome and Disease Susceptibilitymentioning

confidence: 99%

A Fungal World: Could the Gut Mycobiome Be Involved in Neurological Disease?

et al. 2019

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The human microbiome has received decades of attention from scientific and medical research communities. The human gastrointestinal tract is host to immense populations of microorganisms including bacteria, viruses, archaea, and fungi (the gut microbiota). High-throughput sequencing and computational advancements provide unprecedented ability to investigate the structure and function of microbial communities associated with the human body in health and disease. Most research to date has largely focused on elucidating the bacterial component of the human gut microbiota. Study of the gut “mycobiota,” which refers to the diverse array of fungal species, is a relatively new and rapidly progressing field. Though omnipresent, the number and abundance of fungi occupying the human gut is orders of magnitude smaller than that of bacteria. Recent insights however, have suggested that the gut mycobiota may be intricately linked to health and disease. Evaluation of the gut mycobiota has shown that not only are the fungal communities altered in disease, but they also play a role in maintaining intestinal homeostasis and influencing systemic immunity. In addition, it is now widely accepted that host-fungi and bacteria-fungi associations are critical to host health. While research of the gut mycobiota in health and disease is on the rise, little research has been performed in the context of neuroimmune and neurodegenerative conditions. Gut microbiota dysbiosis (specifically bacteria and archaea) have been reported in neurological diseases such as multiple sclerosis, amyotrophic lateral sclerosis, and Alzheimer's, among others. Given the widely accepted bacteria-fungi associations and paucity of mycobiota-specific studies in neurological disease, this review discusses the potential role fungi may play in multiple sclerosis and other neurological diseases. Herein, we provide an overview of recent advances in gut mycobiome research and discuss the plausible role of both intestinal and non-intestinal fungi in the context of neuroimmune and neurodegenerative conditions.

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“…11 In severe mucocutaneous candidiasis cases, antifungal treatment may need to be extended to 12 weeks. 12 Expansion of the lesion with central clearing was observed on the tenth day of the antifungal therapy. The lesion was completely cured after the treatment was continued for two months.…”

Section: Discussionmentioning

confidence: 97%

Cutaneous candidiasis caused by Candida glabrata in a HIV/AIDS patient

et al. 2013

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Cutaneous Candida infections may occur in patients with HIV/AIDS, cancer, receiving chemotherapy and solid organ transplantation. A 32-year-old woman was admitted to the department suffering from pruritic and erythematous plaque on left side of her face for the past two months. The patient was HIV positive, diagnosed five years previously, and had been on antiretroviral therapy (tenofovir/emtricitabine and lopinavir/ritonavir) for a year. She was not compliant with the medication. Elevated HIV RNA load and decreased CD4+ lymphocyte count were observed. Fungal elements were detected from the skin scraping sample taken from the facial plaque. Fluconazole-sensitive Candida glabrata was isolated from this sample. Topical clotrimazole ointment and systemic fluconazole 400 mg/day were used. After systemic fluconazole therapy was continued for two months, the plaque was cured. C. glabrata rarely causes cutaneous infection without involving the mucous membranes. Presentation of cutaneous fungal infections in HIV patients with decreased CD4+ T lymphocyte counts can be atypical and require extensive antifungal treatment.

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SEVERE CUTANEOUS CANDIDA INFECTION DURING NATALIZUMAB THERAPY IN MULTIPLE SCLEROSIS

Cited by 24 publications

References 0 publications

Natalizumab adverse events are rare in patients with multiple sclerosis

Natalizumab adverse events are rare in patients with multiple sclerosis

A Fungal World: Could the Gut Mycobiome Be Involved in Neurological Disease?

Cutaneous candidiasis caused by Candida glabrata in a HIV/AIDS patient

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