Infectious complications in polymyositis and dermatomyositis: a series of 279 patients.

Abstract:

OBJECTIVES:To assess the prevalence and characteristics of severe pyogenic, nonpyogenic, and opportunistic infections in polymyositis and dermatomyositis (PM/DM) patients and to evaluate the predictive values for infections on clinical presentation and biochemical findings of PM/DM to detect patients at risk for such infections. METHODS:The medical records of 279 consecutive PM/DM patients in 3 medical centers were reviewed. RESULTS:One hundred four severe infections occurred in our patients (37.3%), ie, pyogenic (n = 71) and nonpyogenic/opportunistic infections (n = 33). Pyogenic infections were mainly due to aspiration pneumonia (n = 46) and calcinosis cutis infection. Thirty-three PM/DM patients developed nonpyogenic/opportunistic infections that were due to the following: Candida albicans, Pneumocystis jiroveci, Aspergillus fumigatus, Geotrichum capitatum, Mycobacterium (avium-intracellulare complex, xenopi, marinum, peregrinum, tuberculosis), Helicobacter heilmanii, cytomegalovirus, herpes simplex and zoster virus, hepatitis B and C, JC virus, Leishmania major, Strongyloides stercoralis. Esophageal dysfunction, ventilatory insufficiency, malignancy, and lymphopenia were significantly more frequent in the group of PM/DM patients with infections. CONCLUSION:Our study underscores the high frequency of infections in PM/DM, resulting in an increased mortality rate. Our results suggest that prophylaxis against pyogenic infections should be routinely recommended for patients with PM/DM, including regular physical examination of lungs to depict aspiration pneumonia as well as risk factors of aspiration pneumonia. Finally, because a great variety of micro-organisms may be responsible for opportunistic infections, it seems difficult to initiate primary prophylaxis in PM/DM patients exhibiting risk factors for opportunistic infections.

journal_name

Semin Arthritis Rheum

authors

Marie I,Ménard JF,Hachulla E,Chérin P,Benveniste O,Tiev K,Hatron PY

doi

10.1016/j.semarthrit.2010.08.003

subject

Has Abstract

pub_date

2011-08-01 00:00:00

pages

48-60

issue

1

eissn

0049-0172

issn

1532-866X

pii

S0049-0172(10)00175-7

journal_volume

41

pub_type

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