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Background Patients with chronic inflammatory disease in treatment with immunosuppressants have an increased risk of opportunistic infections, including leishmaniasis. Objectives To describe a multicenter case series of leishmaniasis in patients with chronic inflammatory diseases treated with immunosuppressants. To analyze factors related to the infection. Methods Observational retrospective study. We reviewed the clinical history of patients with chronic inflammatory diseases treated with immunosuppressants, who were diagnosed with leishmaniasis between 2007 and 2018. Demographic (age, sex) and clinical (type and time of evolution of the inflammatory disease, comorbidities, current treatment, leishmaniasis form) variables were collected. Immunosuppressant withdraw, subsequent reintroduction and recurrence were recorded. We analyzed differences in clinical presentation related to anti-TNFα treatment. Statistical analysis were performed using SPSS 22.0 program. Results 55 cases were collected. 58,2% were men and the average age was 57,2 (SD 1,9) years. Twenty-one patients had spondyloarthropathy, 17 rheumatoid arthritis, 14 inflammatory bowel disease, 1 systemic lupus erythematosus, 1 Behcet and 1 uveitis. The average duration of the disease was 11,4 (SD 1,4) years and 30,9% of patients had other causes of immunosuppression. Thirty-eight patients received treatment anti-TNFα (19 infliximab, 11 adalimumab, 5 golimumab, 2 certolizumab and 1 etanercept), 15 with DMARD (14 methotrexate, 1 leflunomide), 1 with tocilizumab and 1 with azathioprine. 27.3% patients received corticoids. 52,7% developed cutaneous form, 38,2% visceral form, 7,3% mucocutaneous form and 1 presented visceral and cutaneous involvement. Treatment was withdrawn in 37 cases and it was reintroduced in 23 cases (8 anti-TNFα). Four patients relapsed. More cases of visceral leishmaniasis were seen in patients treated with non-anti-TNFα drugs and in those treated with glucocorticoids. Most of the recurrences were associated with mucocutaneous form. Conclusion In our series, the majority of cases of leishmaniasis occurred in patients treated with anti-TNFα, but non-anti-TNFα patients developed more serious forms. It’s important to keep in mind this infectious complication in daily clinical practice. Disclosure of Interests L Montolio-Chiva: None declared, Elia Valls-Pascual: None declared, D Ybanez-Garcia: None declared, A Martinez-Ferrer: None declared, Marta Aguilar-Zamora: None declared, Ana V Orenes Vera: None declared, I Vazquez-Gomez: None declared, A Sendra-Garcia: None declared, JM Paredes Arquiola: None declared, Meritxell Fernandez Matilla: None declared, L Gomez Escolar: None declared, Jose Miguel Senabre-Gallego: None declared, J Lluch Pons : None declared, C Campos Fernandez: None declared, M Robustillo-Villarino : None declared, Maria Dolores Garcia-Armario: None declared, S Anton-Gonzalez: None declared, ANA URRUTICOECHEA-ARANA: None declared, Isabel de la Morena Speakers bureau: Abbvie, Celgene, Pfzier, UCB, Ghebro, Roche, Sanofi, Janssen., J Fiter-Areste: None declared, Vega Jovani: None declared, A Martinez-Cristobal : None declared, Lourdes Mateo: None declared, Sergi Ordonez : None declared, D Reina-Sanz: None declared, C Vergara-Dangond: None declared, V Nunez-Monje: None declared, I Torner-Hernandez: None declared, Juanjo J Alegre-Sancho: None declared |
