Invasive fungal infection in diffuse connective tissue diseases: a retrospective case-control study / 中华风湿病学杂志

ABSTRACT

ObjectiveInvasive fungal infection(IFI) can be a lethal complication in patients with diffuse connective tissue diseases(DCTD).The aim of this study was to determine the characteristics of hospitalized DCTD patients with IFI,and identify the risk factors.MethodsData from 33 DCTD in patients with IFI at Shanghai Renji Hospital between Jan 2007 and Jan 2011 were collected retrospectively.DCTD patients with either active M.tuberculosis (n=33) or other bacterial infections (n=34) at the same period were taken as controls.Systemic lupus erythematosus (SLE) inpatients with IFI (n=11 ) from Jan 2002 to Dec 2006 were also considered as a historical control group.The method of univariate analysis of data depended on the data distribution type.Variables that suggested association in the univariate analysis P＜0.1 were entered into a stepwise logistic regression model.ResultsThe leading underlying diseases of DCTD with IFI were SLE(n=18,55％),systemic vasculitis(n=4,12％),and inflammatory myopathy(n=4,12％).The most frequent pathogen was Candida spp(n=13,39％ ),followed by Cryptococcus neoformans(n=10,30％ ),and Aspergillus (n=3,9％).The infection locations included lung (n=19,58％),central nervous system (n=9,27％ ),and disseminated IFI(n=4,12％ ).Six patients(18％) died from IFI.Compared with non-IFI infections,patients with IFI infection had a shorter duration of underlying disease and were exposed to high doses of prednisolone prior to infection.More patients with IFI infection had elevated alanine aminotransferase,higher fasting glucose and lower C-reactive protein levels when compared to patients with non-IFI infections.Compared with the two historical SLE-IFI groups, the short-term survival improved in lupus patients complicated with IFI infection over time(64％ vs 83％).ConclusionUnderstanding disease spectrums and risk factors of IFI in DCTD,along with advances in antifungal treatment,will help clinicians to manage those patients with invasive fungal infection effectively to achieve favourable prognosis.