Marie Isabelle
Département de Médecine Interne, CHU Rouen, F-76031 Rouen Cedex, France.
Presse Med. 2009 Feb;38(2):303-16. doi: 10.1016/j.lpm.2008.09.021. Epub 2008 Dec 11.
Infections result in increased mortality rates in patients with polymyositis/dermatomyositis, leading to death in 9 to 30% of cases. The following parameters can be considered of predictive value for infection onset in polymyositis/dermatomyositis: age, lymphopenia, esophageal dysfunction, ventilatory insufficiency, interstitial lung disease, calcinosis cutis, as well as higher mean daily doses of steroids. A great variety of microorganisms may be responsible for pyogenic and opportunistic infections in polymyositis/dermatomyositis. Opportunistic infections are more often due to mycobacteria and fungi (Pneumocystis jiroveci, Candidasp.). Because a great variety of microorganisms may be responsible for opportunistic infections, it seems difficult to initiate primary prophylaxis in patients with polymyositis/dermatomyositis who exhibit risk factors for opportunistic infections. Primary prophylaxis of Pneumocystis jirovecipneumonia should be given in the group of patients exhibiting CD4-cell count lower than 250/mm(3). Vaccination should be performed in patients with polymyositis/dermatomyositis, prior to immunosuppressive therapy institution.
感染会导致多发性肌炎/皮肌炎患者的死亡率上升，9%至30%的病例会因此死亡。以下参数可被视为多发性肌炎/皮肌炎感染发病的预测指标：年龄、淋巴细胞减少、食管功能障碍、通气不足、间质性肺病、皮肤钙质沉着，以及更高的每日平均类固醇剂量。多种微生物可能导致多发性肌炎/皮肌炎的化脓性和机会性感染。机会性感染更常由分枝杆菌和真菌（耶氏肺孢子菌、念珠菌属）引起。由于多种微生物可能导致机会性感染，对于有机会性感染风险因素的多发性肌炎/皮肌炎患者，启动一级预防似乎很困难。对于CD4细胞计数低于250/mm³的患者群体，应进行耶氏肺孢子菌肺炎的一级预防。在开始免疫抑制治疗之前，应对多发性肌炎/皮肌炎患者进行疫苗接种。
