Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis
Published Date:Oct 2016
Source:Emerg Infect Dis. 22(10):1720-1727.
Keywords:-Infection-Related Death Among Persons With Refractory Juvenile Idiopathic Arthritis
Biological Disease-modifying Drugs
Central Venous Catheter Bacteria
Combined Immunosuppressive And Antiinflammatory Therapy
Juvenile Idiopathic Arthritis
TNF-α Blocking Agents
Pubmed Central ID:PMC5038400
Description:Severe infections are emerging as major risk factors for death among children with juvenile idiopathic arthritis (JIA). In particular, children with refractory JIA treated with long-term, multiple, and often combined immunosuppressive and antiinflammatory agents, including the new biological disease-modifying antirheumatic drugs (DMARDs), are at increased risk for severe infections and death. We investigated 4 persons with JIA who died during 1994-2013, three of overwhelming central venous catheter-related bacterial sepsis caused by coagulase-negative Staphylococus or α-hemolytic Streptococcus infection and 1 of disseminated adenovirus and Epstein-Barr virus infection). All 4 had active JIA refractory to long-term therapy with multiple and combined conventional and biological DMARDs. Two died while receiving high-dose systemic corticosteroids, methotrexate, and after recent exposure to anti-tumor necrosis factor-α biological DMARDs, and 2 during hematopoietic stem cell transplantation procedure. Reporting all cases of severe infections and especially deaths in these children is of paramount importance for accurate surveillance.
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