Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis

BACKGROUND AND OBJECTIVE: A high frequency of infections complicating rheumatoid arthritis (RA) has been reported due to the immunomodulatory effect of RA or to agents with immunosuppressive effects used in its treatment. We aimed to assess clinical and radiological characteristics of pulmonary cryp...

Descripción completa

Detalles Bibliográficos
Autores principales: Hosoda, Chiaki, Ishiguro, Takashi, Uozumi, Ryuji, Ueda, Miyuki, Takata, Naomi, Takayanagi, Noboru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323392/
https://www.ncbi.nlm.nih.gov/pubmed/34326152
http://dx.doi.org/10.1136/bmjresp-2020-000805
_version_ 1783731232250527744
author Hosoda, Chiaki
Ishiguro, Takashi
Uozumi, Ryuji
Ueda, Miyuki
Takata, Naomi
Takayanagi, Noboru
author_facet Hosoda, Chiaki
Ishiguro, Takashi
Uozumi, Ryuji
Ueda, Miyuki
Takata, Naomi
Takayanagi, Noboru
author_sort Hosoda, Chiaki
collection PubMed
description BACKGROUND AND OBJECTIVE: A high frequency of infections complicating rheumatoid arthritis (RA) has been reported due to the immunomodulatory effect of RA or to agents with immunosuppressive effects used in its treatment. We aimed to assess clinical and radiological characteristics of pulmonary cryptococcosis in patients with and without RA. METHODS: We retrospectively reviewed the medical records of 52 patients with pulmonary cryptococcosis and divided them into two groups, those with RA and without RA, and compared clinical characteristics and radiological findings between them. RESULTS: Eleven (21.2%) of the 52 patients had RA. Median follow-up periods were 51.2 (range: 1.1–258.7) months for patients with RA and 19.1 (range: 0.63–246.9) months for patients without RA. Among the patients with RA, 81.8% were women, with a mean age of 68.1 years. Female sex and respiratory comorbidities were significantly more frequent in patients with RA than in patients without RA. Frequencies of concomitant cryptococcal meningitis and respiratory failure were not different between the groups. There were no significant differences in frequency of any radiological findings, locations and number between the two groups. Among patients with RA, all but one responded well to antifungal treatment. During the antifungal treatment course, one (9.1%) patient with RA died of cryptococcosis. Despite continuing antirheumatic drugs, no patients had recurrence of pulmonary cryptococcosis during follow-up. CONCLUSION: Other than some differences in background, there were no clinical, radiological or prognostic differences between the patients with and without RA with pulmonary cryptococcosis. The administration of antirheumatic therapy had no negative effect on the clinical course of antifungal treatment.
format Online
Article
Text
id pubmed-8323392
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-83233922021-08-19 Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis Hosoda, Chiaki Ishiguro, Takashi Uozumi, Ryuji Ueda, Miyuki Takata, Naomi Takayanagi, Noboru BMJ Open Respir Res Respiratory Infection BACKGROUND AND OBJECTIVE: A high frequency of infections complicating rheumatoid arthritis (RA) has been reported due to the immunomodulatory effect of RA or to agents with immunosuppressive effects used in its treatment. We aimed to assess clinical and radiological characteristics of pulmonary cryptococcosis in patients with and without RA. METHODS: We retrospectively reviewed the medical records of 52 patients with pulmonary cryptococcosis and divided them into two groups, those with RA and without RA, and compared clinical characteristics and radiological findings between them. RESULTS: Eleven (21.2%) of the 52 patients had RA. Median follow-up periods were 51.2 (range: 1.1–258.7) months for patients with RA and 19.1 (range: 0.63–246.9) months for patients without RA. Among the patients with RA, 81.8% were women, with a mean age of 68.1 years. Female sex and respiratory comorbidities were significantly more frequent in patients with RA than in patients without RA. Frequencies of concomitant cryptococcal meningitis and respiratory failure were not different between the groups. There were no significant differences in frequency of any radiological findings, locations and number between the two groups. Among patients with RA, all but one responded well to antifungal treatment. During the antifungal treatment course, one (9.1%) patient with RA died of cryptococcosis. Despite continuing antirheumatic drugs, no patients had recurrence of pulmonary cryptococcosis during follow-up. CONCLUSION: Other than some differences in background, there were no clinical, radiological or prognostic differences between the patients with and without RA with pulmonary cryptococcosis. The administration of antirheumatic therapy had no negative effect on the clinical course of antifungal treatment. BMJ Publishing Group 2021-07-29 /pmc/articles/PMC8323392/ /pubmed/34326152 http://dx.doi.org/10.1136/bmjresp-2020-000805 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Respiratory Infection
Hosoda, Chiaki
Ishiguro, Takashi
Uozumi, Ryuji
Ueda, Miyuki
Takata, Naomi
Takayanagi, Noboru
Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis
title Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis
title_full Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis
title_fullStr Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis
title_full_unstemmed Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis
title_short Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis
title_sort characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis
topic Respiratory Infection
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323392/
https://www.ncbi.nlm.nih.gov/pubmed/34326152
http://dx.doi.org/10.1136/bmjresp-2020-000805
work_keys_str_mv AT hosodachiaki characteristicsofpulmonarycryptococcosisinpatientswithrheumatoidarthritis
AT ishigurotakashi characteristicsofpulmonarycryptococcosisinpatientswithrheumatoidarthritis
AT uozumiryuji characteristicsofpulmonarycryptococcosisinpatientswithrheumatoidarthritis
AT uedamiyuki characteristicsofpulmonarycryptococcosisinpatientswithrheumatoidarthritis
AT takatanaomi characteristicsofpulmonarycryptococcosisinpatientswithrheumatoidarthritis
AT takayanaginoboru characteristicsofpulmonarycryptococcosisinpatientswithrheumatoidarthritis