Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression
| Autor: | Bosch-Nicolau, Pau, Ubals, Maria, Salvador, Fernando, Sánchez-Montalvá, Adrián, Aparicio, Gloria, Erra Duran, Alba, Martínez de Salazar, Pablo, Sulleiro Igual, Elena, Molina Romero, Israel, Universitat Autònoma de Barcelona |
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| Přispěvatelé: | [Bosch-Nicolau P, Salvador F, Sánchez-Montalvá A, Molina I] Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Programa de salut internacional de l'Institut Català de la Salut (PROSICS), ICS, Barcelona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain. [Ubals M, Aparicio G] Servei de Dermatologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain. [Erra A] Servei de Reumatologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain. [Martinez de Salazar P, Sulleiro E] Servei de Microbiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Programa de salut internacional de l'Institut Català de la Salut (PROSICS), ICS, Barcelona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Male Physiology Biopsy RC955-962 Gastroenterology Etanercept Medicaments antineoplàstics 0302 clinical medicine Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics::Epidemiologic Studies::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics::Epidemiologic Studies::Cohort Studies::Retrospective Studies [ANALYTICAL DIAGNOSTIC AND THERAPEUTIC TECHNIQUES AND EQUIPMENT] Bone Marrow Recurrence Zoonoses Immune Physiology Arctic medicine. Tropical medicine Medicine and Health Sciences Child Leishmaniasis Protozoans Leishmania Aged 80 and over Innate Immune System Parasitic Diseases::Protozoan Infections::Euglenozoa Infections::Leishmaniasis [DISEASES] Mediterranean Region Eukaryota Middle Aged Infectious Diseases enfermedades parasitarias::infecciones por protozoos::infecciones por Euglenozoa::leishmaniosis [ENFERMEDADES] Cytokines Raonament basat en casos Female Public aspects of medicine RA1-1270 Immunosuppressive Agents medicine.drug Research Article Neglected Tropical Diseases aminoácidos péptidos y proteínas::péptidos::péptidos y proteínas de señalización intercelular::citocinas::monocinas::factor de necrosis tumoral alfa [COMPUESTOS QUÍMICOS Y DROGAS] Adult medicine.medical_specialty Adolescent Leishmania Infantum 030231 tropical medicine Immunology técnicas de investigación::métodos epidemiológicos::características de los estudios epidemiológicos::estudios epidemiológicos::técnicas de investigación::métodos epidemiológicos::características de los estudios epidemiológicos::estudios epidemiológicos::estudios de cohortes::estudios retrospectivos [TÉCNICAS Y EQUIPOS ANALÍTICOS DIAGNÓSTICOS Y TERAPÉUTICOS] Surgical and Invasive Medical Procedures Rheumatoid Arthritis Amino Acids Peptides and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Monokines::Tumor Necrosis Factor-alpha [CHEMICALS AND DRUGS] Injections Intramuscular Autoimmune Diseases 03 medical and health sciences Young Adult Cutaneous leishmaniasis Rheumatology Leishmaniosi Internal medicine medicine Adalimumab Parasitic Diseases Humans Aged Retrospective Studies Miltefosine Protozoan Infections business.industry Tumor Necrosis Factor-alpha Arthritis Public Health Environmental and Occupational Health Organisms Biology and Life Sciences Molecular Development medicine.disease Tropical Diseases Infliximab Golimumab Parasitic Protozoans 030104 developmental biology Visceral leishmaniasis Immune System Clinical Immunology Clinical Medicine business Developmental Biology Systematic Reviews as Topic |
| Zdroj: | Scientia PLoS Neglected Tropical Diseases, Vol 13, Iss 8, p e0007708 (2019) Dipòsit Digital de Documents de la UAB Universitat Autònoma de Barcelona PLoS Neglected Tropical Diseases |
| Popis: | Background Tumor necrosis factor alpha (TNF-α) blockers are recognized as a risk factor for reactivation of granulomatous infections. Leishmaniasis has been associated with the use of these drugs, although few cases have been reported. Methodology We performed a retrospective observational study including patients with confirmed leishmaniasis acquired in the Mediterranean basin that were under TNF-α blockers therapy at the moment of the diagnosis. Patients diagnosed in our hospital from 2008 to 2018 were included. Moreover, a systematic review of the literature was performed and cases fulfilling the inclusion criteria were also included. Principal findings Forty-nine patients were analyzed including nine cases from our series. Twenty-seven (55.1%) cases were male and median age was 55 years. Twenty-five (51%) patients were under infliximab treatment, 20 (40.8%) were receiving adalimumab, 2 (4.1%) etanercept, one (2%) golimumab and one (2%) a non-specified TNF-α blocker. Regarding clinical presentation, 28 (57.1%) presented as cutaneous leishmaniasis (CL), 16 (32.6%) as visceral leishmaniasis (VL) and 5 (10.2%) as mucocutaneous leishmaniasis (MCL). All VL and MCL patients were treated with systemic therapies. Among CL patients, 13 (46.4%) were treated with a systemic drug (11 received L-AmB, one intramuscular antimonials and one miltefosine) while 14 (50%) patients were given local treatment (13 received intralesional pentavalent antimonials, and one excisional surgery). TNF-α blockers were interrupted in 32 patients (65.3%). After treatment 5 patients (10.2%) relapsed. Four patients with a CL (3 initially treated with local therapy maintaining TNF-α blockers and one treated with miltefosine) and one patient with VL treated with L-AmB maintaining TNF-α blockers. Conclusions This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis in endemic population modulating the expression of the disease leading to atypical presentations. According to the cases reported, the best treatment strategy would be a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution. Author summary Tumor necrosis factor alpha (TNF-α) blockers are widely used in numerous inflammatory diseases such rheumatoid arthritis, psoriasis or inflammatory bowel diseases. They have been recognized as a risk factor for reactivation of granulomatous infections. Although few cases have been reported, Leishmaniasis has been associated with the use of these drugs. Leishmania infantum is the main causative agent of leishmaniasis in Southern Europe and is prone to produce the visceral form. However, TNF-α has been implicated in the initial events of the infection mediating the disease expression. In our series, we have observed a surprisingly high proportion of cutaneous form (32.6%) and muco-cutaneous form (10.2%). Clinical outcome observed in this series is also unusual. Four cases (14.3%) with cutaneous leishmaniasis who received local therapy relapsed. Among patients with visceral leishmaniasis, one patient who maintained TNF-α blockers therapy relapsed despite etiological treatment. This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis leading to atypical presentations. According to the cases reported we proposed as best treatment strategy a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution. |
| Databáze: | OpenAIRE |
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