Tumor necrosis factor a ( TNF- alpha ) blockade has emerged as a useful therapy for collagen vascular diseases or graft-vs-host disease. Fungal infections complicating such therapy have been reported sporadically.

Of the 281 cases of invasive fungal infections associated with TNF-alpha inhibition, 226 ( 80% ) were associated with Infliximab ( Remicade ), 44 ( 16% ) with Etanercept ( Enbrel ), and 11 ( 4% ) with Adalimumab ( Humira ).

Fungal infections associated with Infliximab occurred a median of 55 days after initiation of therapy and 3 infusions of the medication, whereas those associated with Etanercept occurred a median of 144 days after initiation of therapy.

The median age of patients was 58 years, and 62% were male.

Use of at least 1 other immunosuppressant medication, typically a systemic corticosteroid, was reported during the course of the fungal infection in 102 ( 98% ) of the 104 patients for whom data were available.

The most prevalent invasive fungal infections were histoplasmosis ( 30% ), candidiasis ( 23% ), and aspergillosis ( 23% ).

Pneumonia was the most common pattern of infection.

Of the 90 ( 32% ) of 281 cases for which outcome information was available, 29 fatalities ( 32% ) were recorded.

Tumor necrosis factor a blockade is associated with invasive fungal infections across a range of host groups. A high index of suspicion in patients treated with TNF-alpha antagonists is recommended because the course of such infections can be serious or fulminant, and rapid access to health care should be provided.

Source: Mayo Clinic Proceedings, 2008

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