Been Sayeed S K Jakaria, Moniruzzaman Md, Kabir A K M Humayon, Mallik Md Uzzwal, Chandra Mondal Bikas, Mahmud Shahin, Rahman Fahim T, Rahman Mehrin, Rahman Md Mujibur
Medicine and Rheumatology, National Institute of Neurosciences and Hospital, Dhaka, BGD.
Medicine, Dhaka Medical College Hospital, Dhaka, BGD.
Cureus. 2024 Jan 23;16(1):e52817. doi: 10.7759/cureus.52817. eCollection 2024 Jan.
Background Immunomodulatory therapy for chronic rheumatic disease carries a risk for infectious complications. In Bangladesh, there is limited information regarding patterns and factors associated with infections among patients receiving immunosuppressive medications. Objective The present study aimed to find out patterns and predictors associated with infection among patients who were on different immunosuppressive medications due to chronic rheumatological disease. Methodology This was a retrospective study; all confirmed cases of (new and old) different rheumatological diseases on disease-modifying agents attended at the rheumatology clinic of Dhaka Medical College Hospital from January 2019 to December 2021 were enrolled. Result Among 489 cases, 90 (18.4%) patients had documented infections. The most common rheumatological diseases were systemic lupus erythematosus (28, 31.1%), ankylosing spondylitis (26, 28.8%), and rheumatoid arthritis (20, 22.2%). COVID-19 (28, 31.1%) was the most commonly occurring infection followed by urinary tract infection (14, 15.6%), fungal infection (12, 13.3%), herpes zoster (10, 11.1%), pulmonary tuberculosis (TB) (eight, 8.8%), latent TB (seven, 7.7%), community-acquired pneumonia (six, 6.6%), and sepsis (three, 3.3%). Infection was most prevalent among patients who received steroids of more than 10 mg per day (17, 18.8%) than those less than 10 mg steroid per day (six, 6.7%), Factors associated with infections were (odds ratio, 95% CI, p-value) underweight (2.3, [1.3-2.7], 0.001), anemia (1.8, [1.1-5.7], 0.01), neutropenia (1.6, [1.1-2.9], <0.002), hypoalbuminemia (3.1, [1.6-4.9], 0.001), hypovitaminosis D (1.9, [1.3-4.5], 0.001), high blood sugar (1.5, [1.1-5.3], 0.02), inadequate counseling of steroid side effect (1.7, [1.1-3.9], 0.03), prednisolone >10mg/day (2.2, [1.19-4.10], 0.001). Conclusion COVID-19 pneumonia, urinary tract infections, fungal infection, tuberculosis, herpes zoster, and community-acquired pneumonia were commonly occurring infections among patients receiving different immunosuppressive medications. Factors like poor nutritional status, presence of anemia, leucopenia, hypoalbuminemia, hyperglycemia, and hypovitaminosis D had a significant association with infection. Moreover, inadequate counseling of steroid side effects and history of daily intake of prednisolone (>10mg/day) were also significant factors associated with infection.
背景 慢性风湿性疾病的免疫调节治疗存在感染并发症的风险。在孟加拉国，关于接受免疫抑制药物治疗的患者感染模式及相关因素的信息有限。目的 本研究旨在找出因慢性风湿性疾病而服用不同免疫抑制药物的患者中与感染相关的模式和预测因素。方法 这是一项回顾性研究；纳入了2019年1月至2021年12月期间在达卡医学院医院风湿科门诊就诊的所有确诊（新发病例和旧病例）的不同风湿性疾病且正在使用改善病情抗风湿药的患者。结果 在489例病例中，90例（18.4%）患者有记录在案的感染。最常见的风湿性疾病是系统性红斑狼疮（28例，31.1%）、强直性脊柱炎（26例，28.8%）和类风湿关节炎（20例，22.2%）。新型冠状病毒肺炎（COVID-19，28例，31.1%）是最常见的感染，其次是尿路感染（14例，15.6%）、真菌感染（12例，13.3%）、带状疱疹（10例，11.1%）、肺结核（TB，8例，8.8%）、潜伏性结核（7例，7.7%）、社区获得性肺炎（6例，6.6%）和败血症（3例，3.3%）。接受每日剂量超过10毫克类固醇的患者中感染最为普遍（17例，18.8%），高于每日类固醇剂量低于10毫克的患者（6例，6.7%）。与感染相关的因素为（比值比，95%置信区间，p值）体重过低（2.3，[1.3 - 2.7]，0.001）、贫血（1.8，[1.1 - 5.7]，0.01）、中性粒细胞减少（1.6，[1.1 - 2.9]，<0.002）、低白蛋白血症（3.1，[1.6 - 4.9]，0.001）、维生素D缺乏（1.9，[1.3 - 4.5]，0.001）、高血糖（1.5，[1.1 - 5.3]，0.02）、类固醇副作用咨询不足（1.7，[1.1 - 3.9]，0.03）、泼尼松龙>10毫克/天（2.2，[1.19 - 4.10]，0.001）。结论 COVID-19肺炎、尿路感染、真菌感染、肺结核、带状疱疹和社区获得性肺炎是接受不同免疫抑制药物治疗患者中常见的感染。营养状况差、贫血、白细胞减少、低白蛋白血症、高血糖和维生素D缺乏等因素与感染有显著关联。此外，类固醇副作用咨询不足以及每日服用泼尼松龙（>10毫克/天）的病史也是与感染相关的重要因素。
