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Severe infections in sarcoidosis: Incidence, predictors and long-term outcome in a cohort of 585 patients.

Abstract Sarcoidosis is associated with cell-mediated immunodeficiency and treatment of symptomatic sarcoidosis usually includes systemic immunosuppressants. Data relative to incidence, prognosis factors, and outcome of infections are scarce.Retrospective cohort study of 585 patients with biopsy proven sarcoidosis in a tertiary referral specialist clinic, with a nested case-control analysis. Twenty nine patients (4.9%) with severe infections were compared to 116 controls subjects with sarcoidosis, matched according to their gender, ethnicity, age at diagnosis, and treatment with corticosteroids.After a median follow-up of 8 years [range; 1-46], 38 severe infections [mycobacterial infections (n = 14), fungal infections (n = 10), bacterial (n = 8), viral (n = 3) and parasitic (n = 1)] were observed in 30 patients. The incidence of severe infections was 0.71% persons-year (CI 95% 0.5-0.98) and 0.43% persons-year (CI 95% 0.27-0.66). Patients with severe infection were more frequently of male gender (60% vs 46%) and were more likely treated by ≥ 3 immunosuppressive agents (OR = 3.8, IC 95% [1.5-9.64], P = .005) and by cyclophosphamide (OR = 5.55, IC 95% [1.9-16.1], P = .002), and with neurological (OR = 3.36 CI 95% [1.37-8.25], P = .008), or cardiac (OR = 2.65 CI 95% [1.09-6.43], P = .031) involvement of the sarcoidosis, compared to the controls. Two patients died within the 6 months following infection, due to progressive multifocal leucoencephalopathy (n = 1), and of peritonitis (n = 1).Severe infections are observed in 5.1% of our patients with sarcoidosis after a median follow-up of 8 years. Risk factors for severe infections included neurological or cardiac involvement of sarcoidosis, the use of immunosuppressive agents and mainly cyclophosphamide.
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Journal Title medicine
Publication Year Start




PMID- 29245251
OWN - NLM
STAT- MEDLINE
DCOM- 20171221
LR  - 20171222
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 49
DP  - 2017 Dec
TI  - Severe infections in sarcoidosis: Incidence, predictors and long-term outcome in 
      a cohort of 585 patients.
PG  - e8846
LID - 10.1097/MD.0000000000008846 [doi]
AB  - Sarcoidosis is associated with cell-mediated immunodeficiency and treatment of
      symptomatic sarcoidosis usually includes systemic immunosuppressants. Data
      relative to incidence, prognosis factors, and outcome of infections are
      scarce.Retrospective cohort study of 585 patients with biopsy proven sarcoidosis 
      in a tertiary referral specialist clinic, with a nested case-control analysis.
      Twenty nine patients (4.9%) with severe infections were compared to 116 controls 
      subjects with sarcoidosis, matched according to their gender, ethnicity, age at
      diagnosis, and treatment with corticosteroids.After a median follow-up of 8 years
      [range; 1-46], 38 severe infections [mycobacterial infections (n = 14), fungal
      infections (n = 10), bacterial (n = 8), viral (n = 3) and parasitic (n = 1)] were
      observed in 30 patients. The incidence of severe infections was 0.71%
      persons-year (CI 95% 0.5-0.98) and 0.43% persons-year (CI 95% 0.27-0.66).
      Patients with severe infection were more frequently of male gender (60% vs 46%)
      and were more likely treated by >/= 3 immunosuppressive agents (OR = 3.8, IC 95% 
      [1.5-9.64], P = .005) and by cyclophosphamide (OR = 5.55, IC 95% [1.9-16.1], P = 
      .002), and with neurological (OR = 3.36 CI 95% [1.37-8.25], P = .008), or cardiac
      (OR = 2.65 CI 95% [1.09-6.43], P = .031) involvement of the sarcoidosis, compared
      to the controls. Two patients died within the 6 months following infection, due
      to progressive multifocal leucoencephalopathy (n = 1), and of peritonitis (n =
      1).Severe infections are observed in 5.1% of our patients with sarcoidosis after 
      a median follow-up of 8 years. Risk factors for severe infections included
      neurological or cardiac involvement of sarcoidosis, the use of immunosuppressive 
      agents and mainly cyclophosphamide.
FAU - Dureault, Amelie
AU  - Dureault A
AD  - aDepartement de Medecine Interne et d'Immunologie Clinique, Hopital Pitie
      Salpetriere, Paris, France. Centre de Reference Maladies Auto-Immunes et
      Systemiques Rares, Universite Pierre et Marie Curie, Paris, France. DHU
      Inflammation, Immunopathology, Biotherapy UPMC, Paris VIbDepartment of
      Biostatistics and Medical Information (SBIM)cDepartment of Ophtalmology,
      Universite Pierre et Marie CuriedDepartment of Infectious disease, Hopital Pitie 
      Salpetriere, Paris, France.
FAU - Chapelon, Catherine
AU  - Chapelon C
FAU - Biard, Lucie
AU  - Biard L
FAU - Domont, Fanny
AU  - Domont F
FAU - Savey, Lea
AU  - Savey L
FAU - Bodaghi, Bahram
AU  - Bodaghi B
FAU - Pourcher, Valerie
AU  - Pourcher V
FAU - Rigon, Matthieu Resche
AU  - Rigon MR
FAU - Cacoub, Patrice
AU  - Cacoub P
FAU - Saadoun, David
AU  - Saadoun D
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Immunosuppressive Agents)
RN  - 8N3DW7272P (Cyclophosphamide)
SB  - AIM
SB  - IM
MH  - Adrenal Cortex Hormones/adverse effects
MH  - Adult
MH  - Case-Control Studies
MH  - Cyclophosphamide/adverse effects
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Immunosuppressive Agents/*adverse effects
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Opportunistic Infections/*epidemiology/microbiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sarcoidosis/*drug therapy/microbiology
MH  - Treatment Outcome
PMC - PMC5728866
EDAT- 2017/12/17 06:00
MHDA- 2017/12/22 06:00
CRDT- 2017/12/17 06:00
PHST- 2017/12/17 06:00 [entrez]
PHST- 2017/12/17 06:00 [pubmed]
PHST- 2017/12/22 06:00 [medline]
AID - 10.1097/MD.0000000000008846 [doi]
AID - 00005792-201712080-00040 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(49):e8846. doi: 10.1097/MD.0000000000008846.