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Pneumonia in myasthenia gravis: Microbial etiology and clinical management

INTRODUCTION: Patients with myasthenia gravis (MG) are prone to the development of pneumonia due to the long-term immunotherapies they receive and a tendency for aspiration. Pneumonia remains a risk factor for MG worsening and is the most prevalent cause of mortality in MG patients. Classification o...

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Autores principales: Su, Manqiqige, Jin, Shan, Jiao, Kexin, Yan, Chong, Song, Jie, Xi, Jianying, Zhao, Chongbo, Zhou, Zhirui, Zheng, Jianming, Luo, Sushan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9780595/
https://www.ncbi.nlm.nih.gov/pubmed/36569203
http://dx.doi.org/10.3389/fcimb.2022.1016728
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author Su, Manqiqige
Jin, Shan
Jiao, Kexin
Yan, Chong
Song, Jie
Xi, Jianying
Zhao, Chongbo
Zhou, Zhirui
Zheng, Jianming
Luo, Sushan
author_facet Su, Manqiqige
Jin, Shan
Jiao, Kexin
Yan, Chong
Song, Jie
Xi, Jianying
Zhao, Chongbo
Zhou, Zhirui
Zheng, Jianming
Luo, Sushan
author_sort Su, Manqiqige
collection PubMed
description INTRODUCTION: Patients with myasthenia gravis (MG) are prone to the development of pneumonia due to the long-term immunotherapies they receive and a tendency for aspiration. Pneumonia remains a risk factor for MG worsening and is the most prevalent cause of mortality in MG patients. Classification of the pathogens involved and exploration of the risk factors for mechanical ventilation (MV) could aid in improving clinical outcomes. METHODS: Between January 2013 and October 2022, we performed an inpatient database review for MG patients with pneumonia concurrence in a tertiary research center specializing in neuromuscular disorders. The clinical and microbiological characteristics of 116 MG patients with pneumonia were retrospectively analyzed. RESULTS: In our cohort, 90.32% (112/124) of organisms were bacteria and 42.86% (48/112) of pathogenic bacteria were carbapenem-resistant. A high abundance of Epstein–Barr virus (EBV) was detected using next-generation sequencing (NGS) in 12 patients, while cytomegalovirus (CMV) was detected in 8 patients. Non-fermentative Gram-negative bacilli were the most prevalent microorganisms, in which ampicillin, sulfamethoxazole-trimethoprim (SMZ-TMP), piperacillin, cefoperazone, ceftazidime, and cefepime may have an anti-infectious effect. Moreover, peripheral lymphocyte percentage [odds ratio (OR) 0.88, 95% CI 0.75–0.96, p = 0.02] and serum globulin (OR 1.16, 95% CI 1.02–1.35, p = 0.03) were significantly associated with the risk of MV demand. DISCUSSION: Our identification of the microbial etiology of pneumonia in MG patients may provide future perspectives on accurate antibiotic options and enable early interventions when risk factors are present.
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spelling pubmed-97805952022-12-24 Pneumonia in myasthenia gravis: Microbial etiology and clinical management Su, Manqiqige Jin, Shan Jiao, Kexin Yan, Chong Song, Jie Xi, Jianying Zhao, Chongbo Zhou, Zhirui Zheng, Jianming Luo, Sushan Front Cell Infect Microbiol Cellular and Infection Microbiology INTRODUCTION: Patients with myasthenia gravis (MG) are prone to the development of pneumonia due to the long-term immunotherapies they receive and a tendency for aspiration. Pneumonia remains a risk factor for MG worsening and is the most prevalent cause of mortality in MG patients. Classification of the pathogens involved and exploration of the risk factors for mechanical ventilation (MV) could aid in improving clinical outcomes. METHODS: Between January 2013 and October 2022, we performed an inpatient database review for MG patients with pneumonia concurrence in a tertiary research center specializing in neuromuscular disorders. The clinical and microbiological characteristics of 116 MG patients with pneumonia were retrospectively analyzed. RESULTS: In our cohort, 90.32% (112/124) of organisms were bacteria and 42.86% (48/112) of pathogenic bacteria were carbapenem-resistant. A high abundance of Epstein–Barr virus (EBV) was detected using next-generation sequencing (NGS) in 12 patients, while cytomegalovirus (CMV) was detected in 8 patients. Non-fermentative Gram-negative bacilli were the most prevalent microorganisms, in which ampicillin, sulfamethoxazole-trimethoprim (SMZ-TMP), piperacillin, cefoperazone, ceftazidime, and cefepime may have an anti-infectious effect. Moreover, peripheral lymphocyte percentage [odds ratio (OR) 0.88, 95% CI 0.75–0.96, p = 0.02] and serum globulin (OR 1.16, 95% CI 1.02–1.35, p = 0.03) were significantly associated with the risk of MV demand. DISCUSSION: Our identification of the microbial etiology of pneumonia in MG patients may provide future perspectives on accurate antibiotic options and enable early interventions when risk factors are present. Frontiers Media S.A. 2022-12-09 /pmc/articles/PMC9780595/ /pubmed/36569203 http://dx.doi.org/10.3389/fcimb.2022.1016728 Text en Copyright © 2022 Su, Jin, Jiao, Yan, Song, Xi, Zhao, Zhou, Zheng and Luo https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cellular and Infection Microbiology
Su, Manqiqige
Jin, Shan
Jiao, Kexin
Yan, Chong
Song, Jie
Xi, Jianying
Zhao, Chongbo
Zhou, Zhirui
Zheng, Jianming
Luo, Sushan
Pneumonia in myasthenia gravis: Microbial etiology and clinical management
title Pneumonia in myasthenia gravis: Microbial etiology and clinical management
title_full Pneumonia in myasthenia gravis: Microbial etiology and clinical management
title_fullStr Pneumonia in myasthenia gravis: Microbial etiology and clinical management
title_full_unstemmed Pneumonia in myasthenia gravis: Microbial etiology and clinical management
title_short Pneumonia in myasthenia gravis: Microbial etiology and clinical management
title_sort pneumonia in myasthenia gravis: microbial etiology and clinical management
topic Cellular and Infection Microbiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9780595/
https://www.ncbi.nlm.nih.gov/pubmed/36569203
http://dx.doi.org/10.3389/fcimb.2022.1016728
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