Infections and the relationship to treatment in neuromuscular autoimmunity

Muscle Nerve. 2018 Jun;57(6):927-931. doi: 10.1002/mus.26032. Epub 2017 Dec 20.

Abstract

Introduction: This study aimed to identify infections in patients with myasthenia gravis, dermatomyositis, and chronic inflammatory demyelinating polyradiculoneuropathy, and to investigate the relationship between infection and immunomodulation.

Methods: A retrospective chart review examined 631 patients with myasthenia gravis (n = 358), chronic inflammatory demyelinating polyradiculoneuropathy (n = 124), and dermatomyositis (n = 149) patients over a 10-year time period.

Results: Infection rates were similar at approximately 19% in all 3 diseases. Of the infections in which a causative organism was identified, pneumonia, sepsis, and opportunistic infections were the leading diagnoses. A multivariate model demonstrated a significant association between infection and an increased dose of plasma exchange, mycophenolate mofetil, and corticosteroid therapy.

Discussion: There are few large studies investigating rates of infections in patients with autoimmune neuromuscular disorders and the relationship to immunomodulation. This study not only demonstrates the remarkably similar infection rates across the 3 diseases studied, but also shows their relationship to commonly used immunotherapies. Muscle Nerve 57: 927-931, 2018.

Keywords: chronic inflammatory demyelinating polyradiculoneuropathy; dermatomyositis; immunosuppression; infection; myasthenia gravis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Autoimmunity / physiology
  • Comorbidity
  • Dermatomyositis / epidemiology*
  • Dermatomyositis / immunology
  • Dermatomyositis / therapy
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Infections / epidemiology*
  • Infections / immunology
  • Male
  • Middle Aged
  • Myasthenia Gravis / epidemiology*
  • Myasthenia Gravis / immunology
  • Myasthenia Gravis / therapy
  • Plasmapheresis
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / epidemiology*
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / immunology
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / therapy
  • Retrospective Studies

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents