A Multicenter Study of Invasive Fungal Infections in Patients with Childhood-onset Systemic Lupus Erythematosus

Imagem de Miniatura
Arquivos
art_SILVA_A_Multicenter_Study_of_Invasive_Fungal_Infections_in_2015.PDF (118.45 KB)
Citações na Scopus
34
Tipo de produção
article
Data de publicação
2015
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
J RHEUMATOL PUBL CO
Autores
TERRERI, Maria T.
MAGALHAES, Claudia S.
OKUDA, Eunice M.
APPENZELLER, Simone
FERRIANI, Virginia P.
Citação
JOURNAL OF RHEUMATOLOGY, v.42, n.12, p.2296-2303, 2015
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objective. To study the prevalence, risk factors, and mortality of invasive fungal infections (IFI) in patients with childhood-onset systemic lupus erythematosus (cSLE). Methods. A retrospective multicenter cohort study was performed in 852 patients with cSLE from 10 pediatric rheumatology services. An investigator meeting was held and all participants received database training. IFI were diagnosed according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria (proven, probable, and possible). Also evaluated were demographic, clinical, and laboratory data, and disease activity [SLE Disease Activity Index 2000 (SLEDAI-2K)], cumulative damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), treatment, and outcomes. Results. IFI were observed in 33/852 patients (3.9%) with cSLE. Proven IFI was diagnosed in 22 patients with cSLE, probable IFI in 5, and possible IFI in 6. Types of IFI were candidiasis (20), aspergillosis (9), cryptococcosis (2), and 1 each disseminated histoplasmosis and paracoccidioidomycosis. The median of disease duration was lower (1.0 vs 4.7 yrs, p < 0.0001) with a higher current SLEDAI-2K [19.5 (0-44) vs 2 (0-45), p < 0.0001] and current prednisone (PRED) dose [50 (10-60) vs 10 (2-90) mg/day, p < 0.0001] in patients with IFI compared with those without IFI. The frequency of death was higher in the former group (51% vs 6%, p < 0.0001). Logistic regression analysis revealed that SLEDAI-2K (OR 1.108, 95% CI 1.057-1.163, p < 0.0001), current PRED dose (OR 1.046, 95% CI 1.021-1.071, p < 0.0001), and disease duration (OR 0.984, 95% CI 0.969-0.998, p = 0.030) were independent risk factors for IFI (R-2 Nagelkerke 0.425). Conclusion. To our knowledge, this is the first study to characterize IFI in patients with cSLE. We identified that disease activity and current glucocorticoid use were the main risk factors for these life-threatening infections, mainly in the first years of disease course, with a high rate of fatal outcome.
Palavras-chave
INFECTION, INVASIVE FUNGAL INFECTION, INVASIVE FUNGAL DISEASE, CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS, MULTICENTER COHORT
URI
https://observatorio.fm.usp.br/handle/OPI/12612
Referências
  1. Liang MH, 1999, ARTHRITIS RHEUM-US, V42, P599
  2. Barber CE, 2012, J RHEUMATOL, V39, P1772, DOI 10.3899/jrheum.120707
  3. Brunner HI, 2008, ARTHRITIS RHEUM, V58, P556, DOI 10.1002/art.23204
  4. Silva CA, 2012, ARTHRIT CARE RES, V64, P1787, DOI 10.1002/acr.21757
  5. Chen HS, 2007, RHEUMATOLOGY, V46, P539, DOI 10.1093/rheumatology/kel343
  6. Jesus AA, 2011, CLIN DEV IMMUNOL, DOI 10.1155/2011/428703
  7. Hochberg MC, 1997, ARTHRITIS RHEUM, V40, P1725, DOI 10.1002/art.1780400928
  8. Gladman D, 1996, ARTHRITIS RHEUM, V39, P363, DOI 10.1002/art.1780390303
  9. Ozsevik SN, 2015, J PEDIAT HEMATOL ONC, V37, pE69, DOI 10.1097/MPH.0000000000000225
  10. Akcan-Arikan A, 2007, KIDNEY INT, V71, P1028, DOI 10.1038/sj.ki.5002231
  11. Fan YC, 2012, GENE, V506, P184, DOI 10.1016/j.gene.2012.06.059
  12. Colombo AL, 2007, INFECT CONT HOSP EP, V28, P570, DOI 10.1086/513615
  13. Franca CMP, 2012, ACTA REUMATOL PORT, V37, P276
  14. Canova EG, 2002, CLIN EXP RHEUMATOL, V20, P736
  15. GONZALEZCRESPO MR, 1995, SEMIN ARTHRITIS RHEU, V24, P304, DOI 10.1016/S0049-0172(95)80002-6
  16. BRANDT JT, 1995, THROMB HAEMOSTASIS, V74, P1185
  17. Avcin T, 2009, LUPUS, V18, P894, DOI 10.1177/0961203309106917
  18. Kim HJ, 2009, LUPUS, V18, P661, DOI 10.1177/0961203309103081
  19. Al-Mayouf SM, 2001, CLIN EXP RHEUMATOL, V19, P748
  20. Hoenigl M, 2012, J ANTIMICROB CHEMOTH, V67, P2029, DOI 10.1093/jac/dks155
  21. Faco MMM, 2007, BRAZ J MED BIOL RES, V40, P993, DOI 10.1590/S0100-879X2006005000110
  22. Lee PPW, 2007, RHEUMATOLOGY, V46, P1290, DOI 10.1093/rheumatology/kem102
  23. Vinicki JP, 2013, LUPUS, V22, P892, DOI 10.1177/0961203313496342
  24. De Pauw B, 2008, CLIN INFECT DIS, V46, P1813, DOI 10.1086/588660
  25. Gladman DD, 2002, J RHEUMATOL, V29, P288
  26. Cavalcante EG, 2014, REV BRAS REUMATOL, V54, P155, DOI [10.1016/j.rbre.2014.03.012, 10.1016/j.rbr.2014.03.012]
  27. Marques VLS, 2013, LUPUS, V22, P1409, DOI 10.1177/0961203313502859
  28. Jesus AA, 2011, LUPUS, V20, P1275, DOI 10.1177/0961203311411598
  29. Chan James C M, 2002, Pediatr Rev, V23, P47, DOI 10.1542/pir.23-2-47
  30. Costa-Reis P, 2013, CLIN IMMUNOL, V149, P442, DOI 10.1016/j.clim.2013.08.009
  31. Danza A, 2013, LUPUS, V22, P1286, DOI 10.1177/0961203313493032
  32. Groll AH, 2014, LANCET ONCOL, V15, pE327, DOI 10.1016/S1470-2045(14)70017-8
  33. Lube GE, 2014, ACTA REUMATOL PORT, V39, P182
  34. Martinez-Martinez MU, 2012, J RHEUMATOL, V39, P1814, DOI 10.3899/jrheum.111498
  35. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, 2004, PEDIATRICS, V114, P555, DOI 10.1542/PEDS.114.2
  36. National KF, 2002, AM J KIDNEY DIS S, V39, pS1, DOI 10.1053/AJKD.2002.30582.PUBMED:11904577
  37. Silva MF, 2012, LUPUS, V21, P1011, DOI 10.1177/0961203312442752
  38. Wang LDR, 2014, SEMIN ARTHRITIS RHEU, V44, P325, DOI 10.1016/j.semarthrit.2014.06.001
  39. Weng CT, 2010, LUPUS, V19, P1204, DOI 10.1177/0961203310368969
  40. Yeh TC, 2014, CANCER-AM CANCER SOC, V120, P1255, DOI 10.1002/cncr.28524

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - FM/MPE
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/ICr
Artigos e Materiais de Revistas Científicas - LIM/17
Artigos e Materiais de Revistas Científicas - LIM/36
Carregar mais