Valeyre Dominique, Bernaudin Jean-François, Brauner Michel, Nunes Hilario, Jeny Florence
INSERM-UMR 1272, SMBH Université Sorbonne Paris-Nord, 93009 Bobigny, France.
Service de Pneumologie, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France.
J Clin Med. 2024 Jan 7;13(2):342. doi: 10.3390/jcm13020342.
In this review, the infectious complications observed in sarcoidosis are considered from a practical point of view to help the clinician not to overlook them in a difficult context, as pulmonary sarcoidosis makes the recognition of superinfections more difficult. An increased incidence of community-acquired pneumonia and of opportunistic pneumonia has been reported, especially in immunosuppressed patients. Pulmonary destructive lesions of advanced sarcoidosis increase the incidence of chronic pulmonary aspergillosis and infection by other agents. Screening and treatment of latent tuberculosis infection are crucial to prevent severe tuberculosis. Severity in COVID-19 appears to be increased by comorbidities rather than by sarcoidosis per se. The diagnosis of infectious complications can be challenging and should be considered as a potential differential diagnosis when the exacerbation of sarcoidosis is suspected. These complications not only increase the need for hospitalizations, but also increase the risk of death. This aspect must be carefully considered when assessing the overall health burden associated with sarcoidosis. The impact of immune dysregulation on infectious risk is unclear except in exceptional cases. In the absence of evidence-based studies on immunosuppressants in the specific context of pulmonary sarcoidosis, it is recommended to apply guidelines used in areas outside sarcoidosis. Preventive measures are essential, beginning with an appropriate use of immunosuppressants and the avoidance of unjustified treatments and doses. This approach should take into account the risk of tuberculosis, especially in highly endemic countries. Additionally, parallel emphasis should be placed on vaccinations, especially against COVID-19.
在本综述中，从实际角度考虑结节病中观察到的感染性并发症，以帮助临床医生在困难情况下不忽视这些并发症，因为肺结节病会使识别重叠感染更加困难。据报道，社区获得性肺炎和机会性肺炎的发病率有所增加，尤其是在免疫抑制患者中。晚期结节病的肺部破坏性病变会增加慢性肺曲霉病和其他病原体感染的发病率。潜伏性结核感染的筛查和治疗对于预防严重结核病至关重要。COVID-19的严重程度似乎因合并症而非结节病本身而增加。感染性并发症的诊断可能具有挑战性，当怀疑结节病病情加重时，应将其视为潜在的鉴别诊断。这些并发症不仅增加了住院需求，还增加了死亡风险。在评估与结节病相关的总体健康负担时，必须仔细考虑这一方面。除特殊情况外，免疫失调对感染风险的影响尚不清楚。在缺乏针对肺结节病特定背景下免疫抑制剂的循证研究时，建议应用结节病以外领域使用的指南。预防措施至关重要，首先要合理使用免疫抑制剂，避免不合理的治疗和剂量。这种方法应考虑到结核病风险，尤其是在结核病高流行国家。此外，应同时强调接种疫苗，尤其是针对COVID-19的疫苗接种。
