Non tuberculous anti-TNF associated opportunistic infections

Anti-TNF alpha agents have revolutionized the treatment of patients with rheumatoid arthritis, spondylar-thropathies and Crohn's disease. However, their use is associated with an increased risk of infections. Pyogenic infections (involving the lungs, skin and urinary tract) and tuberculosis are the more commonly observed infectious complications in patients receiving anti-TNF alpha agents. However, opportunistic infections have been increasingly reported in anti-TNF alpha-treated patients, and include non tuberculous mycobacteria, fungi (Pneumocystis jiroveci, Candida sp, Aspergillus, Cryptococcus, Histoplasma), opportunistic bacterial (Nocardia), parasitic (Leishmania) and viral (e.g. Cytomegalovirus, human herpes virus 8 [HHV 8]) infections. These infectious complications usually occur within the first months of therapy and are important causes of morbidity and mortality in anti-TNFa-treated patients. It is recommended to rule out infections, especially latent or active tuberculosis, before the initiation of anti-TNFa therapy. However, it is necessary to follow-up closely these patients to detect the possible occurrence of opportunistic infections. (C) 2010 Societe nationale francaise de medecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.