What are TNF alpha blockers? Who takes them, and why might they increase the risk of contracting a fungal infection?
Tumor necrosis factor is a protein that's released from blood cells that causes inflammation and enhances the ability of blood cells to fight infection. TNF is also involved in symptoms in inflammatory disorders like ulcerative colitis, Crohn's disease and rheumatoid arthritis.
Usually these patients already are receiving corticosteroids and methotrexate to manage the disorder. The TNF inhibitor is prescribed to reduce the effects of TNF in a patient's inflammatory response, so patients with inflammatory disorders not controlled by traditional immunosuppressants improve markedly with TNF inhibitors.
But TNF also kills those fungi. So while inhibiting TNF leads to improvement in the inflammatory disorder, if a patient has one of these infections, the drug can lead to worsening of the infection because TNF is involved in controlling the infection.
Do other drugs also increase the risk of these infections?
Almost any immunosuppressive medication -- corticosteroids, prednisone, cortisone, methotrexate for Psoriasis and rheumatoid arthritis -- would. So would anti-thymocyte globulin taken by organ transplant recipients to prevent or treat rejection.
What can patients do to minimize their risk of serious infection?
The first step is for a doctor to be aware of the risk and order tests for these infections. There are a number of tests, including a biopsy where you could see the organism in the tissue, and that could give a rapid diagnosis. There also is an antigen-detection system to pick up the fungi in the blood or urine. Both tests could give a result in 24 to 48 hours.
The third option would be a culture of the tissue, but it can take a month in histoplasmosis to get a positive result. Serology, which measures antibody response, can be helpful, but it often shows a negative result because patients are immunosuppressed and can't make antibodies.
How are these infections treated?
Patients diagnosed before they're severely ill are treated with antifungals, including amphtericin D and another group of oral medications called triazoles, including itraconazole, fluconazole, voriconazole and posaconazole. If patients are ill enough to be hospitalized, they'd begin with amphetericin D and later with an oral triazole. If it's a mild case, they may not be hospitalized, but would be treated with one of the triazoles. These treatments are over 90 percent effective if the patient is not severely ill with the infection. If they are severely ill, there is a 50 percent mortality rate.
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3 Comments
Add CommentThere is no discussion in the story as to those persons on TNF medications and what their mortality rates might be. What is the definition of a severe infection? Can someone be exhibiting only minor symptoms and still be suffering from a life-threatening infection of the fungus?
Reply | Report Abuse | Link to thisI have R.A. and live in Tucson Az. should I be tested for histo or cocci plasmosis? I am being treated with Humira and nothing else. Thank you, Judy
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