Mushtaq Kamran, Khan Zubair, Aziz Muhammad, Alyousif Zakaria Abdullah, Siddiqui Nauman, Khan Muhammad Ali, Nawras Ali
Department of Medicine, Hamad General Hospital and Weill-Cornell Medical College, Doha, Qatar.
Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.
Transl Gastroenterol Hepatol. 2020 Jul 5;5:35. doi: 10.21037/tgh.2019.10.14. eCollection 2020.
Immunosuppressive therapy is being increasingly used in the management of inflammatory bowel disease (IBD) which comprises of ulcerative colitis (UC) and Crohn's disease (CD). Patients on immunosuppressive therapy are at increased risk of developing opportunistic fungal infections. We conducted this analysis to describe the epidemiology of opportunistic fungal infections in this cohort.
We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of IBD (UC and Crohn's disease) & Fungal infections (Histoplasmosis, Pneumocystosis, Cryptococcosis, Aspergillosis, Blastomycosis, candidiasis, Coccidioidomycosis) as primary or secondary diagnosis via ICD 9 codes during the period from 2002-2014.
In UC, the incidence of all fungal infections was more in age above 50 (except for pneumoconiosis) male gender (except Candidiasis) and in Caucasians. In CD, the incidence was more in age above 50 (except Pneumocystosis, Blastomycosis & Coccidioidomycosis), female gender (except Histoplasmosis, Pneumocystosis & Cryptococcosis) and in Caucasians. Histoplasmosis and Blastomycosis were more prevalent in Midwest, Cryptococcosis and Candidiasis in South, Coccidioidomycosis in west in both UC and CD. Age above 50, south region, HIV, Congestive heart failure, underlying malignancies, diabetes mellitus with complications, chronic pulmonary disease, anemia, rheumatoid arthritis, collagen vascular disease, pulmonary circulation disorders, weight loss were significant predictors of fungal infections in IBD. The yearly trend showed a consistent small rise in incidence, and the mortality dropped till 2006 to peak again in 2008 with a subsequent decline.
Our study is the first one to describe the basic demographics features and characteristics of opportunistic fungal infections in hospitalized patients with IBD. The yearly incidence of fungal infections did not show a significant rise. The mortality increased between 2006-2008 and a significant difference remains between IBD patients with and without fungal infections. One explanation of rise in mortality but a consistent incidence could be due to the use of biologics that did not increase but compromised the ability of IBD patients to fight opportunistic fungal infections.
免疫抑制疗法在炎症性肠病（IBD，包括溃疡性结肠炎（UC）和克罗恩病（CD））的治疗中使用得越来越多。接受免疫抑制治疗的患者发生机会性真菌感染的风险增加。我们进行了这项分析，以描述该队列中机会性真菌感染的流行病学情况。
我们通过国际疾病分类第九版（ICD 9）编码，分析了国家住院患者样本（NIS）数据库中2002年至2014年期间出院诊断为IBD（UC和克罗恩病）及真菌感染（组织胞浆菌病、肺孢子菌病、隐球菌病、曲霉菌病、芽生菌病、念珠菌病、球孢子菌病）作为主要或次要诊断的所有受试者。
在UC中，所有真菌感染的发病率在50岁以上人群（肺尘埃沉着病除外）、男性（念珠菌病除外）和白种人中更高。在CD中，发病率在50岁以上人群（肺孢子菌病、芽生菌病和球孢子菌病除外）、女性（组织胞浆菌病、肺孢子菌病和隐球菌病除外）和白种人中更高。组织胞浆菌病和芽生菌病在中西部地区更为普遍，隐球菌病和念珠菌病在南部地区更为普遍，球孢子菌病在西部的UC和CD患者中更为普遍。50岁以上、南部地区、HIV、充血性心力衰竭、潜在恶性肿瘤、伴有并发症的糖尿病、慢性肺病、贫血、类风湿关节炎、胶原血管病、肺循环障碍、体重减轻是IBD患者发生真菌感染的重要预测因素。年度趋势显示发病率持续小幅上升，死亡率在2006年之前下降，在2008年再次达到峰值，随后下降。
我们的研究是首个描述住院IBD患者机会性真菌感染的基本人口统计学特征和特点的研究。真菌感染的年发病率没有显著上升。死亡率在2006年至2008年期间有所增加，有真菌感染和无真菌感染的IBD患者之间仍存在显著差异。死亡率上升但发病率保持稳定这一现象的一种解释可能是生物制剂的使用没有增加但损害了IBD患者对抗机会性真菌感染的能力。
