Presentation and outcome of histoplasmosis in pediatric inflammatory bowel disease patients treated with antitumor necrosis factor alpha therapy: A case series

Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 01/2011; 17(1):56-61. DOI: 10.1002/ibd.21378
Source: PubMed


Antitumor necrosis factor alpha (aTNF) therapies are commonly used in the treatment of pediatric inflammatory bowel disease (IBD). However, inhibition of the TNF-alpha pathway predisposes to serious infections, including histoplasmosis, which is the most common invasive fungal infection in individuals on aTNF therapy and carries a high mortality rate when associated with delayed diagnosis. Few data exist on the frequency, presentation, and appropriate treatment of pediatric patients with histoplasmosis on aTNF therapy.
Following Institutional Review Board approval, cases were identified then reviewed with their primary gastroenterologist and infectious disease specialists.
Herein we describe histoplasmosis in five pediatric patients receiving aTNF therapy for IBD in an endemic area.
Histoplasmosis is an important complication of treatment with TNF-alpha neutralizing agents. Children with IBD treated with aTNF therapy who develop the infection may present with minimal pulmonary symptoms. While discontinuation of aTNF therapy is important initially, few data exist to determine when and how aTNF therapy can be reinstituted. Recognition of Histoplasma capsulatum is often delayed due to the overlap of symptoms with some of the extraintestinal manifestations of IBD and other more prevalent infectious complications.

Download full-text


Available from: Dennis Cunningham, Dec 19, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Infliximab, adalimumab, and certolizumab are monoclonal antibodies against tumor necrosis factor-α (TNFα), a proinflammatory cytokine with an increased expression in the inflamed tissues of inflammatory bowel disease (IBD) patients. Currently, infliximab is the only anti-TNF drug that has been approved for use in refractory pediatric Crohn's disease (CD). Nevertheless, adalimumab and certolizumab have been used off-label to treat refractory pediatric IBD. Over the past 10 years, anti-TNF treatment has been of great benefit to many pediatric IBD patients, but their use is not without risks (infections, autoimmune diseases, malignancies). Despite the growing experience with these drugs in children with IBD, optimal treatment strategies still need to be determined. The purpose of this review is to summarize the current knowledge on the use of anti-TNF drugs in pediatric IBD and to discuss the yet-unsolved issues.
    Inflammatory Bowel Diseases 05/2012; 18(5):985-1002. DOI:10.1002/ibd.21871 · 4.46 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Inflammatory bowel disease (IBD) patients are at increased risk of cytomegalovirus (CMV) reactivation, and although CMV pneumonia may be a fatal disease in IBD patients, little information is available on this issue. The objectives of this study were to identify risk factors for the development of CMV pneumonia in IBD patients and to find useful information to better manage this potentially fatal complication. A computerized search without language restrictions was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported detailed data on patients with IBD presenting with pneumonia due to CMV. Overall, 12 articles describing the history of 13 patients, published between the years 1996 and 2011, were finally considered. All patients were adults with a mean age of 33 years, and 11/13 were females. Fever and dyspnea were the most frequent symptoms. The most frequent radiological signs were bilateral pulmonary infiltrates. Six cases were complicated by hemophagocytic lymphohistiocytosis. Eight of the 13 were transferred to intensive care units and four of them died. CMV pneumonia should always be suspected in IBD patients who present with fever and tachypnea, especially if the latter is worsening and/or is associated with dyspnea. Treatment must be early and specific.
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 05/2012; 16(7):e474-9. DOI:10.1016/j.ijid.2012.03.008 · 1.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print., *2007 Journal Citation Report (Thomson Reuters, 2008)
    The American Journal of Gastroenterology 02/2013; 108(2):281-3. DOI:10.1038/ajg.2012.396 · 10.76 Impact Factor
Show more