Department of Internal Medicine IV, Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria.
Department of Medicine, University of Cambridge, Cambridge, UK.
Nephrol Dial Transplant. 2023 Nov 8;38(Supplement_2):ii40-ii49. doi: 10.1093/ndt/gfad080.
The coronavirus disease 2019 (COVID-19) pandemic revealed that our understanding of infectious complications and strategies to mitigate severe infections in patients with glomerular diseases is limited. Beyond COVID-19, there are several infections that specifically impact care of patients receiving immunosuppressive measures. This review will provide an overview of six different infectious complications frequently encountered in patients with glomerular diseases, and will focus on recent achievements in terms of vaccine developments and understanding of the use of specific antimicrobial prophylaxis. These include influenza virus, Streptococcus pneumoniae, reactivation of a chronic or past infection with hepatitis B virus in cases receiving B-cell depletion, reactivation of cytomegalovirus, and cases of Pneumocystis jirovecii pneumonia in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. Varicella zoster virus infections are particularly frequent in patients with systemic lupus erythematosus and an inactivated vaccine is available to use as an alternative to the attenuated vaccine in patients receiving immunosuppressants. As with COVID-19 vaccines, vaccine responses are generally impaired in older patients, and after recent administration of B-cell depleting agents, and high doses of mycophenolate mofetil and other immunosuppressants. Strategies to curb infectious complications are manifold and will be outlined in this review.
2019 年冠状病毒病（COVID-19）大流行表明，我们对肾小球疾病患者感染并发症的理解以及减轻严重感染的策略是有限的。除 COVID-19 外，还有几种感染会特别影响接受免疫抑制措施的患者的护理。这篇综述将概述肾小球疾病患者中经常遇到的六种不同的感染并发症，并将重点介绍疫苗开发和理解特定抗菌预防措施的最新进展。这些并发症包括流感病毒、肺炎链球菌、接受 B 细胞耗竭治疗的患者乙型肝炎病毒的慢性或既往感染的再激活、巨细胞病毒再激活以及抗中性粒细胞胞质抗体相关性血管炎患者的卡氏肺孢子虫肺炎。水痘带状疱疹病毒感染在系统性红斑狼疮患者中尤为常见，并且有灭活疫苗可替代接受免疫抑制剂治疗的减毒疫苗。与 COVID-19 疫苗一样，老年患者的疫苗反应通常较差，并且在最近使用 B 细胞耗竭剂以及大剂量吗替麦考酚酯和其他免疫抑制剂后，疫苗反应会受到抑制。遏制感染并发症的策略是多种多样的，本文将对此进行概述。
