PMID- 37558492 OWN - NLM STAT- MEDLINE DCOM- 20231012 LR - 20231012 IS - 2056-5933 (Electronic) IS - 2056-5933 (Linking) VI - 9 IP - 3 DP - 2023 Aug TI - Invasive fungal diseases in patients with autoimmune diseases: a case series from the French RESSIF network. LID - 10.1136/rmdopen-2023-003281 [doi] LID - e003281 AB - OBJECTIVES: We aimed to describe patients with autoimmune diseases (AID) developing invasive fungal disease (IFD) and identify factors associated with short-term mortality. METHODS: We analysed cases of IFD associated with AID from the surveillance network of invasive fungal diseases (Reseau de surveillance des infections fongiques invasives, RESSIF) registry of the French national reference centre for invasive mycoses. We studied association of AID-specific treatments with 30-day mortality. We analysed total lymphocyte and CD4-T cell counts in patients with Pneumocystis jirovecii pneumonia (PCP). RESULTS: From 2012 to 2018, 549 individuals with IFD and AID were included, mainly with PCP (n=227, 41.3%), fungemia (n=167, 30.4%) and invasive aspergillosis (n=84, 15.5%). Rheumatoid arthritis (RA) and anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) were the most frequent AID in PCP (n=55 and 25, respectively) and invasive aspergillosis (n=15 and 10, respectively), inflammatory bowel diseases (IBDs) were predominant in fungemia (n=36). At IFD diagnosis, 365 (66.5%) patients received glucocorticoids (GCs), 285 (51.9%) immunosuppressants, 42 (7.7%) tumor necrosis factor (TNF)-alpha blockers, 75 (13.7%) other biologics. Mortality at 30 days was 28.1% (143/508). Fungemia and high-dose GCs were independently associated with higher 30-day mortality. In PCP patients, lymphopenia <1500/mm(3) was frequent (132/179, 73.7%) even if CD4+T cell count exceeded 200/mm(3) in 56/78 patients (71.8%) (median 472.5/mm(3), IQR 160-858). CONCLUSION: IFD associated with AID occurs primarily in RA, AAV and IBD, especially when treated with GCs and immunosuppressants. Mortality is high, especially for patients on high-dose GCs. Lymphopenia may help identify risk of PCP, but normal CD4+T cell count does not rule out the risk. Further studies are needed to assess the individual risk factors for IFD. CI - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Galmiche, Simon AU - Galmiche S AUID- ORCID: 0000-0002-1691-1744 AD - Emerging Diseases Epidemiology Unit, Institut Pasteur, Universite Paris Cite, Paris, Ile-de-France, France simon.galmiche@pasteur.fr. AD - Ecole doctorale Pierre Louis de sante publique, Sorbonne Universite, Paris, France. FAU - Thoreau, Benjamin AU - Thoreau B AD - National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Cochin Hospital, AP-HP, Universite Paris Cite, Paris, Ile-de-France, France. AD - INSERM U1016, Cochin Institute, Paris, Universite Paris Cite, CNRS UMR 8104, Paris, Ile-de-France, France. FAU - Bretagne, Stephane AU - Bretagne S AD - Parasitologie - Mycologie, Hopital St Louis, APHP, Paris, Ile-de-France, France. AD - Institut Pasteur, Universite Paris Cite, CNRS, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, Ile-de-France, France. FAU - Alanio, Alexandre AU - Alanio A AD - Parasitologie - Mycologie, Hopital St Louis, APHP, Paris, Ile-de-France, France. AD - Institut Pasteur, Universite Paris Cite, CNRS, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, Ile-de-France, France. FAU - Paugam, Andre AU - Paugam A AD - Parasitologie - Mycologie, Universite Paris Cite, Cochin Hospital, APHP, Paris, Ile-de-France, France. FAU - Letscher-Bru, Valerie AU - Letscher-Bru V AD - Laboratoire de Parasitologie et Mycologie Medicale, Les Hopitaux Universitaires de Strasbourg, Strasbourg, France. AD - Institut de Parasitologie et Pathologie Tropicale, UR7292 Dynamique des interactions hote pathogene, Federation de Medecine Translationnelle, Universite de Strasbourg, Strasbourg, France. FAU - Cassaing, Sophie AU - Cassaing S AD - Parasitologie - Mycologie, Universite de Toulouse, CHU Toulouse, Toulouse, Occitanie, France. AD - PharmaDev, Faculte de Pharmacie, Universite de Toulouse, UPS, IRD, Toulouse, Occitanie, France. FAU - Gangneux, Jean-Pierre AU - Gangneux JP AD - Universite de Rennes, CHU, INSERM, Irset: Institut de Recherche en Sante, Environnement et Travail, UMR_S 1085, Rennes, France. FAU - Guegan, Helene AU - Guegan H AD - Universite de Rennes, CHU, INSERM, Irset: Institut de Recherche en Sante, Environnement et Travail, UMR_S 1085, Rennes, France. FAU - Favennec, Loic AU - Favennec L AD - French National Cryptosporidiosis Reference Center, CHU de Rouen, Rouen, Normandie, France. AD - EA 7510, UFR Sante, University of Rouen Normandy, Normandy University, Rouen, France. FAU - Minoza, Alida AU - Minoza A AD - Faculte de Medecine et Pharmacie, Universite de Poitiers, Poitiers, Nouvelle-Aquitaine, France. AD - Departement des agents anti-infectieux, Service de Mycologie-Parasitologie, CHU Poitiers, Poitiers, France. FAU - Morio, Florent AU - Morio F AD - Parasitologie - Mycologie, CHU Nantes, Nantes, Pays de la Loire, France. AD - UR 1155 IICiMed, Institut de Recherche en Sante 2, Universite de Nantes, Nantes, Pays de la Loire, France. FAU - Bonhomme, Julie AU - Bonhomme J AD - Microbiologie, CHU de Caen, ToxEMAC-ABTE Unicaen, Caen, Normandie, France. FAU - Desoubeaux, Guillaume AU - Desoubeaux G AD - Centre d'Etude des Pathologies Respiratoires - Inserm UMR1100, Universite de Tours, Tours, France. AD - Parasitologie - Mycologie - Medecine tropicale, CHU de Tours, Tours, Centre-Val de Loire, France. FAU - Eloy, Odile AU - Eloy O AD - Microbiologie, CH Versailles, Le Chesnay, Ile-de-France, France. FAU - Hasseine, Lilia AU - Hasseine L AD - Parasitologie - Mycologie, hopital de l'Archet, CHU Nice, Nice, Provence-Alpes-Cote d'Azur, France. FAU - Sasso, Milene AU - Sasso M AD - Laboratoire de Parasitologie - Mycologie, CHU Nimes, Universite de Montpellier, CNRS, IRD, MiVEGEC, Nimes, Occitanie, France. FAU - Millon, Laurence AU - Millon L AD - Laboratoire de Parasitologie - Mycologie, CHU de Besancon, Besancon, Bourgogne-Franche-Comte, France. AD - UMR 6249 CNRS Chrono-Environnement, Universite Bourgogne Franche-Comte, Besancon, Bourgogne - Franche-Comte, France. FAU - Bellanger, Anne-Pauline AU - Bellanger AP AD - Laboratoire de Parasitologie - Mycologie, CHU de Besancon, Besancon, Bourgogne-Franche-Comte, France. FAU - Poirier, Philippe AU - Poirier P AD - Parasitologie - Mycologie, CHU Clermont-Ferrand, Clermont-Ferrand, France. AD - Microbes, Intestin, Inflammation et Susceptibilite de l'Hote (M2iSH), UMR Inserm/Universite Clermont Auvergne U1071, USC INRA 2018, Clermont-Ferrand, Auvergne-Rhone-Alpes, France. FAU - Moniot, Maxime AU - Moniot M AD - Parasitologie - Mycologie, CHU Clermont-Ferrand, Clermont-Ferrand, France. FAU - Chouaki, Taieb AU - Chouaki T AD - Mycologie - parasitologie, CHU Amiens-Picardie, Amiens, Hauts-de-France, France. FAU - Huguenin, Antoine AU - Huguenin A AD - Parasitologie - Mycologie, hopital Maison-Blanche, CHU de Reims, Reims, France. FAU - Dalle, Frederic AU - Dalle F AD - Parasitologie - Mycologie, Plateforme de Biologie Hospitalo-Universitaire Gerard Mack, Dijon, Bourgogne-Franche-Comte, France. AD - UMR PAM Univ Bourgogne Franche-Comte - AgroSup Dijon - Equipe Vin, Aliment, Microbiologie, Stress, Universite Bourgogne Franche-Comte, Dijon, Bourgogne-Franche-Comte, France. FAU - Bouteille, Bernard AU - Bouteille B AD - Parasitologie - Mycologie, Centre de Biologie et de Recherche en Sante, CHU Limoges, Limoges, Nouvelle-Aquitaine, France. FAU - Nicolas, Muriel AU - Nicolas M AD - Mycologie - Parasitologie, Centre Hospitalier Universitaire Pointe-a-Pitre Abymes, Pointe-a-Pitre, Guadeloupe. FAU - Desbois-Nogard, Nicole AU - Desbois-Nogard N AD - Parasitologie - Mycologie, CHU de Martinique, Fort-de-France, Martinique. FAU - Bougnoux, Marie-Elisabeth AU - Bougnoux ME AD - Laboratoire de Parasitologie - Mycologie, Service de Microbiologie, Necker-Enfants Malades University Hospital, APHP, Paris, Ile-de-France, France. AD - Institut Pasteur, Universite Paris Cite, Unite Biologie et Pathogenicite Fongiques, Departement Mycologie, Paris, Ile-de-France, France. FAU - Danion, Francois AU - Danion F AD - Maladies infectieuses et tropicales, Les Hopitaux Universitaires de Strasbourg, Strasbourg, Grand Est, France. AD - Laboratoire d'Immuno-rhumatologie moleculaire UMR_S 1109, INSERM, Strasbourg, Grand Est, France. FAU - Poindron, Vincent AU - Poindron V AD - Service d'Immunologie clinique, Hopitaux universitaires de Strasbourg, Strasbourg, France. FAU - Neel, Antoine AU - Neel A AD - CRTI UMR 1064, INSERM, Universite de Nantes, Nantes, France. AD - Service de Medecine interne, CHU Nantes, Nantes, Pays de la Loire, France. FAU - Boukris-Sitbon, Karine AU - Boukris-Sitbon K AD - Institut Pasteur, Universite Paris Cite, CNRS, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, Ile-de-France, France. FAU - Lanternier, Fanny AU - Lanternier F AD - Institut Pasteur, Universite Paris Cite, CNRS, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, Ile-de-France, France. AD - Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Paris, France. FAU - Terrier, Benjamin AU - Terrier B AUID- ORCID: 0000-0001-6612-7336 AD - National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Cochin Hospital, AP-HP, Universite Paris Cite, Paris, Ile-de-France, France. AD - Universite Paris Cite, U970, PARCC, INSERM, Paris, Ile-de-France, France. CN - French Mycoses Study Group LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - RMD Open JT - RMD open JID - 101662038 RN - 0 (Glucocorticoids) RN - 0 (Immunosuppressive Agents) SB - IM MH - *Autoimmune Diseases/complications/therapy MH - *Invasive Fungal Infections/complications/epidemiology/etiology/mortality MH - Humans MH - Male MH - Female MH - Middle Aged MH - Aged MH - Glucocorticoids/adverse effects/therapeutic use MH - Immunosuppressive Agents/adverse effects/therapeutic use MH - Risk Factors MH - France MH - Prevalence PMC - PMC10414070 OTO - NOTNLM OT - Antirheumatic Agents OT - Arthritis, Rheumatoid OT - Autoimmune Diseases OT - Glucocorticoids COIS- Competing interests: None declared. FIR - Bailly, Eric IR - Bailly E FIR - Mahinc, Caroline IR - Mahinc C FIR - Pihet, Marc IR - Pihet M FIR - Demar, Magalie IR - Demar M FIR - Merabet, Lilia IR - Merabet L FIR - Salle, Valery IR - Salle V FIR - Damiani, Celine IR - Damiani C FIR - Durieux, Marie-Fleur IR - Durieux MF FIR - Kamar, Nassim IR - Kamar N FIR - Charpentier, Elena IR - Charpentier E FIR - Maillot, Francois IR - Maillot F FIR - Nourrisson, Cecile IR - Nourrisson C FIR - Suzon, Benoit IR - Suzon B EDAT- 2023/08/10 00:42 MHDA- 2023/08/11 06:43 PMCR- 2023/08/09 CRDT- 2023/08/09 21:24 PHST- 2023/05/03 00:00 [received] PHST- 2023/07/28 00:00 [accepted] PHST- 2023/08/11 06:43 [medline] PHST- 2023/08/10 00:42 [pubmed] PHST- 2023/08/09 21:24 [entrez] PHST- 2023/08/09 00:00 [pmc-release] AID - rmdopen-2023-003281 [pii] AID - 10.1136/rmdopen-2023-003281 [doi] PST - ppublish SO - RMD Open. 2023 Aug;9(3):e003281. doi: 10.1136/rmdopen-2023-003281.