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Vol. 20. Issue 5.
Pages 237-242 (May 2024)
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Vol. 20. Issue 5.
Pages 237-242 (May 2024)
Original Article
Severe infections in systemic necrotizing vasculitis
Infecciones graves en vasculitis necrosantes sistémicas
Claudia Pena
Corresponding author
claudiaepena@gmail.com

Corresponding author.
, Ana Carolina Costi, Lucila García, Mercedes García
Hospital Interzonal General de Agudos General José de San Martín, La Plata, Buenos Aires, Argentina
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Tables (4)
Table 1. Baseline clinical characteristics and associated organic involvement.
Table 2. Foci of infection and bacteriological isolation.
Table 3. Bivariate analysis.
Table 4. Logistical regression model.
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Figures (1)
Abstract

Infections in patients with systemic vasculitis represent one of the main causes of mortality. Corticosteroid use, immunosuppressive therapy, age, associated organic involvement and dialysis dependence are risk factors of infection.

Objectives

To determine the prevalence of severe infection and associated factors in patients diagnosed with ANCA-associated vasculitis (AAV) and Polyarteritis Nodosa (PAN).

Methods

retrospective study was conduced in a single rheumatology center (2000–2018). We included patients diagnosed with AAV (Granulomatosis with Polyangiitis (GPA), Eosinophilic Granulomatosis with Polyangiitis (EGPA) and Microscopic Polyangiitis (PAM) and Polyarteritis nodosa (PAN). Serious infectious events requiring hospitalisation or prolonged antibiotic/antiviral treatment, recurrent infection of Herpes Zoster Virus or opportunistic infections were evaluated. Sites of infection, isolated microorganisms and mortality related were analyzed.

Results

105 patients were analyzed, follow-up time median 18 m, 58.7% were women and median age was 52 years. Types of vasculitis: 41.9% PAM, 16.2% EPGA, 40% GPA, 1.9% PAN. Constitutional, pulmonary, renal and otorhinolaryngology manifestations were the most frequent.

Prevalence of infection

34.2%, with a median of 3 months from diagnosis of vasculitis to the infectious event. Low respiratory tract (42.8%), sepsis (31.4%), and urinary tract (14.3%) were the most common sites of infections. Bacterial aetiology was the most prevalent (67.7%). Mortality at the first event was 14.3% and a 72.2% of patients were in the induction phase of treatment.

Infectious events were significantly associated with age > 65 years (p = 0.030), presence of lung (p = 0.016) and renal involvement (p = 0.001), BVASv3 > 15, mortality (p = 0.0002).

Conclusions

The prevalence of infection was 34.2%. Lower airway infections, septicemia and urinary tract infections were the most prevalent. Infections were associated with renal and pulmonary involvement, age older than 65 years and score BVAS > 15. Severe infections were associated with mortality, especially in elderly patients.

Keywords:
ANCA associated vasculitis
Necrotizing vasculitis
Severe infections
Resumen

Las infecciones en pacientes con vasculitis sistémica representan una de las principales causas de mortalidad. Son factores de riesgo conocidos la edad, el compromiso orgánico asociado, el uso de corticoides y de inmunosupresores, asi como el requerimiento de diálisis, entre otros.

Objetivo

Determinar la prevalencia de infección severa y factores asociados en pacientes diagnosticados de Vasculitis asociada a ANCA (VAA) y Poliarteritis Nodosa (PAN).

Métodos

Estudio retrospectivo realizado en un único centro de reumatología entre los años 2000 y 2018. Se incluyeron pacientes con Granulomatosis con Poliangeítis (GPA), Granulomatosis Eosinofílica con Poliangeítis (EGPA), Poliangeítis Microscópica (PAM) y PAN. Se registraron eventos infecciosos severos que requirieron hospitalización o tratamiento antibiótico/antiviral prolongado, infección recurrente por Virus Herpes Zoster o infecciones oportunistas.

Resultados

Se incluyeron 105 pacientes, la mediana del tiempo de seguimiento:18 m, 58.7% mujeres, mediana de edad 52 años, siendo 41.9% PAM, 16.2 % EGPA, 40% GPA, 1.9% PAN. El compromiso constitucional, pulmonar, renal y otorrinolaringologico fue el más frecuente.

Prevalencia de infección

34,2% con una mediana de 3 meses desde el diagnóstico de vasculitis. Las infecciones de vías respiratorias bajas (42,8%), la sepsis (31,4%) y el tracto urinario (14,3%) fueron los sitios de infección más comunes. Predomino la etiología bacteriana (67.7%). La mortalidad en el primer evento fue del 14,3%. Se encontraban en fase de inducción del tratamiento el 72,2%. Las infecciones se asociaron significativamente con edad > 65 años ( p: 0,030), compromiso pulmonar ( p 0,016), renal ( p 0.001), BVAS3 > 15 y a mortalidad (p 0.0002).

Conclusiones

La prevalencia de infecciones graves fue del 34,2%. Las infecciones pulmonares, septicemia y urinarias fueron las mas frecuentes y se asociaron a compromiso renal y pulmonar, asi como a mortalidad, especialmente en pacientes de edad avanzada.

Palabras clave:
Vasculitis asociadas a ANCA
Vasculitis necrotizantes
Infecciones severas

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