Risk Of Mycobacterial Infections Research Articles

The controversy of immune checkpoint inhibition and risk of mycobacterial infections: the need for further studies and continued discussions on this puzzling issue.

The controversy of immune checkpoint inhibition and risk of mycobacterial infections: the need for further studies and continued discussions on this puzzling issue.

A narrative review of the controversy on the risk of mycobacterial infections with immune checkpoint inhibitor use: does Goldilocks have the answer?

Immune checkpoint inhibitors (ICIs) have revolutionized oncologic treatment. Whether ICIs increase susceptibility to or provide protection against mycobacterial infections remains controversial. The objective of this narrative review is to summarize the literature on the link between ICI use and mycobacterial infections-tuberculosis and non-tuberculous mycobacterial (NTM) infections-and to critically discuss evidence linking ICIs with mycobacterial infections, the possible confounders, and, if indeed the ICIs predispose to such infections, the potential mechanisms of how this may occur. We conducted a literature search on PubMed for relevant articles published from 2011 to current time [2024] utilizing specific keywords of "immune checkpoint inhibitors", "programmed cell death protein-1", "PD-1", "programmed death-ligand 1", "PD-L1", "cytotoxic T-lymphocyte-associated protein-4", or "CTLA-4" with that of "non-tuberculous mycobacterial lung disease", "tuberculosis", or "mycobacteria". The bibliographies of identified papers were perused for additional relevant articles. Ex vivo studies using human cells indicate that ICIs would be salubrious for the host against mycobacteria. Yet, many case reports associate ICI use with mycobacterial infections, mostly tuberculosis. Potential confounders include immunosuppression from the cancer, concomitant use of immunosuppressive drugs, lung injury and distortion from chemotherapeutics or radiation, and reporting bias. Mice with genetic disruption of the programmed cell death protein-1 (PD-1) gene are paradoxically more susceptible to Mycobacterium tuberculosis (M. tuberculosis). In contrast, mice administered neutralizing antibody to T cell immunoglobulin and mucin domain-containing protein 3 (TIM3) or knocked out for TIM3 gene have greater capacity to control an M. tuberculosis infection. We posit that hosts with greater baseline immunodeficiency are more likely to derive benefit from ICIs against mycobacterial infections than those with more intact immunity, where ICIs are more likely to be detrimental. Studies are needed to test the hypothesis that ICIs may either protect or predispose to mycobacterial infections, depending on the baseline host immune status. Prospective studies are required of patients on ICIs that control for potential confounders as anecdotal case reports are insufficient to provide a causal link. Murine studies with ICIs are also required to corroborate or refute studies of mice with genetic disruption of an immune checkpoint.

Risk of Infections in patients using Anti-TNF Medications: A Literature Review

The paradigm for treating chronic Autoimmune Rheumatic Disorders (ARDs) has changed thanks to biologic disease-modifying anti-rheumatic medicines (bDMARDs), however one of its most significant adverse effects is an elevated risk of infections. The current research assessed the incidence, severity, and type of infections in ARD patients on bDMARDs. Disease activity is interwoven with both infectious and chronic inflammatory diseases. Infections are more likely to occur in people with Rheumatoid Arthritis as high disease activity actually reflects persistent inflammation, which may weaken immunity and encourage the spread of various types of infections. Those with RA had an adjusted risk of being hospitalized with an infection that was two times greater when age, sex, concomitant conditions, and prescription medication use were taken into consideration. The risk of mycobacterial infection appears to be lowest with Etanercept (ETN) and highest with Adalimumab (ADA) and Infliximab (INF). Centers of Disease Control and Prevention (CDC) recommends administration of shingles vaccine to all individuals who are on Tumor Necrosis Factor (TNF) inhibitors to prevent Skin and Soft Tissue Infections (SSTI).

Steroid inhalers linked to increased risk of mycobacterial infection

Steroid inhalers linked to increased risk of mycobacterial infection

Mycobacterial disease in renal allograft recipients.

Implication for health policy/practice/research/medical education:Solid organ transplant recipients have impaired cell-mediated immunity, and are at increased risk of mycobacterial infection. Mycobacterium tuberculosis infection (TB) has a high mortality rate among this population. The diagnosis of tuberculosis in solid organ transplant recipients is a big challenge and needs rapid and accurate modalities. These patients have 3.8 time greater risk of developing extra-pulmonary TB than general population. High index of suspicion and applying with invasive diagnostic procedure are needed for diagnosis of TB in renal transplanted patients.

Mycobacterial Disease in Renal Allograft Recipients

Implication for health policy/practice/research/medical education:Solid organ transplant recipients have impaired cell-mediated immunity, and are at increased risk of mycobacterial infection. Mycobacterium tuberculosis infection (TB) has a high mortality rate among this population. The diagnosis of tuberculosis in solid organ transplant recipients is a big challenge and needs rapid and accurate modalities. These patients have 3.8 time greater risk of developing extra-pulmonary TB than general population. High index of suspicion and applying with invasive diagnostic procedure are needed for diagnosis of TB in renal transplanted patients.

Digesting the Unexpected Side Effects of Chronic Antibiotic Use

Chronic antibody use may block autophagy, increasing the risk of mycobacterial infection.