Patients on biologic therapies are at increased risk of Legionnaire’s disease and considerably more likely to die from it if they are infected, say Australian researchers.
Their review of over 100 cases ofLegionella pneumonia in patients taking biologics showed 19% of those who contracted the disease died of it, compared with reported figures for the general population of just 2% to 6%.
Twelve percent of the survivors needed treatment in an intensive care unit.
Over 70% of infected patients were being treated with biologics for rheumatologic diseases and 16% for inflammatory bowel disease, the authors from the University of Queensland Centre for Clinical Research said.
Infliximab was the biologic most frequently related to Legionella infection, followed by adalimumab and to a lesser extent etanercept.
Most of the patients were also on other immunosuppressant therapies, in particular systemic corticosteroids, methotrexate and azathioprine. Combining therapies may play a role in the added risk and severity of infection, the study authors suggested.
Infections occurred mostly in the first six months of biologic treatment, a finding the authors said was in line with other research showing a decline in the infection risk over time with biologics.
Reporting in Respiratory Medicine, the authors said previous research had shown people taking anti-TNF-alpha medication were 16 to 21 times more likely to contract Legionnaire’s disease compared with the general population.
“Physicians should be aware of this potentially severe association. Early recognition and treatment would likely result in reduced mortality and morbidity,” the authors concluded.
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