Infectious events and associated risk factors in mycosis fungoides/Sezary syndrome: a retrospective cohort study
Infectious events and associated risk factors in mycosis fungoides/Sezary syndrome: a retrospective cohort study
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DOI：
10.1111/bjd.17073
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发表时间：
2018-12-01
影响因子：
10.3
通讯作者：
Pham-Ledard, A.
中科院分区：
文献类型：
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作者：
Blaizot, R.;Ouattara, E.;Pham-Ledard, A.
感染是晚期蕈样肉芽肿（MF）或塞扎里综合征（SS）患者死亡的主要原因之一。然而，关于这些传染性事件的特征和风险因素的最新数据很少。目的方法描述MF/SS患者队列中发生的感染事件，并确定相关的临床和生物学危险因素。进行了一项回顾性队列研究，以调查2011年5月至2016年5月在法国波尔多大学医院随访的MF（IB期及以上）或SS患者的感染事件和相关因素。结果71例患者获得完整随访。在40名患者中记录了80起感染事件，包括28例皮肤和软组织感染和25例肺炎。通常与细胞介导的免疫力耗尽相关的寄生虫感染很少（9%）。在多变量分析中，心脏、肾脏或肺部合并症[比值比（OR）7中心点2，95%置信区间（CI）3中心点3-15中心点9; P = 0中心点002]，SS（OR 8中心点8，95%CI 7中心点7-10中心点2; P = 0中心点037）和淋巴细胞计数< 0中心点5 x 10（9）个细胞L-1（OR 6中心点4，95%CI 1中心点5-27中心点4; P = 0中心点004）与较高的感染风险显著相关。很少记录到寄生虫性细菌，但通过适当的预防（28%的患者正在进行）可能可以预防其发生。与艾滋病患者一样，肺炎也很常见。另一方面，细菌性皮肤感染代表MF/SS患者的特定模式。慢性器官衰竭、淋巴细胞减少症和SS患者应被视为感染事件的高风险患者。应系统地推荐肺炎球菌疫苗接种，当CD 4计数< 0中心点2 × 10（9）个细胞L-1时，应使用复方新诺明和伐昔洛韦预防。
Background Infections are one of the major causes of death in patients with advanced-stage mycosis fungoides (MF) or Sezary syndrome (SS). However, few recent data are available on the characteristics and risk factors of these infectious events. Objectives Methods To describe infectious events occurring in a cohort of patients with MF/SS, and to identify associated clinical and biological risk factors. A retrospective cohort study was performed to investigate infectious events and associated factors in patients diagnosed with MF (stage IB and beyond) or SS followed from May 2011 to May 2016 at the University Hospital of Bordeaux, France. Results Conclusions Seventy-one patients with complete follow-up were included. Eighty infectious events were recorded in 40 patients, including 28 skin and soft tissue infections and 25 cases of pneumonia. Opportunistic infections, which are usually associated with depleted cell-mediated immunity, were scarce (9%). In multivariate analysis, cardiac, renal or lung comorbidities [odds ratio (OR) 7 center dot 2, 95% confidence interval (CI) 3 center dot 3-15 center dot 9; P = 0 center dot 002], SS (OR 8 center dot 8, 95% CI 7 center dot 7-10 center dot 2; P = 0 center dot 037) and lymphocyte count < 0 center dot 5 x 10(9) cells L-1 (OR 6 center dot 4, 95% CI 1 center dot 5-27 center dot 4; P = 0 center dot 004) were significantly associated with a higher risk of infection. Opportunistic germs were rarely recorded, but their incidence was probably prevented by adequate prophylaxis (ongoing in 28% of patients). As in patients living with AIDS, pneumonias were frequent. On the other hand, bacterial cutaneous infections represent a specific pattern in patients with MF/SS. Patients with chronic organ failure, lymphocytopenia and SS should be considered as being at high risk for infectious events. Pneumococcal vaccination should be systematically recommended, and prophylaxis with co-trimoxazole and valaciclovir when the CD4 count is < 0 center dot 2 x 10(9) cells L-1.