Clinical–Alimentary TractRisk Factors for Opportunistic Infections in Patients With Inflammatory Bowel Disease
Section snippets
Cases
This study was reviewed and approved by the Institutional Review Board of Mayo Foundation. The Mayo Clinic Rochester diagnostic index was searched for patients diagnosed with ulcerative colitis or Crohn’s disease, and cross-referenced against lists of patients with various opportunistic infections including viral (eg, cytomegalovirus, Epstein–Barr, herpes simplex, and varicella zoster), fungal (eg, histoplasmosis, candidiasis, and blastomycosis), and bacterial (eg, tuberculosis and
Spectrum of Pathogens and Clinical Syndromes
Between January 1998 and December 2003, we identified 100 consecutive IBD patients who developed an opportunistic infection and who fit the inclusion criteria for this study (Table 1). A wide range of opportunistic infections occurred, arising from viral, fungal, bacterial, and mycobacterial organisms. The severity of these varied considerably, ranging from mucosal herpes infections to a life-threatening systemic fungal infection. One patient developed an Epstein–Barr virus–associated lymphoma.
Discussion
From this case-control study, we have found that the use of corticosteroids, AZA/6MP, or infliximab was associated significantly with the development of opportunistic infections in patients with IBD. Moreover, when used in combination, these drugs synergistically increased the likelihood of an opportunistic infection. These observations firmly establish opportunistic infections as iatrogenic complications of the drug therapy of IBD.
Patients who received corticosteroid therapy were about 2 to 3
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