类风湿关节炎患者的组织胞浆菌感染，1998-2009 年。
Histoplasmosis infection in patients with rheumatoid arthritis, 1998-2009.
机构信息
Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
出版信息
BMC Infect Dis. 2011 May 23;11:145. doi: 10.1186/1471-2334-11-145.
BACKGROUND
Patients with rheumatic diseases including rheumatoid arthritis (RA) are at increased risk for infections related to both the disease and its treatments. These include uncommonly reported infections due to histoplasmosis.
METHODS
Medical record review of all patients with a diagnosis of RA who developed new histoplasmosis infection in an endemic region between Jan 1, 1998 and Jan 30, 2009 and who were seen at Mayo Clinic in Rochester, Minnesota was performed.
RESULTS
Histoplasmosis was diagnosed in 26 patients. Most patients were on combination therapies; 15 were on anti-tumor necrosis factor (anti-TNF) agents, 15 on corticosteroids and 16 on methotrexate. Most received more than 6 months of itraconazole and/or amphotericin treatment. Two patients died of causes unrelated to histoplasmosis. Anti-TNF treatment was restarted in 4/15 patients, with recurrence of histoplasmosis in one.
CONCLUSIONS
In this largest single center series of patients with RA and histoplasmosis in the era of immunomodulatory therapy, we found that most patients had longstanding disease and were on multiple immunomodulatory agents. Most cases were pulmonary; typical signs and symptoms of disease were frequently lacking.
背景
包括类风湿关节炎（RA）在内的风湿性疾病患者因疾病及其治疗而面临更高的感染风险。这些感染包括由于组织胞浆菌病引起的罕见报道的感染。
方法
对 1998 年 1 月 1 日至 2009 年 1 月 30 日期间在明尼苏达州罗切斯特市梅奥诊所就诊的、在地方性流行区域被诊断患有新发组织胞浆菌病感染的 RA 患者的所有病历进行回顾性分析。
结果
诊断出 26 例组织胞浆菌病。大多数患者接受联合治疗；15 例接受抗肿瘤坏死因子（anti-TNF）药物治疗，15 例接受皮质激素治疗，16 例接受甲氨蝶呤治疗。大多数患者接受了超过 6 个月的伊曲康唑和/或两性霉素治疗。有 2 例患者因与组织胞浆菌病无关的原因死亡。在接受抗 TNF 治疗的 15 例患者中有 4 例重新开始治疗，其中 1 例出现组织胞浆菌病复发。
结论
在这个接受免疫调节治疗的时代，在最大的单一中心 RA 与组织胞浆菌病患者系列中，我们发现大多数患者患有长期疾病且使用多种免疫调节药物。大多数病例为肺部；疾病的典型体征和症状经常缺失。
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