Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
J Dermatol. 2020 Apr;47(4):378-384. doi: 10.1111/1346-8138.15244. Epub 2020 Feb 11.
A long-term immunosuppressive treatment can provoke latent infections. Autoimmune blistering diseases (AIBD) are mostly treated with systemic immunosuppressive agents. To prevent the reactivation or exacerbation of existing latent infections, patients must be screened for infectious diseases before immunosuppressive treatments are initiated. However, the prevalence of infectious diseases in AIBD remains to be elucidated. To evaluate the necessity of screening infectious diseases in AIBD, we retrospectively reviewed the clinical records of 215 patients at a single center with AIBD for hepatitis B virus (HBV), hepatitis C virus (HCV), Mycobacterium tuberculosis, Treponema pallidum, human T-cell leukemia virus type 1 (HTLV-1) and HIV infections. Approximately 40% of patients were infected with HBV. During systemic corticosteroid treatment, HBV DNA became positive in 3.4% of cases. Antibodies to HCV, interferon-γ release assays for M. tuberculosis and the T. pallidum latex agglutination test were positive in 0.6%, 6.6% and 1.2% cases, respectively. Neither HTLV-1 nor HIV infections were detected. In conclusion, checks for HBV and M. tuberculosis infections should be made before immunosuppressive treatments are started, because of the high prevalence of these potentially life-threatening infections. Other infections should be tested for depending on the patient's risk factors.
长期免疫抑制治疗可引发潜伏感染。自身免疫性水疱病（AIBD）多采用系统性免疫抑制剂治疗。为预防潜伏感染的再激活或恶化，在开始免疫抑制治疗前，必须对患者进行传染病筛查。然而，AIBD 患者中传染病的流行情况仍有待阐明。为评估 AIBD 筛查传染病的必要性，我们回顾性分析了单中心 215 例 AIBD 患者的临床资料，评估乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、结核分枝杆菌、梅毒螺旋体、人类 T 细胞白血病病毒 1 型（HTLV-1）和人类免疫缺陷病毒（HIV）感染情况。约 40%的患者感染了 HBV。在全身皮质类固醇治疗期间，3.4%的患者 HBV DNA 转为阳性。HCV 抗体、结核分枝杆菌干扰素-γ释放试验和梅毒螺旋体乳胶凝集试验阳性率分别为 0.6%、6.6%和 1.2%。未检测到 HTLV-1 或 HIV 感染。总之，由于这些潜在危及生命的感染发病率较高，在开始免疫抑制治疗前应进行 HBV 和结核分枝杆菌感染检查。应根据患者的危险因素检测其他感染。
