Información del artículo
Las infecciones en pacientes con enfermedades del tejido conectivo (ETC) conllevan una morbilidad y una mortalidad considerables. Algunos pacientes con ETC sufren cierto grado de desregulación inmunitaria inherente a su enfermedad reumática. Otros factores como la edad avanzada o el curso de otras enfermedades crónicas –como la diabetes mellitus– también pueden favorecer el desarrollo de infecciones. Los glucocorticoides inducen una disminución en la síntesis de la mayoría de las citocinas conocidas, una alteración de la migración de los leucocitos desde el torrente sanguíneo que afecta a la presentación de antígenos y deteriora la respuesta citotóxica. Los inmunosupresores afectan fundamentalmente a la inmunidad celular y su efecto está relacionado con la duración y la dosis empleada. Se ha observado una relación clara entre el empleo de fármacos contra el factor de necrosis tumoral (anti-TNF) y la reactivación de la tuberculosis. Sus manifestaciones clínicas e histológicas con frecuencia son atípicas. En casos de sospecha de tuberculosis activa, los anti-TNF deben suspenderse hasta descartar la infección. El tratamiento profiláctico contra Pneumocystis jiroveci con cotrimoxazol ha sido recomendado en pacientes que reciben glucocorticoides junto con inmunosupresores, especialmente si el agente usado es ciclofosfamida o si se produce linfocitopenia.
Palabras clave:
Infliximab
Infecciones oportunistas
Tuberculosis
Pacientes inmunodeficientes
Infections in patients with connective tissue diseases (CTD) are associated to considerable morbidity and mortality. Some patients with CTD suffer a certain degree of immune deregulation inherent to their rheumatic disease. Other factors such as advanced age, and the coexistence of other chronic diseases such as diabetes mellitus can also lead to the development of infection. Glucocoticosteroids induce a reduction in the synthesis of most of the known cytokines, an alteration in the migration of leukocytes from the blood with an alteration in antigen presentation and an abnormal cytotoxic response. Immunosuppresants fundamentally affect cellular immunity and its effect is related to the duration of treatment and dose. There is a clear relationship between the use of anti-TNF drugs and the reactivation of tuberculosis. Its clinical and histological manifestations are frequently atypical. In those cases in which active tuberculosis is suspected, anti-TNF must be suspended until infection is ruled out. Prophylactic treatment when faced with Pneumocystis jiroveci with cotrimoxazole has been recommended in patients that receive steroids and immunosuppressants, especially if the agent employed is cyclophosphmide or if lymphopenia develops.
Key words:
Infliximab
Opportunistic infections
Tuberculosis
Immunocompromised hosts
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