Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T00:37:18.923Z Has data issue: false hasContentIssue false
  • English
  • Français

Invasive Pulmonary Aspergillosis Soon After Therapy With Infliximab, a Tumor Necrosis Factor-Alpha–Neutralizing Antibody: A Possible Healthcare-Associated Case?

Published online by Cambridge University Press:  02 January 2015

Francesco G. De Rosa ,
David Shaz ,
Anthony C. Campagna ,
Paul F. Dellaripa ,
Urmila Khettry  and
Donald E. Craven
Francesco G. De Rosa
Affiliation:
Department of Infectious Diseases, Lahey Clinic, Burlington, Massachusetts Department of Infectious Diseases, University of Turin, Turin, Italy
David Shaz
Affiliation:
Department of Pulmonary and Critical Care Medicine, Lahey Clinic, Burlington, Massachusetts
Anthony C. Campagna
Affiliation:
Department of Pulmonary and Critical Care Medicine, Lahey Clinic, Burlington, Massachusetts
Paul F. Dellaripa
Affiliation:
Department of Rheumatology, Lahey Clinic, Burlington, Massachusetts
Urmila Khettry
Affiliation:
Department of Pathology, Lahey Clinic, Burlington, Massachusetts
Donald E. Craven*
Affiliation:
Department of Infectious Diseases, Lahey Clinic, Burlington, Massachusetts
*
Department of Infectious Diseases, Lahey Clinic, 41 Mall Road, Burlington, MA 01805
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Infliximab is a chimeric monoclonal antibody against tumor necrosis factor (TNF)-alpha, used for the treatment of Crohn's disease and rheumatoid arthritis. Recently, an increased risk of infection due to Mycobacterium tuberculosis and rare cases of invasive fungal disease have been reported following infliximab therapy.

Case Report:

A 73-year-old woman with chronic rheumatoid arthritis who had been treated with methotrexate, leflunomide, and prednisone was given the first of three doses of infliximab in June 2001. In July 2001, she presented with cough, and in August, she had a right upper lobe infiltrate that was treated with levofloxacin without improvement. In October, the patient had right upper and middle lobe infiltrates on a chest x-ray and computed tomography scan. At bronchoscopy, an endobronchial mass was biopsied, which demonstrated Aspergillus fumigatus. Our patient had frequently accompanied her daughter on visits to another medical center following a stem cell transplant, where her daughter was instructed to wear a mask during all visits because of extensive building construction. We postulate that our patient may have acquired pulmonary aspergillosis during this period. Literature reviews on granulomatous diseases following infliximab therapy and hospital-acquired aspergillosis are presented.

Conclusion:

The temporal relationship between the administration of infliximab and A. fumigatus infection in this patient suggests a causal relationship and possible healthcare-associated acquisition. These data underscore the importance of both patient and family education on prevention strategies when potent immune-modulating medications such as infliximab have been prescribed (Infect Control Hosp Epidemiol 2003;24:477-482)

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 7 , July 2003 , pp. 477 - 482
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Keating, GM, Perry, CM. Infliximab: an updated review of its use in Crohn's disease and rheumatoid arthritis. Bio Drugs 2002;16:111–148.Google Scholar
2.Scallon, BJ, Moore, MA, Trinh, H, Knight, DM, Ghrayeb, J. Chimeric anti–TNF-alpha monoclonal antibody cA2 binds recombinant transmembrane TNF-alpha and activates immune effector functions. Cytokine 1995;7:251–259.Google Scholar
3.Bell, SJ, Kamm, MA. Review article: the clinical role of anti–TNF-alpha antibody treatment in Crohn's disease. Aliment Pharmacol Ther 2000;14:501–514.Google Scholar
4.Keane, J, Gershon, S, Wise, RP, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001;345:1098–1104.Google Scholar
5.Keenan, GF, Schaible, TF, Boscia, JA. Invasive pulmonary aspergillosis associated with infliximab therapy. N Engl J Med 2001;344:1100.Google Scholar
6.Warris, A, Bjorneklett, A, Gaustad, P. Invasive pulmonary aspergillosis associated with infliximab therapy. N Engl J Med 2001;344:1099–1100.Google ScholarPubMed
7.Starrett, WG, Czachor, J, Dallal, M, Drehmer, T. Cryptococcal pneumonia following treatment with infliximab for rheumatoid arthritis. Presented at the 40th Annual Meeting of the Infectious Diseases Society of America; October 24-27, 2002; Chicago, IL. Abstract 374.Google Scholar
8.Shrestha, R, Stoller, JK, Procop, G, Gordon, S. Possible zoonotic transmission of Cryptococcus neoformans from a pet cockatiel to a patient associated with infliximab. Presented at the 40th Annual Meeting of the Infectious Diseases Society of America; October 24-27, 2002; Chicago, IL. Abstract 376.Google Scholar
9.Marty, FM, Lee, SJ, Alyea, EP, Soiffer, RJ, Antin, JH, Baden, LR. Risk of non-Candida invasive fungal infections in allogeneic bone marrow transplant patients who received infliximab to control severe graft v. host disease. Presented at the 42nd Annual Meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 27-30, 2002; San Diego, CA. Abstract M-1234.Google Scholar
10.Latge, JP. The pathobiology of Aspergillus fumigatus. Trends Microbiol 2001;9:382–389.Google Scholar
11.Denning, DW. Invasive aspergillosis. Clin Infect Dis 1998;26:781–803.Google Scholar
12.Aisner, J, Schimpff, SC, Bennett, JE, Young, VM, Wiernik, PH. Aspergillus infections in cancer patients: association with fireproofing materials in a new hospital. JAMA 1976;235:411–412.Google Scholar
13.Arnow, PM, Andersen, RL, Mainous, PD, Smith, EJ. Pulmonary aspergillosis during hospital renovation. Am Rev Respir Dis 1978;118:49–53.Google Scholar
14.Stone, HH, Cuzzell, JZ, Kolb, LD, Moskowitz, MS, McGowan, JE Jr. Aspergillus infection of the burn wound. J Trauma 1979;19:765–767.Google Scholar
15.Sarubbi, FA Jr, Kopf, HB, Wilson, MB, McGinnis, MR, Rutala, WA. Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction. Am Rev Respir Dis 1982;125:33–38.Google Scholar
16.Opal, SM, Asp, AA, Cannady, PB Jr, Morse, PL, Burton, LJ, Hammer, PG. Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction. J Infect Dis 1986;153:634–637.Google Scholar
17.Hopkins, CC, Weber, DJ, Rubin, RH. Invasive Aspergillus infection: possible non-ward common source within the hospital environment. J Hosp Infect 1989;13:19–25.Google Scholar
18.Barnes, RA, Rogers, TR. Control of an outbreak of nosocomial aspergillosis by laminar air-flow isolation. J Hosp Infect 1989;14:89–94.CrossRefGoogle ScholarPubMed
19.Mehta, G. Aspergillus endocarditis after open heart surgery: an epidemiological investigation. J Hosp Infect 1990;15:245–253.Google Scholar
20.Loudon, KW, Coke, AP, Burnie, JP, Shaw, AJ, Oppenheim, BA, Morris, CQ. Kitchens as a source of Aspergillus niger infection. J Hosp Infect 1996;32:191–198.CrossRefGoogle ScholarPubMed
21.Lass-Florl, C, Rath, P, Niederwieser, D, et al. Aspergillus terreus infections in hematological malignancies: molecular epidemiology suggests association with in-hospital plants. J Hosp Infect 2000;46:31–35.Google Scholar
22.Hara, KS, Ryu, JH, Lie, JT, Roberts, GD. Disseminated Aspergillus terreus infection in immunocompromised hosts. Mayo Clin Proc 1989;64:770–775.Google Scholar
23.Verweij, PE, van den Bergh, MF, Rath, PM, de Pauw, BE, Voss, A, Meis, JF. Invasive aspergillosis caused by Aspergillus ustus: case report and review. J Clin Microbiol 1999;37:1606–1609.Google Scholar
24.Saugier-Veber, P, Devergie, A, Sulahian, A, et al. Epidemiology and diagnosis of invasive pulmonary aspergillosis in bone marrow transplant patients: results of a 5-year retrospective study. Bone Marrow Transplant 1993;12:121–124.Google Scholar
25.Brown, RS Jr, Lake, JR, Katzman, BA, et al. Incidence and significance of Aspergillus cultures following liver and kidney transplantation. Transplantation 1996;61:666–669.Google Scholar
26.Wald, A, Leisenring, W, van Burik, JA, Bowden, RA. Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis 1997;175:1459–1466.Google Scholar
27.Grow, WB, Moreb, JS, Roque, D, et al. Late onset of invasive Aspergillus infection in bone marrow transplant patients at a university hospital. Bone Marrow Transplant 2002;29:15–19.Google Scholar
28.Bartley, JM. APIC state–of-the–art report: the role of infection control during construction in health care facilities. Am J Infect Control 2000;28:156–169.Google Scholar
29.Mohan, VP, Scanga, CA, Yu, K, et al. Effects of tumor necrosis factor alpha on host immune response in chronic persistent tuberculosis: possible role for limiting pathology. Infect Immun 2001;69:1847–1855.Google Scholar
30.Choy, EH, Panayi, GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 2001;344:907–916.CrossRefGoogle ScholarPubMed
31.Zaman, R, Abbas, M. Case report of a fatal disseminated histoplasmosis in a patient with rheumatoid arthritis following therapy with etanercept and methotrexate. Presented at the 40th Annual Meeting of the Infectious Diseases Society of America; October 24-27, 2002; Chicago, IL. Abstract 378.Google Scholar
32.Wagner, TE, Huseby, ES, Huseby, JS. Exacerbation of Mycobacterium tuberculosis enteritis masquerading as Crohn's disease after treatment with a tumor necrosis factor-alpha inhibitor. Am J Med 2002;112:67–69.Google Scholar
33.Nunez, MO, Ripoll, NC, Carneros Martin, JA, Gonzalez, LV, Gregorio Maranon, HG. Reactivation tuberculosis in a patient with anti–TNF-alpha treatment. Am J Gastroenterol 2001;96:1665–1666.Google Scholar
34.Mayordomo, L, Marenco, JL, Gomez-Mateos, J, Rejon, E. Pulmonary miliary tuberculosis in a patient with anti–TNF-alpha treatment. Scand J Rheumatol 2002;31:44–45.Google Scholar