Viral and fungal infections take over as key opportunistic diseases

3 minute read

Australian research presented at EULAR Congress 2022 shows opportunistic infection rates are same same, but different, over the past 30 years.

Australian researcher Professor Hans Nossent presented two longitudinal studies at EULAR 2022.

Both studies explored opportunistic infections in patients with various rheumatic diseases in Western Australia over 30 years.

Professor Nossent’s oral presentation on Friday showed that the rate of opportunistic infections in inflammatory joint diseases hasn’t increased in three decades, but the type of infection is very different now.

“Overall, patients are still equally often admitted for opportunistic infections, but now it’s viral and mycotis more than tuberculosis and pneumocystis. Screening and prevention of infections have been helpful in reducing hospital admissions for patients with rheumatoid arthritis and spondylitis,” Professor Nossent told Rheumatology Republic.

Professor Nossent said that despite “all the anxiety around tuberculosis and TNF inhibitors”, tuberculosis had actually declined significantly.

Pneumocystis jirovecii, formerly called P. carini, also largely disappeared as a reason for hospitalisation of patients with rheumatic disease, but Professor Nossent said that viral infections were “rampant”.

“I was surprised that we haven’t been able to prevent viral infections as much as we probably can. The new zoster vaccination doesn’t seem to have had as widespread use as it should have, or could have,” he said.

The research showed that though admission rates for most opportunistic infections have decreased in rheumatoid arthritis patients, the rate was twice as high for them compared to ankylosing spondylitis and psoriatic arthritis patients.

One of the study limitations was the absence of outpatient data which Professor Nossent said is “the whole downside of Australian data collections”.

“Nowhere in Australia is outpatient data being collected and nobody seems very interested because it falls under the federal government and is not state based.

“Other countries have outpatient data and easy access to pharmacy data. That would make life so much easier here. We would get a much more complete picture of what’s going on,” Professor Nossent said.

Despite these data limitations, Professor Nossent said that Western Australian researchers have a “head start” over other states and territories with the D’Arcy database, which was the first large scale integration between commonwealth and state health data. It was established years before other parts of Australia started similar collections.

“It’s a rare thing. It’s been very productive over the last 20 years and there are hundreds of publications on the various linked data sets there,” Professor Nossent said.

Professor Nossent also presented a poster on how opportunistic infections impacted hospitalisation rates of people with connective tissue diseases and systemic vasculitis.

“It’s similar to the other research but in lupus patients. We basically see a similar trend with reduction of pneumocystis and more viral infections and certainly more mycotic infections are occurring,” Professor Nossent said.

Although hospitalisation due to opportunistic infections dropped for lupus patients, viral and mycotic opportunistic infection rates have increased for both systemic vasculitis and other (non-lupus) connective tissue disease patients.

Professor Nossent’s research called for increased prevention of opportunistic infection as it was also found to be associated with significant case fatality, especially for systemic vasculitis patients.

The research acknowledged that patients with autoimmune connective tissue diseases and systemic vasculitis face a treatment dilemma where the aggressive immune-modulating therapy needed to prevent organ damage also increased the risk for infections.

  • OP0274 Hospitalisation for tuberculosis and other opportunistic infections in patients with inflammatory joint diseases before and after the introduction of biological therapy (in Rheumatoid arthritis: Clinical aspects and comorbidities – II, 3 June)
  • POS0751 Temporal trend in hospitalisation for opportunistic infections in patients with connective tissue diseases

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