Immune Suppression and Infection
Fungal infections in hospitals are increasing as the number of patients with
defective immune defenses increases. Immune deficiency may be inherited, caused
by infection, metabolic diseases such as diabetes and may also be caused by
immune suppressant medication. The use of immune suppressant drugs has risen
Immune Suppressant Drugs
New agents have been introduced to treat immune mediated diseases. The
strategy of drug companies has been varied, but the goal with each new agent is
to block immune activation at some level or another. While there may be
benefits, the research and product hype can be distracting. There is no easy and
safe way to block immune activity. The more effective immune blockers are, the
more damage they can do. New immunosuppressant's come with many possible
- The drugs are expensive.
- The negative effects are often severe.
- The long term effects both good and bad are not well known
- Expensive, and intensifies dependency on medical facilities, laboratories and hospitals.
- Blocking immune function facilitates infection by a variety of
- Blocking immune activity may also increase the rate of cancer emergence.
Tumor Necrosis Factor (TNF) blocking agents
TNF blockers has become popular, despite concerns about serious infection and
cancer facilitation. Since the initial approval of the TNF blockers, the
prescribing information for these drugs has included information about the risk
of serious infections, including tuberculosis and fungal infections.
Knine reported that makers of tumor necrosis factor (TNF)-blocking agents
were ordered to strengthen warnings regarding the risk for histoplasmosis and
other invasive fungal infections by the US Food and Drug Administration. The FDA
is concerned that physician are not recognizing cases of histoplasmosis
and other invasive fungal infections, leading to delays in treatment.
The US FDA has received 240 reports of histoplasmosis in patients receiving
infliximab (Remicade); 207 cases, etanercept (Enbrel) 17 cases, adalimumab (Humira)
. 1 case occurred during treatment with certolizumab
pegol (Cimziac), approved in 2008. Missed diagnoses in 21 patients led to
treatment delays and 12 deaths. Fatal cases of coccidioidomycosis and
blastomycosis have also been reported. Healthcare professionals are advised to
closely monitor patients for signs and symptoms of fungal infection during
and after treatment with anti-TNF drugs. Patients who develop fever, malaise,
weight loss, sweats, cough, dyspnea, pulmonary infiltrates on X-ray, or serious
systemic illness should undergo a complete diagnostic workup.
The FDA advised that a high index of suspicion should be maintained for
invasive fungal infections in symptomatic patients. If possible, the decision to
initiate empiric antifungal therapy should be made in conjunction with an
infectious diseases specialist. An infectious disease consultation is also
recommended when determining the duration of antifungal therapy and whether
anti-TNF therapy should be resumed on recovery, particularly for patients who
reside in regions of endemic mycoses. TNF blockers are immunosuppressive
agents approved to treat immune system diseases, including juvenile
idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, plaque
psoriasis, Crohn's disease, and ankylosing spondylitis.
See Yael Waknine. Patient Deaths Spark Stronger Warnings for TNF Blockers.
Medscape Medical News 2008. Accessed online September 4, 2008. In the US,
adverse events related to use of anti-TNF agents should be reported to the FDA's
MedWatch reporting program by telephone at 1-800-FDA-1088, by fax at
1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to 5600
Fishers Lane, Rockville, MD 20852-9787.