SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

8/9/05

Immune status and risk for infection in patients receiving chronic immunosuppressive therapy

Summary
Background - A major concern during therapy with systemic corticosteroids (CS) and cytotoxic immunosuppressive drugs is an increased incidence of serious infections. Can sequential assessments of blood leukocyte levels and function help predict the likelihood of such infections?

Findings - Gluck et al at the Univ of Regensburg in Germany sequentially measured the effects of different chronic immunosuppressive regimens used in a variety of inflammatory diseases. Infections requiring hospitalization occurred in 19 of 95 patients. Lymphocytopenia <600/microl, and in particular a CD4+ cell count of <250/microl as well as daily CS doses of >10 mg prednisolone/day (or equivalent) were predictive of such infections. Indeed, a CD4+cell count of >250/microl was associated with a very low risk of serious infection (negative predictive value = 0.97).

Reference
 J Rheumatol 2005;32:1473-80

Editor's Comments
These findings provide helpful information in monitoring patients on chronic immunosuppressive therapy. It is of considerable interest that the "cut-off" CD4+ cell level of 250/microl is close to the CD4+ cell below which there is an increased risk for serious infection in most AIDS patients.

 

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