Infections and the Relationship to Treatment in Neuromuscular Autoimmunity

Overview

Journal Muscle Nerve

Date 2017 Dec 7

PMID 29211921

Citations 9

Authors

Devin E Prior

Emily Nurre

Stephanie L Roller

David Kline

Ramit Panara

Amro M Stino

John A Davis

Miriam L Freimer

W David Arnold

Affiliations

Soon will be listed here.

Abstract

Introduction: This study aimed to identify infections in patients with myasthenia gravis, dermatomyositis, and chronic inflammatory demyelinating polyradiculoneuropathy, and to investigate the relationship between infection and immunomodulation.

Methods: A retrospective chart review examined 631 patients with myasthenia gravis (n = 358), chronic inflammatory demyelinating polyradiculoneuropathy (n = 124), and dermatomyositis (n = 149) patients over a 10-year time period.

Results: Infection rates were similar at approximately 19% in all 3 diseases. Of the infections in which a causative organism was identified, pneumonia, sepsis, and opportunistic infections were the leading diagnoses. A multivariate model demonstrated a significant association between infection and an increased dose of plasma exchange, mycophenolate mofetil, and corticosteroid therapy.

Discussion: There are few large studies investigating rates of infections in patients with autoimmune neuromuscular disorders and the relationship to immunomodulation. This study not only demonstrates the remarkably similar infection rates across the 3 diseases studied, but also shows their relationship to commonly used immunotherapies. Muscle Nerve 57: 927-931, 2018.

Citing Articles

Epidemiology of Chronic Inflammatory Demyelinating Polyneuropathy in South Korea: A Population-Based Study.

Jung S, Jung G, Kim D, Oh J, Choi K J Clin Neurol. 2023; 19(6):558-564.

PMID: 37488959 PMC: 10622719. DOI: 10.3988/jcn.2023.0007.

Pneumonia in myasthenia gravis: Microbial etiology and clinical management.

Su M, Jin S, Jiao K, Yan C, Song J, Xi J Front Cell Infect Microbiol. 2022; 12:1016728.

PMID: 36569203 PMC: 9780595. DOI: 10.3389/fcimb.2022.1016728.

Application of lymphoplasmapheresis in the treatment of severe myasthenia gravis.

Duan W, Zhou H, Dong X, Li B, Li Y, Cai H Front Neurol. 2022; 13:1018509.

PMID: 36303555 PMC: 9595276. DOI: 10.3389/fneur.2022.1018509.

Adverse Side Effects Associated with Corticosteroid Therapy: A Study in 39 Patients with Generalized Myasthenia Gravis.

Johnson S, Katyal N, Narula N, Govindarajan R Med Sci Monit. 2021; 27:e933296.

PMID: 34707081 PMC: 8562011. DOI: 10.12659/MSM.933296.

Pneumonia in Neurologic Disorders: Is Prophylaxis Necessary?.

Pike-Lee T, Syed S, Willis M, Li Y Neurol Clin Pract. 2021; 11(3):242-248.

PMID: 34484891 PMC: 8382367. DOI: 10.1212/CPJ.0000000000000923.

References

Williamson E, Berger J . Infection risk in patients on multiple sclerosis therapeutics. CNS Drugs. 2015; 29(3):229-44. DOI: 10.1007/s40263-015-0226-2. View

Efthimiou P, Pokharna H, Kukar M, Hennessey K . PCP chemoprophylaxis is essential for lymphopenic dermatomyositis patients treated with immunomodulators. Muscle Nerve. 2011; 43(6):918-9. DOI: 10.1002/mus.21997. View

Cai T, Betensky R . Hazard regression for interval-censored data with penalized spline. Biometrics. 2003; 59(3):570-9. DOI: 10.1111/1541-0420.00067. View

Hernandez-Cruz B, Sifuentes-Osornio J, Diaz-Jouanen E . Mycobacterium tuberculosis infection in patients with systemic rheumatic diseases. A case-series. Clin Exp Rheumatol. 1999; 17(3):289-96. View

Needham M, Mastaglia F . Immunotherapies for Immune-Mediated Myopathies: A Current Perspective. Neurotherapeutics. 2015; 13(1):132-46. PMC: 4720681. DOI: 10.1007/s13311-015-0394-2. View

Soni C, Kumar G, Bollu P, Sahota P, Litofsky N . Salmonella brain abscess in a patient on chronic azathioprine therapy for myasthenia gravis: report of an unusual case and review of literature in the postantibiotic era. J Neurovirol. 2010; 16(1):83-92. DOI: 10.3109/13550280903493906. View

Skeie G, Apostolski S, Evoli A, Gilhus N, Illa I, Harms L . Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol. 2010; 17(7):893-902. DOI: 10.1111/j.1468-1331.2010.03019.x. View

Maddur M, Vani J, Lacroix-Desmazes S, Kaveri S, Bayry J . Autoimmunity as a predisposition for infectious diseases. PLoS Pathog. 2010; 6(11):e1001077. PMC: 2973828. DOI: 10.1371/journal.ppat.1001077. View

Chen I, Tsai W, Wu Y, Luo S, Ho H, Liou L . Infections in polymyositis and dermatomyositis: analysis of 192 cases. Rheumatology (Oxford). 2010; 49(12):2429-37. DOI: 10.1093/rheumatology/keq279. View

10.

Marie I, Menard J, Hachulla E, Cherin P, Benveniste O, Tiev K . Infectious complications in polymyositis and dermatomyositis: a series of 279 patients. Semin Arthritis Rheum. 2010; 41(1):48-60. DOI: 10.1016/j.semarthrit.2010.08.003. View

11.

Ravn P, Munk M, Andersen A, Lundgren B, Nielsen L, Lillebaek T . Reactivation of tuberculosis during immunosuppressive treatment in a patient with a positive QuantiFERON-RD1 test. Scand J Infect Dis. 2004; 36(6-7):499-501. DOI: 10.1080/00365540410015222. View

12.

Cettomai D, Gelber A, Christopher-Stine L . A survey of rheumatologists' practice for prescribing pneumocystis prophylaxis. J Rheumatol. 2010; 37(4):792-9. DOI: 10.3899/jrheum.090843. View

13.

van den Bergh P, Hadden R, Bouche P, Cornblath D, Hahn A, Illa I . European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the.... Eur J Neurol. 2010; 17(3):356-63. DOI: 10.1111/j.1468-1331.2009.02930.x. View

14.

Hoesly F, Sluzevich J . Chronic cutaneous varicella zoster virus infection complicating dermatomyositis. J Dermatol. 2014; 41(4):334-6. DOI: 10.1111/1346-8138.12402. View

15.

Nau R, Behrends T, Henze T, Prange H . [Central nervous system infection caused by Aspergillus fumigatus. A complication of immunosuppressive therapy in myasthenia gravis]. Nervenarzt. 1989; 60(3):178-80. View

16.

Airio A, Kauppi M, Kautiainen H, Hakala M, Kinnula V . High association of mycobacterial infections with polymyositis in a non-endemic country for tuberculosis. Ann Rheum Dis. 2007; 66(10):1404-5. PMC: 1994311. DOI: 10.1136/ard.2007.070177. View

17.

Termsarasab P, Katirji B . Opportunistic infections in myasthenia gravis treated with mycophenolate mofetil. J Neuroimmunol. 2012; 249(1-2):83-5. DOI: 10.1016/j.jneuroim.2012.04.016. View

18.

Mukhopadhyay C, Garg A, Ayyagari A . First documented cure of a suggestive exogenous reinfection in polymyositis with same but multidrug resistant M. tuberculosis. BMC Infect Dis. 2004; 4(1):63. PMC: 548298. DOI: 10.1186/1471-2334-4-63. View

19.

Kelly D, Cronin S . PCP prophylaxis with use of corticosteroids by neurologists. Pract Neurol. 2013; 14(2):74-6. DOI: 10.1136/practneurol-2013-000727. View

20.

Nagaoka S, Tani K, Ishigatsubo Y, Chiba J, Kato K, Matsunaga K . Herpes zoster in patients with polymyositis and dermatomyositis. Kansenshogaku Zasshi. 1990; 64(11):1394-9. DOI: 10.11150/kansenshogakuzasshi1970.64.1394. View