Invasive fungal diseases in patients with autoimmune diseases: a case series from the French RESSIF network
Authors' conclusion
IFD associated with AID occurs primarily in RA, AAV and IBD, especially when treated with GCs and immunosuppressants. Mortality is high, especially for patients on high-dose GCs. Lymphopenia may help identify risk of PCP, but normal CD4+T cell count does not rule out the risk.
Study context
- Population
- Patients with autoimmune diseases developing invasive fungal disease, RESSIF registry of the French national reference centre for invasive mycoses, 2012–2018508 with 30-day mortality data
- Participants
- 549 patients
- Outcome
- 30-day mortality and associated factors
- Follow-up
- 30 days
Methodological detailsnational surveillance registry (RESSIF)
- National surveillance registry (RESSIF)
Main finding
As reported in the abstract
30-day mortality
Mortality at 30 days
28.1%
143/508
Observational data: associations, not effects.
Further findings
Type of invasive fungal disease (IFD)
- PCP
- n=227, 41.3%
- Fungemia
- n=167, 30.4%
- Invasive aspergillosis
- n=84, 15.5%
- Rheumatoid arthritis (RA) and AAV most frequent autoimmune diseases (AID) in PCP (n=55 and 25) and invasive aspergillosis (n=15 and 10); IBD predominant in fungemia (n=36)
Treatment at IFD diagnosis
- Glucocorticoids (GCs)
- 365 (66.5%)
- Immunosuppressants
- 285 (51.9%)
- Tumor necrosis factor (TNF)-α blockers
- 42 (7.7%)
- Other biologics
- 75 (13.7%)
Lymphocyte and CD4+ T cell counts in PCP
- Lymphopenia <1500/mm³
- 132/179, 73.7%
- CD4+ T cell count >200/mm³
- 56/78 patients (71.8%)
- CD4+ T cell count, median (IQR)
- 472.5/mm³ (160-858)
Original publication
Invasive fungal diseases in patients with autoimmune diseases: a case series from the French RESSIF network. RMD Open. Published 9 August 2023. doi:10.
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