Use Of Immunosuppressive Medications Research Articles

Localized Pneumocystis jirovecii pneumonia in a malnourished, non-HIV-infected man in the absence of any established or diagnosed immunosuppressive condition: a case report

BackgroundPneumocystis jirovecii infection is an opportunistic infection that mostly affects patients with immunosuppressive conditions like human immunodeficiency virus (HIV) infection or medications, like corticosteroids. This study reports a rare case of Pneumocystis Jiroveci infection in a relatively immunocompetent patient which presented with uncommon radiological findings.Case presentationA 46-year-old man with a malnourished appearance and a history of opium dependence presented with dry cough, dyspnea, and weight loss to the hospital. There was no evidence of an immunocompromised condition or use of any immunosuppressive medication in the history of the patient. A lung high-resolution computed tomography (HRCT) scan revealed a crazy-paving appearance and localized infiltration. Methenamine silver staining and the histopathological findings in the transbronchial lung biopsy confirmed the diagnosis of PJP. Antibiotics and bronchodilators were administrated and the patient was discharged after 6 days of hospitalization. HIV testing and immunoglobulin levels were normal in the hospital course as well as his follow-up visits. After a 2-month follow-up, the patient was in good condition despite of mild remaining infiltration in his lung.ConclusionsPJP typically affects HIV-infected patients, but due to excessive use of immunosuppressive medications, its prevalence is increasing in non-HIV-infected patients. Malnutrition may predispose the patients to PJP, even in the absence of immunosuppressive conditions.

Incidence and risk factors for invasive fungal infections in patients initiating TNF-alpha inhibitors for inflammatory bowel disease and rheumatoid arthritis.

In a commercial claims database analysis, <0.5% of patients with inflammatory bowel disease or rheumatoid arthritis developed an IFI within one year of initiating TNF-alpha therapy. Histoplasmosis was the most common IFI type. Overall IFI incidence varied based on region, underlying conditions, and use of certain immunosuppressive medications.

Infection prophylaxis among patients with antineutrophil cytoplasmic antibody (ANCA) vasculitis: a scoping review.

Severe infections associated with the use of strong immunosuppressive medication are a leading cause of morbidity and mortality in patients with ANCA vasculitis (AV). While guidelines conditionally recommend trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis for Pneumocystis jirovecii pneumonia in AV patients, robust evidence on prophylaxis strategies is lacking. This scoping review aimed to assess the existing evidence on infection prophylaxis in AV patients, identify knowledge gaps, and guide future study design. A comprehensive search of six databases and relevant references identified original studies in English from January 1, 2000, to July 31, 2020. Inclusion criteria encompassed studies evaluating the impact of any antimicrobial prophylaxis strategy on infection-related outcomes in AV patients receiving immunosuppressive treatment. Studies were screened by four researchers using a blinded approach. Data was extracted by two reviewers, with differences resolved via consensus in consultation with a third reviewer. Nineteen studies met inclusion criteria, including two randomized trials and 17 cohort studies, with TMP-SMX being the most commonly assessed prophylactic strategy. The studies varied in sample sizes, outcomes measured, prophylactic strategies employed, and proportion of patients who received the regimen. Most cohort studies included no or limited control of potential confounding factors. This scoping review suggests significant variation in AV patients' receipt of TMP-SMX and alternative infection prophylaxis approaches. Observational studies using large secondary healthcare databases with rigorous designs are needed to provide high-quality evidence of the real-world effectiveness of antimicrobial prophylactic regimens, to improve clinical decision-making and quality of care for AV patients receiving immunosuppressive treatment.

The Effect of Fear of Covid-19 on Immunosuppressive Treatment Compliance in Patients with Liver Transplantation

Objective: In this study, we aimed to examine the effect of fear of Covid-19 on immunosuppressive treatment compliance in patients who underwent liver transplantation surgery. Method: This descriptive study was conducted at the liver transplant center of a university hospital with the participation of 169 patients. Data; It was collected face to face and online by researchers between February and March 2024. Data were collected using the Personal Information Form, Coronavirus (Covid-19) Fear Scale and Compliance with Immunosuppressive Medication Use scales. Data analysis was done with IBM SPSS (Statistical Package for the Social Sciences) Statistics 25 program. Results: 58.6% of the patients were male, 80.5% were married, 72% of the patients used tacrolimus as the immunosuppressive drug after the transplant, 63.3% did not catch Covid-19, 15.4% were diagnosed with Covid-19. It was determined that he lost a relative. Simple linear regression analysis was performed to determine the relationship between the scales used and no statistically significant relationship was found between the two scales (p&gt;0.05). Conclusion: It is recommended to create support programs that will include the normalization processes of liver transplant patients who are afraid of Covid-19 in order to become more compatible with their daily lives.

Immunosuppressive drugs and cancer risk

The use of immunosuppressive medications is an area of interest for organ transplantation. These medications have been repurposed for the treatment of cancer in recent years. In the context of cancer therapy, the use of immunosuppressive medications such as cyclosporine, tacrolimus, sirolimus, mycophenolate acid mofetil (MMF), mycophenolate, and azathioprine is discussed. Treatment for cancer frequently includes methods designed to use the immune system to find and destroy cancer cells. Cancer cells can, however, avoid immune surveillance and eradication because the tumor microenvironment frequently has immune-suppressive components. Drugs that suppress the immune system, which were initially designed to avoid organ rejection, have demonstrated potential for obstructing these inhibitory pathways and boosting antitumour immune responses. Tacrolimus and cyclosporine, two immunosuppressive medications frequently used in transplantation, have potential anticancer effects. The immune system and stifling tumor-promoting inflammatory responses, can prevent tumor growth, angiogenesis, and metastasis. Another immunosuppressive drug, sirolimus, has shown anticancer effects by reducing angiogenesis and tumor cell growth while promoting immune-mediated tumors. Mycophenolate medicines, such as MMF and mycophenolate, have strong immunosuppressive properties. By inhibiting the enzymes responsible for purine production, these enzymes aim to inhibit lymphocyte proliferation. By altering immune cell function and reducing tumor growth, these medications have demonstrated promise in the treatment of cancer. Azathioprine, a medication that suppresses the immune system and is frequently used to treat autoimmune illnesses, has also been investigated as a possible cancer treatment. Although immunosuppressive medications have potential in the treatment of cancer, their usage needs to be carefully addressed due to potential side effects and the delicate balance between immune suppression and antitumour action. The immune system plays a crucial role in identifying and eliminating abnormal cells, including those associated with cancer.

Chagas disease in the immunocompromised host.

To highlight recent advances in our understanding of Trypanosoma cruzi infection in immunocompromised individuals, a condition that is increasingly recognized as populations shift and use of immunosuppressive medications becomes more commonplace. Chagas disease screening programs should include people at risk for both Chagas disease and immunocompromise, e.g. people who have resided for ≥6 months in endemic Latin America who have an immunocompromising condition such as HIV or who are planned to start an immunosuppressive medication regimen. The goal of identifying such individuals is to allow management strategies that will reduce their risk of T. cruzi reactivation disease. For people with HIV- T. cruzi coinfection, strict adherence to antiretroviral therapy is important and antitrypanosomal treatment is urgent in the setting of symptomatic reactivation. People at risk for T. cruzi reactivation due to immunosuppression caused by advanced hematologic conditions or postsolid organ transplantation should be monitored via T. cruzi qPCR and treated with preemptive antitrypanosomal therapy if rising parasite load on serial specimens indicates reactivation. Reduction of the immunosuppressive regimen, if possible, is important. Chronic Chagas disease can lead to severe disease in immunocompromised individuals, particularly those with advanced HIV (CD4 + < 200 cells/mm 3 ) or peri-transplantation.

Updates in the Management of Giant Cell Arteritis.

To briefly review the latest updates in management in giant cell arteritis, an autoimmune vasculitis affecting the medium to large vessels. Here, we review the known and newer trends in management of giant cell arteritis. While high dose glucocorticoids remain the mainstay of therapy, immunosuppressive medications are increasingly utilized to reduce the burden and risk of long-term glucocorticoid use. Published guidelines by the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) suggest early use of steroid-sparing immunosuppressive medications in patients with recently diagnosed or relapsing giant cell arteritis. Immunosuppressive medications include oral small molecules such as methotrexate and leflunomide and biologics, including the recently Federal Drug Administration (FDA) approved tocilizumab. Glucocorticoids remain the cornerstone of management for newly diagnosed disease but with the increasing use of medications such as IL-6 inhibitors, patients are decreasing steroid use within weeks, thereby limiting risks associated with long-term steroid use.

Survival in dogs with meningoencephalomyelitis of unknown etiology with and without lesions detected by magnetic resonance imaging.

The prognosis of individual dogs with meningoencephalomyelitis of unknown etiology (MUE) remains difficult to predict. MUE cases with no lesions detected by magnetic resonance imaging (MRI) occur, but it is unknown whether this finding is associated with prognosis. MUE cases without detectable lesions on MRI have a better outcome than cases with detectable lesions. Study included 73 client-owned dogs with MUE presenting to Purdue University Veterinary Hospital from 2010 to 2020. Retrospective study. Dogs with a clinical diagnosis of MUE were identified by medical record search. MRI reports were reviewed for presence or absence of lesions consistent with MUE. Clinical findings at presentation, treatment, disease-specific survival, and outcomes including rates of remission and relapse were compared between cases with normal MRI or abnormal MRI. Overall, 54 dogs (74%) were classified as abnormal MRI, and 19 dogs (26%) were classified as normal MRI cases. Death caused by MUE occurred in 1/19 (5%) normal MRI dogs and 18/54 (33%) abnormal MRI dogs (P = .016). Median survival was >107 months in both groups, but survival was significantly longer in the normal MRI group (P = .019). On multivariate analysis, abnormal MRI was significantly related to death (hazard ratio, 7.71; 95% confidence interval 1.03-58.00, P = .0470), whereas significant relationships with death were not identified for either the use of secondary immunosuppressive medications or cerebrospinal fluid nucleated cell count. MUE dogs with no detectable lesions on MRI have reduced disease-related death compared with dogs with abnormal MRI. The presence or absence of MRI lesions in MUE dogs is prognostically relevant.

Insights into invasive fungal infection diagnostic and treatment capacities in tertiary care centres of Germany.

In Germany, the growing incidence of invasive fungal infections (IFIs) is a significant health concern, particularly impacting individuals with compromised immune systems due to factors like increasing transplant recipients, an ageing population, and heightened use of immunosuppressive medications. Diagnosing IFI remains challenging, and the integration of biomarker assays into clinical practice is difficult. Antifungal resistance, exemplified by pan-antifungal-resistant Candida auris cases, adds complexity to treatment. This study aims to provide a concise overview of the diagnostic and treatment landscape for IFI in Germany, identifying areas for improvement and paving the way for targeted interventions. Data were collected using an online electronic case report form from October 2021 to February 2023. The survey included questions about institutional practices related to fungal infection diagnosis and treatment, with invitations extended to researchers nationwide. The study surveyed 58 hospitals across Germany. Notably, 77.6% managed high-risk patients for IFI. While 86% had onsite microbiology labs, a significant difference was noted for high-risk patients (93% in specialized hospitals versus 62% in others). Microscopy services had 96% coverage, while overall access to culture was 96%. Antigen tests had 96% coverage, and antibody access was reported at 98%. PCR testing was available at 98%. Imaging access showed no significant access differences. Variability existed in amphotericin B formulations based on patient profiles. Therapeutic drug monitoring was more common in high-risk patient institutions (89.5% versus 50.0%). All analysed institutions reported access to surgery (100%). Addressing identified disparities in diagnostic and therapeutic resources for IFI is crucial to improving patient outcomes. The study calls for ongoing research and collaboration to optimize strategies for the prevention and treatment of IFI, emphasizing the importance of equitable access to resources, especially in high-risk patient populations.

Native nephrectomy in polycystic kidney disease patients on transplant lists: how and when?

Autosomal dominant polycystic kidney disease (ADPKD), the most common hereditary kidney disease, accounts for approximately 10% of the patients on kidney transplantation waitlists.High rates of complications including hemorrhage, infections, nephrolithiasis and kidney size-related compressive complaints have been reported among ADPKD patients. Therefore, the need for routine native nephrectomy and timing of such procedure in ADPKD patients being prepared for transplantation are debated. Even though pre-transplant nephrectomy has the potential to provide fewer infectious complications due to lack of immunosuppressive medication use, such procedure has been associated with longer hospital stay, loss of residual kidney function and need for dialysis. Although simultaneous nephrectomy and transplantation could potentially lead to longer perioperative duration, perioperative complications and need for blood transfusions, this was not confirmed in cohort studies. Therefore, some institutions routinely perform simultaneous unilateral nephrectomy and kidney transplantation. In this narrative review, our aim is to evaluate the current evidence regarding the need andtiming of nephrectomy in ADPKD patients in relation to kidney transplantation.

Hydrochlorothiazide and increased risk of atypical fibroxanthoma and pleomorphic dermal sarcoma.

Previous work has demonstrated that hydrochlorothiazide (HCTZ) is a risk factor for squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) due to pro-photocarcinogenic effects. Atypical fibroxanthoma (AFX) and pleomorphic sarcoma (PDS), both ultraviolet-induced cancers, display a rare but rising cutaneous tumor entity. This study aimed to evaluate if the use of HCTZ is higher in patients with AFX/PDS than in patients with SCC/BCC and subsequently may be a risk factor for AFX/PDS-development. In a retrospective study of four German skin cancer centers, AFX/PDS cases and SCC/BCC controls were sex and age matched (1:3) over a time-period of 7years (2013-2019) to evaluate the use of HCTZ, immunosuppressive medication, second malignancies, and presence of diabetes mellitus. Overall, 146 AFX/PDS and 438 controls (SCC/BCC) were included in the study. The use of HCTZ was significantly higher in patients with AFX/PDS (44.5%) compared to patients with SCC/BCC (25.3%). Additionally, the presence of diabetes mellitus was significantly higher in AFX/PDS patients. This study demonstrates a significantly higher use of HCTZ in patients with AFX/PDS compared to SCC/BCC. This result suggests that HCTZ may be a risk factor for AFX/PDS. Additionally, diabetes mellitus or its comorbidities may be associated with an increased risk for AFX/PDS.

Antifungal drug resistance in Candida: a special emphasis on amphotericin B.

Invasive fungal infections in humans caused by several Candida species, increased considerably in immunocompromised or critically ill patients, resulting in substantial morbidity and mortality. Candida albicans is the most prevalent species, although the frequency of these organisms varies greatly according to geographic region. Infections with C. albicans and non-albicans Candida species have become more common, especially in the past 20 years, as a result of aging, immunosuppressive medication use, endocrine disorders, malnourishment, extended use of medical equipment, and an increase in immunogenic diseases. Despite C. albicans being the species most frequently associated with human infections, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei also have been identified. Several antifungal drugs with different modes of action are approved for use in clinical settings to treat fungal infections. However, due to the common eukaryotic structure of humans and fungi, only a limited number of antifungal drugs are available for therapeutic use. Furthermore, drug resistance in Candida species has emerged as a result of the growing use of currently available antifungal drugs against fungal infections. Amphotericin B (AmB), a polyene class of antifungal drugs, is mainly used for the treatment of serious systemic fungal infections. AmB interacts with fungal plasma membrane ergosterol, triggering cellular ion leakage via pore formation, or extracting the ergosterol from the plasma membrane inducing cellular death. AmB resistance is primarily caused by changes in the content or structure of ergosterol. This review summarizes the antifungal drug resistance exhibited by Candida species, with a special focus on AmB.

A Review of Hepatitis B Reactivation Risk on Immunosuppressants with a Focus on Newer Immunomodulators

Abstract Purpose of Review Hepatitis B virus reactivation (HBVr) can complicate the use of immunosuppressive, antiviral, and chemotherapeutic medications in individuals with a history of prior exposure to HBV or chronic infection. Timely management is crucial to prevent fatalities. This review focuses on the various classes of biologics linked to the risk of HBVr, with emphasis on newer immunosuppressive and immunomodulator therapies. Recent Findings Immune checkpoint inhibitors, tyrosine kinase inhibitors, cytokine inhibitors, and chimeric antigen receptor T-cell immunotherapies are associated with a high risk of hepatitis B virus reactivation (HBVr) in patients who are hepatitis B surface antigen-positive (HbsAg-positive). This risk decreases significantly when patients start nucleoside analogue (NA) prophylaxis. It is recommended to use NA prophylaxis alongside these medications and closely monitor for reactivation upon discontinuation of NA prophylaxis. Summary To minimize the risk of reactivation when starting immunosuppressive, antiviral, and chemotherapeutic agents in individuals at high, intermediate, and low risk for hepatitis B virus reactivation (HBVr), it is crucial to employ specific strategies for risk assessment, monitoring, and management.

Negative Vaccination Strategies for Promotion of Transplant Tolerance.

Organ transplantation requires the use of immunosuppressive medications that lack antigen specificity, have many adverse side effects, and fail to induce immunological tolerance to the graft. The safe induction of tolerance to allogeneic tissue without compromising host responses to infection or enhancing the risk of malignant disease is a major goal in transplantation. One promising approach to achieve this goal is based on the concept of "negative vaccination." Vaccination (or actively acquired immunity) involves the presentation of both a foreign antigen and immunostimulatory adjuvant to the immune system to induce antigen-specific immunity. By contrast, negative vaccination, in the context of transplantation, involves the delivery of donor antigen before or after transplantation, together with a "negative adjuvant" to selectively inhibit the alloimmune response. This review will explore established and emerging negative vaccination strategies for promotion of organ or pancreatic islet transplant tolerance. These include donor regulatory myeloid cell infusion, which has progressed to early-phase clinical trials, apoptotic donor cell infusion that has advanced to nonhuman primate models, and novel nanoparticle antigen-delivery systems.

Treatment of osteoarthritis knee with bone marrow aspirate concentrate injection

To assess the clinical effectiveness and safety of bone marrow aspirate concentrate (BMAC) injections given intraarticularly as a potential treatment for knee osteoarthritis (OA). Data from 60 patients with knee osteoarthritis treated with BMAC injection at a single centre between December 2021 and December 2022 were retrospectively examined. We only included patients with idiopathic osteoarthritis. Post-traumatic osteoarthritis, prior knee surgery, ageless then 50 years or over 85 years, an active infection, uncontrolled diabetes mellitus, rheumatological or another systemic condition, cancer, or immunosuppressive medication use were all exclusion factors. A single-spin manual approach was used to aspirate and concentrate bone marrow from the iliac crest. The Numeric pain scale (NPS) and Oxford knee score (OKS) were used to evaluate patients both before and after the treatment. A 12-month follow-up period was used. The statistical analysis comprised a total of 60 patients. With a mean age of 67 years (range 50-85), there were 42 females and 18 males. At the end of the follow-up period, the mean NPS reduced from 8.12 to 4.31 (p&amp;#60; 0.001) and the mean OKS rise from 22.30 to 34.74 (p &amp;#60;0.001). There were no problems. A single BMAC intra-articular injection is a dependable and safe technique that improves the clinical condition of knee OA.

Erythematous pemphigus in dog without defined breed: case report

Pemphigus Erythematosus is an autoimmune disease without a cure. It has a predisposition to the Collies and Sharpeis breeds, regardless of age and gender. Clinical signs range from nasal plane depigmentation to erosions and ulcerations. Its diagnosis is made by a combination of the clinical signs shown by the animal, as well as by laboratory examinations. Therapy of the disease is done by the use of immunosuppressive and immunomodulatory medications. The prognosis of the disease is considered good if the disease is adequately controlled. The present report aimed to describe a case of Pemphigus Erythematosus in dog that was attended in the veterinary school clinic of UNICENTRO, in order to clarify the way of diagnosis and treatment of this disease.

Macrophage activation syndrome: a review of recent renal findings

The pathogenesis of Macrophage activation syndrome consists of excessive macrophage and T-cell activation, leading to the uncontrolled release of cytokines and chemokines, which can cause multi-organ dysfunction. The diagnostic criteria for MAS include fever, splenomegaly, cytopenia, hypertriglyceridemia and/or hypofibrinogenemia, hemophagocytosis, low or absent natural killer cell activity, elevated ferritin levels, and elevated soluble interleukin-2 receptor levels. Kidney involvement in this disease included glomerular changes, including mesangial expansion, endocapillary proliferation, and thrombotic microangiopathy. Renal biopsy in MAS may also show evidence of macrophage infiltration and activation, such as the presence of hemophagocytic macrophages within the glomeruli and interstitium. These macrophages may contain phagocytosed erythrocytes, platelets, and other cells, indicating ongoing hemophagocytosis. The presence of hemophagocytic macrophages on renal biopsy is highly suggestive of MAS and can help differentiate it from other causes of acute kidney injury (AKI). Management of macrophage activation syndrome-associated kidney involvement involves treating the underlying autoimmune disorder and controlling the systemic inflammation. This may include the use of immunosuppressive medications, such as corticosteroids, disease-modifying anti-rheumatic drugs, and biological agents. Supportive measures, such as renal replacement therapy, may be necessary in severe cases of renal dysfunction.

Immunosuppressant Medications in Pregnancy.

Pregnant patients are often on immunosuppressant medications, most commonly to manage transplantation or autoimmune disorders. Most immunosuppressant agents, including tacrolimus, corticosteroids, azathioprine, and calcineurin inhibitors, are safe during pregnancy and lactation. However, mycophenolic acid is associated with higher risks of birth defects and should be avoided in pregnancy. Tacrolimus, the commonly used drug in transplantation medicine and autoimmune disorders, requires monitoring of serum levels for dose adjustment, particularly during pregnancy. Although no pregnancy-specific therapeutic range exists, the general target range is 5-15 ng/mL, and pregnant patients may require higher doses to achieve therapeutic levels. Adherence to prescribed immunosuppressive regimens is crucial to prevent graft rejection and autoimmune disorder flare-ups. This review aims to provide essential information about the use of immunosuppressant medications in pregnant individuals. With a rising number of pregnant patients undergoing organ transplantations or having autoimmune disorders, it is important to understand the implications of the use of these medications during pregnancy.

Management of the fungal infections and challenges associated with it

Fungal infections are becoming more common at an alarming rate, which poses a significant challenge to medical experts. This growth is directly linked to the rise in the number of people with impaired immune systems as a result of modifications to medical practice, including the use of immunosuppressive medications and intense chemotherapy. HIV and other illnesses that impair immunity have also had a role in this issue. Mucous membranes, keratinous tissues, and the skin are all impacted by superficial and subcutaneous fungal infections. This class includes some of the most common skin conditions that impact millions of people globally. They can have crippling consequences on a person's quality of life and, in certain cases, spread to other people or become invasive, even though they are rarely life-threatening. Fungal pathogens employ several tactics to compromise the immune system of the host and escalate infections. The range of antifungal drugs available is used to treat a number of superficial and systemic diseases. The well-established evidence of fungal resistance to most antifungal medicines complicates antifungal therapy and makes disease control challenging. Fungal resistance is caused by a range of genetic alterations, physiological alterations, and selection in the presence of antifungal drugs. The lack of a wide range of antifungal drugs, resistance building, and biofilm-conferred resistance are the main reasons for the need for novel therapeutics and other approaches to enhance treatment outcomes against mycoses.

Avaliação de parâmetros periodontais em pacientes transplantados renais que usam medicações imunossupressoras: estudo transversal

ABSTRACT Objective: The aim of this study was to evaluate periodontal parameters in renal transplant patients compared to a control group, due to the possible interference caused by the use of immunosuppressive medication. Methods: This was a cross-sectional observational epidemiological study of 80 patients. The transplant patients consisted of 40 patients, in whom the plaque index, clinical probing depth, clinical attachment level, bleeding on probing and the presence of gingival hyperplasia were analyzed. The control group, made up of 40 patients, was assessed according to the same indices. Results: No statistically significant difference was found between the groups with regard to the presence of plaque (p = 0.279), bleeding (p = 0.262), severity (p = 0.707) and location (p = 0.949) of periodontitis, only in relation to the grade (p = 0.041), where grade C was more present in transplant patients, with transplant time being a contributing factor. The presence of hyperplasia (p = 0.021), the gingival bleeding index (p = 0.011) and the plaque index (p = 0.031) were significantly higher in patients taking Ciclosporin. transplant patients had rapidly progressing periodontitis. Conclusion: Increased gingival volume, bleeding and plaque index were more associated with Ciclosporin use.