Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Pneumocystis jirovecii Pneumonia and Other Infections in Idiopathic Inflammatory Myositis

  • 50 Accesses

Abstract

Purpose of Review

The management of patients with idiopathic inflammatory myositis (IIM) can be complex and challenging due to the myriad of complications they can experience. The continued use of corticosteroids, in addition to the rise of combination immunosuppressive therapy, has contributed to the ongoing concern for infection. Perhaps the most feared infection in IIM patients is Pneumocystis jirovecii pneumonia (PJP) given its infrequent occurrence yet high mortality. The field has been, and continues to be, without evidence-based guidelines to help clinicians determine which patients with IIM to prescribe prophylaxis. Herein, we review this literature to provide the clinician with an up-to-date view of infections in IIM.

Recent Findings

In the past 5 years, a number of studies have been reported highlighting various infectious complications, which help us better understand their frequency and associated risk factors. In addition, data has been published on the potential harms of PJP prophylaxis, to better inform the risk/benefit of our decision-making.

Summary

Infection remains a major contributor to morbidity and mortality in IIM. A better understanding of which patient subgroups are at risk for particular infections will inform optimal management strategies.

This is a preview of subscription content, log in to check access.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Wu C, Wang Q, He L, Yang E, Zeng X. Hospitalization mortality and associated risk factors in patients with polymyositis and dermatomyositis: a retrospective case-control study. PLoS One. 2018;23:e0192491.

  2. 2.

    Peng JM, Du B, Wang Q, Weng L, Hu XY, Wu CY, et al. Dermatomyositis and Polymyositis in the intensive care unit: a single-center retrospective cohort study of 102 patients. PLoS One. 2016;26:e0154441.

  3. 3.

    Amaral Silva M, Cogollo E, Isenberg DA. Why do patients with myositis die? A retrospective analysis of a single-centre cohort. Clin Exp Rheumatol. 2016;34:820–6.

  4. 4.

    Murray SG, Schmajuk G, Trupin L, Lawson E, Cascino M, Barton J et al. A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis. Arthritis Care Res (Hoboken). 2015;67:673–80.

  5. 5.

    Marie I, Ménard JF, Hachulla E, Chérin P, Benveniste O, Tiev K, et al. Infectious complications in polymyositis and dermatomyositis: a series of 279 patients. Semin Arthritis Rheum. 2011;41:48–60. https://doi.org/10.1016/j.semarthrit.2010.08.003.

  6. 6.

    Prior DE, Nurre E, Roller SL, Kline D, Panara R, Stino AM, et al. Infections and the relationship to treatment in neuromuscular autoimmunity. Muscle Nerve. 2018;57:927–31. https://doi.org/10.1002/mus.26032.

  7. 7.

    Fillatre P, Decaux O, Jouneau S, Revest M, Gacouin A, Robert-Gangneux F, et al. Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients. Am J Med. 2014;127:e11–7.

  8. 8.

    Falagas ME, Manta KG, Betsi GI, Pappas G. Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin Rheumatol. 2007;26:663–70.

  9. 9.

    Mecoli CA, Saylor D, Gelber AC, Christopher-Stine L. Pneumocystis jiroveci pneumonia in rheumatic disease: a 20-year single-centre experience. Clin Exp Rheumatol. 2017;35:671–3.

  10. 10.

    Cettomai D, Gelber AC, Christopher-Stine L. A survey of rheumatologists’ practice for prescribing pneumocystis prophylaxis. J Rheum. 2010;37:792–9.

  11. 11.

    Schmajuk G, Jafria K, Evansa M, Shiboskic S, Gianfrancesco M, Izadi Z, et al. Pneumocystis jiroveci pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs. Semin Arthritis Rheum. 2019;48:1087–92.

  12. 12.

    • Tadros S, Teichtahl AJ, Wicks IP CS. Pneumocystis jirovecii pneumonia in systemic autoimmune rheumatic disease: a case-control study. Semin Arthritis Rheum. 2017;46:804–9 Provides a summary of different PJP prophylaxis recommendations from several other groups.

  13. 13.

    Baulier G, Issa N, Gabriel F, Accoceberry I, Camou F, Duffau P. Guidelines for prophylaxis of Pneumocystis pneumonia cannot rely solely on CD4-cell count in autoimmune and inflammatory diseases. Clin Exp Rheumatol. 2018;36:490–3.

  14. 14.

    Park JW, Curtis JR, Moon J, Song YW, Kim S, Lee EB. Prophylactic effect of trimethoprim-sulfamethaxazole for pneumocystis pneumonia in patients with rheumatic diseases exposed to prolonged high-dose glucocorticoids. Ann Rheum Dis. 2018;77:664–9.

  15. 15.

    Limper AH, Knox KS, Sarosi GA, et al. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011;183:96–128.

  16. 16.

    •• Winthrop KL, Baddley JW. Pneumocystis and glucocorticoid use: to prophylax or not to prophylax (and when?); that is the question. Ann Rheum Dis. 2018;77:631–3 Provides context for prior PJP recommendations and puts forth another set of recommendations based both on evidence and expert opinion.

  17. 17.

    Viguier M, Fouéré S, de la Salmonière P, Rabian C, Lebbe C, Dubertret L, et al. Peripheral blood lymphocyte subset counts in patients with dermatomyositis: clinical correlations and changes following therapy. Medicine (Baltimore). 2003;82:82–6.

  18. 18.

    Vulliemoz S, Lurati-Ruiz F, Borruat FX, Delavelle J, Koralnik IJ, Kuntzer T, et al. Favourable outcome of progressive multifocal leucoencephalopathy in two patients with dermatomyositis. J Neurol Neurosurg Psychiatry. 2006;77:1079–82.

  19. 19.

    Molloy ES, Calabrese LH. Progressive multifocal leukoencephalopathy associated with immunosuppressive therapy in rheumatic diseases: evolving role of biologic therapies. Arthritis Rheum. 2012;64:3043–51.

  20. 20.

    Belhassen-Garcia M, Rábano-Gutiérrez A, Velasco-Tirado V, Romero-Alegria A, Pérez-Garcia ML, Martin-Oterino JA. Atypical progressive multifocal leukoencephalopathy in a patient with antisynthetase syndrome. Intern Med. 2015;54:519–24. https://doi.org/10.2169/internalmedicine.54.2748.

  21. 21.

    Dastmalchi M, Laki J, Lundberg IE, Iacobaeus E. Progressive multifocal leukoencephalopathy in a patient with polymyositis: case report and literature review. J Rheumatol. 2012;39:1299–303.

  22. 22.

    Gheuens S, Pierone G, Peeters P, Koralnik IJ. Progressive multifocal leukoencephalopathy in individuals with minimal or occult immunosuppression. J Neurol Neurosurg Psychiatry. 2010;81:247–54.

  23. 23.

    Center for Disease Control and Prevention. https://www.cdc.gov/shingles/index.html. Accessed 15 June 2019.

  24. 24.

    Tsai SY, Lin CL, Wong YC, Yang TY, Kuo CF, Cheng JM et al. Increased Risk of Herpes Zoster Following Dermatomyositis and Polymyositis: A Nationwide Population-Based Cohort Study. Medicine (Baltimore). 2015;94:e1138.

  25. 25.

    Center for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/flu/index.html. Accessed 15 June 2019.

  26. 26.

    Center for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/pneumo/index.html. Accessed 15 June 2019.

Download references

Author information

Correspondence to Sonye K. Danoff.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Inflammatory Muscle Disease

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mecoli, C.A., Danoff, S.K. Pneumocystis jirovecii Pneumonia and Other Infections in Idiopathic Inflammatory Myositis. Curr Rheumatol Rep 22, 7 (2020). https://doi.org/10.1007/s11926-020-0883-0

Download citation

Keywords

  • Inflammatory myositis
  • Antisynthetase syndrome
  • Immunosuppression
  • Infection
  • Pneumocystis jirovecii pneumonia