1
|
Okai N, Otsuka Y, Masaki S, Kudo M, Watanabe T. Necrotizing Fasciitis of the Serratus Anterior in a Patient Treated With Infliximab and Prednisolone for Ulcerative Colitis and Rheumatoid Arthritis. Cureus 2024; 16:e59346. [PMID: 38817521 PMCID: PMC11137776 DOI: 10.7759/cureus.59346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Necrotizing fasciitis (NF) is a rapidly progressive bacterial infection with high mortality. Invasive group A Streptococcus (GAS) infection is the leading cause of NF. Our understanding regarding clinicopathological features and pathogenesis of invasive GAS infection is expanding as the incidence of NF in healthy individuals increases. However, clinicopathological features of NF in the presence of autoimmune diseases have been poorly defined. We experienced NF in a patient treated with infliximab and prednisolone for ulcerative colitis and rheumatoid arthritis. Herein, we present time kinetics findings of clinical symptoms and laboratory data of GAS-associated NF in the presence of immunosuppressant-treated immune disorders.
Collapse
Affiliation(s)
- Natsuki Okai
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Yasuo Otsuka
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Sho Masaki
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Masatoshi Kudo
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Tomohiro Watanabe
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| |
Collapse
|
2
|
Ogica A, Burdelski C, Rohde H, Kluge S, de Heer G. Necrotizing Soft Tissue Infections in Intensive Care. J Intensive Care Med 2021; 37:393-400. [PMID: 33896254 PMCID: PMC8772247 DOI: 10.1177/08850666211010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Necrotizing soft tissue infections (NSTIs) are typically characterized by extensive soft tissue destruction with systemic signs of toxicity, ranging from sepsis to septic shock. Our aim was to analyze the clinical characteristics, microbiological results, laboratory data, therapies, and outcome of patients with NSTIs admitted to an intensive care unit (ICU). Methods: A monocentric observational study of patients admitted to the ICU of a university hospital between January 2009 and December 2017. The demographic characteristics, comorbidities, clinical features, microbiology and laboratory results, organ dysfunctions, therapies, and outcome were retrospectively analyzed. Results: There were 59 patients and 70% males. The mean age (± SD) was 55 ± 18; type II (monomicrobial) NSTI was present in 36 patients (61%); the most common isolated pathogen was Streptococcus pyogenes in 28 patients (48%). Septic shock was diagnosed in 41 patients (70%). The most common organ dysfunctions were circulatory and renal in 42 (71%) and 38 patients (64%). The mean value (± SD) of serum lactate at admission to the ICU was 4.22 ± 5.42 mmol/l, the median SOFA score and SAPS II were 7 (IQR 4 - 10) and 46 (IQR 30.5 - 53). ICU mortality rate was 25%. Both SOFA score and serum lactate demonstrated a good prognostic value regarding ICU outcome (OR 1.29, 95%CI 1.07-1.57, P < 0.007 and OR 1.53, 95%CI 1.19-1.98, P < 0.001). A cut-off value for serum lactate of 6.55 mmol/L positively predicted mortality with 67% sensitivity and 97% specificity. Conclusion: NSTIs carry a high risk of septic shock and multiple organ dysfunction syndrome and thus are still associated with high mortality. In our study, the value of serum lactate at admission to the ICU correlated well with mortality. This easy-to-measure parameter could play a role in the decision-making process regarding prognosis and continuation of care.
Collapse
Affiliation(s)
- Alexandru Ogica
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Burdelski
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- Institute of Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Geraldine de Heer
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Shiota S, Takakura T, Miyazaki E. Ludwig's angina in a rheumatoid arthritis patient taking sarilumab. Rheumatology (Oxford) 2021; 60:e139-e140. [PMID: 33200168 DOI: 10.1093/rheumatology/keaa593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seiji Shiota
- Department of General Medicine, Almeida Memorial Hospital, Yufu, Oita, Japan.,Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Takeshi Takakura
- Department of General Medicine, Almeida Memorial Hospital, Yufu, Oita, Japan
| | - Eishi Miyazaki
- Department of General Medicine, Oita University Faculty of Medicine, Yufu, Oita, Japan
| |
Collapse
|
4
|
The Effect of Tocilizumab on Inflammatory Markers in Patients Hospitalized with Serious Infections. Case Series and Review of Literature. Life (Basel) 2021; 11:life11030258. [PMID: 33804790 PMCID: PMC8003879 DOI: 10.3390/life11030258] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 02/08/2023] Open
Abstract
Background: The human anti-IL-6 receptor antibody tocilizumab (TCZ) has been approved for the treatment of rheumatoid arthritis (RA) and giant cell arteritis (GCA). It is observed that CRP levels drop quickly after starting TCZ treatment. This may lead to misinterpretation of laboratory results when accessing the patient with infectious disease while on TCZ. We conducted this study to report cases treated with tocilizumab who developed serious infections with special reference to levels of CRP and to review the literature on the effect of tocilizumab on acute phase response (APR) during infections. Methods: The files of RA and GCA patients hospitalized in the Tel Aviv medical center between 2009–2019 were reviewed. Cases of patients with RA and GCA treated with tocilizumab who were hospitalized due to severe infections were reviewed with special emphasis on the duration of treatment, type of infection, and APR. Results: We identified nine admissions. Seven patients were treated with tocilizumab for RA, two for GCA. The diagnosis was pneumonia in three cases, osteomyelitis in one, cellulitis in one, endocarditis due to Whipple disease in one, abscess of cervix uteri in one, meningitis in one, and perforated diverticulitis in one. The mean CRP levels on admission were 4.75 mg/L (normal range, up to 5 mg/L). All cases were diagnosed correctly on admission. Conclusions: CRP levels may not correctly reflect the severity of infectious diseases during tocilizumab treatment. Increased awareness of the masking effect of tocilizumab on the APR during infection is needed in order to avoid a delay in the diagnosis.
Collapse
|
5
|
Psoas abscess during treatment with intravenous tocilizumab in a patient with rheumatoid arthritis: a case-based review. Rheumatol Int 2021; 41:819-825. [PMID: 33576887 PMCID: PMC7880036 DOI: 10.1007/s00296-021-04800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/02/2022]
Abstract
Interleukin-6 receptor antagonist tocilizumab is a biologic drug used for treating patients with active rheumatoid arthritis (RA) who failed to respond to synthetic or other biologic disease-modifying antirheumatic drugs or where they were contraindicated. Interleukin-6 receptor blockade results in a decrease of disease activity but has some potential adverse effects, the most common being infections. We present a case of a 75-year-old female patient with long-lasting RA, several comorbidities and multiple prior therapies, who developed back pain and general malaise during tocilizumab intravenous treatment. The laboratory findings were typical of toxemia, and the imaging findings revealed large psoas muscle abscess. Surgical and antibiotic treatment was performed with a good outcome. To our knowledge, this has been the first case of a psoas abscess in a patient with RA treated with tocilizumab described in the literature so far. We also present a review of the literature regarding infection, and particularly abscess formation in patients treated with biological disease-modifying antirheumatic drugs, tocilizumab included.
Collapse
|
6
|
Mastorino L, Avallone G, Dapavo P, Merli M, Agostini A, Grandinetti D, Fierro MT, Quaglino P, Ribero S. Tocilizumab and its usage for skin diseases. Ital J Dermatol Venerol 2020; 157:13-22. [PMID: 33314888 DOI: 10.23736/s2784-8671.20.06772-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The monoclonal anti-IL6 receptor antibody called Tocilizumab is widely used by rheumatologists for joint diseases. Its application in dermatology has mainly concerned scleroderma and Systemic Sclerosis in the last years. The most varied skin diseases treated with tocilizumab, such as psoriasis, psoriatic arthritis, Behcet's Syndrome, Lupus, and the already mentioned scleroderma up to multi-organ syndromes with skin involvement will be discussed. At the same time, there have been several side reactions to the drug involving the skin forcing careful skin monitoring during treatment. Despite the evidence currently available in the appropriate literature, there is no formal recommendation for any of these diseases to use Tocilizumab for therapeutic purposes. The aim of this review was to collect all the main evidence on the use and involvement of the drug in dermatological practice in order to stimulate further research or hypothesize on possible therapeutic options.
Collapse
Affiliation(s)
- Luca Mastorino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gianluca Avallone
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Martina Merli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Agostini
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Damiano Grandinetti
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria T Fierro
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy -
| |
Collapse
|
7
|
Wilde S, Olivares KL, Nizet V, Hoffman HM, Radhakrishna S, LaRock CN. Opportunistic Invasive Infection by Group A Streptococcus During Anti-Interleukin-6 Immunotherapy. J Infect Dis 2020; 223:1260-1264. [PMID: 32808035 DOI: 10.1093/infdis/jiaa511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/07/2020] [Indexed: 12/20/2022] Open
Abstract
Invasive group A Streptococcus (GAS) in immunocompetent individuals is largely linked to hypervirulent strains. Congenital immunodeficiencies and those acquired from chronic disease or immunosuppressant drugs also increase risk of severe illness. We recovered GAS from the blood of a patient receiving a biologic inhibitor of interleukin 6 (IL-6). Growth of this serotype M4 isolate in human blood or a murine bacteremia model was promoted by interleukin 1 or IL-6 inhibition. Hyperinvasive M1T1 GAS was unaffected by IL-6 in both models. These findings based on a natural experiment introduce IL-6 signaling deficiencies as a risk factor for invasive GAS.
Collapse
Affiliation(s)
- Shyra Wilde
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katherine L Olivares
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA.,Wayne State University, Detroit, Michigan, USA
| | - Victor Nizet
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA.,Rady Children's Hospital, San Diego, California, USA.,Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Hal M Hoffman
- Rady Children's Hospital, San Diego, California, USA.,Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Suhas Radhakrishna
- Rady Children's Hospital, San Diego, California, USA.,Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Christopher N LaRock
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
8
|
Matsumura T, Ikebe T, Arikawa K, Hosokawa M, Aiko M, Iguchi A, Togashi I, Kai S, Ohara S, Ohara N, Ohnishi M, Watanabe H, Kobayashi K, Takeyama H, Yamasaki S, Takahashi Y, Ato M. Sequential Sensing by TLR2 and Mincle Directs Immature Myeloid Cells to Protect against Invasive Group A Streptococcal Infection in Mice. Cell Rep 2020; 27:561-571.e6. [PMID: 30970258 DOI: 10.1016/j.celrep.2019.03.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/22/2019] [Accepted: 03/14/2019] [Indexed: 01/27/2023] Open
Abstract
Severe invasive group A Streptococcus (GAS) infection evades anti-bacterial immunity by attenuating the cellular components of innate immune responses. However, this loss of protection is compensated for by interferon (IFN)-γ-producing immature myeloid cells (γIMCs), which are selectively recruited upon severe invasive GAS infection in mice. Here, we demonstrate that γIMCs provide this IFN-γ-mediated protection by sequentially sensing GAS through two distinct pattern recognition receptors. In a mouse model, GAS is initially recognized by Toll-like receptor 2 (TLR2), which promptly induces interleukin (IL)-6 production in γIMCs. γIMC-derived IL-6 promotes the upregulation of a recently identified GAS-sensing receptor, macrophage-inducible C-type lectin (Mincle), in an autocrine or paracrine manner. Notably, blockade of γIMC-derived IL-6 abrogates Mincle expression, downstream IFN-γ production, and γIMC-mediated protection against severe invasive GAS infection. Thus, γIMCs regulate host protective immunity against severe invasive GAS infection via a TLR2-IL-6-Mincle axis.
Collapse
Affiliation(s)
- Takayuki Matsumura
- Department of Immunology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
| | - Tadayoshi Ikebe
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Koji Arikawa
- Research Organization for Nano and Life Innovation, Waseda University, 513 Waseda-tsurumaki-cho, Shinjuku-ku, Tokyo 162-0041, Japan; Computational Bio Big-Data Open Innovation Laboratory, National Institute of Advanced Industrial Science and Technology, 3-4-1 Okubo, Shinjuku-ku, Tokyo 169-8555, Japan
| | - Masahito Hosokawa
- Research Organization for Nano and Life Innovation, Waseda University, 513 Waseda-tsurumaki-cho, Shinjuku-ku, Tokyo 162-0041, Japan; Institute for Advanced Research of Biosystem Dynamics, Waseda Research Institute for Science and Engineering, Waseda University, 2-2 Wakamatsu-cho, Shinjuku-ku, Tokyo 162-8480, Japan
| | - Michio Aiko
- Department of Immunology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Aoi Iguchi
- Department of Immunology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan; Tokyo College of Biotechnology, 1-3-14 Kita-Kojiya, Ota-ku, Tokyo 144-0032, Japan
| | - Ikuko Togashi
- Department of Immunology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan; Tokyo College of Biotechnology, 1-3-14 Kita-Kojiya, Ota-ku, Tokyo 144-0032, Japan
| | - Sayaka Kai
- Department of Immunology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan; Dental School, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Sakiko Ohara
- Department of Immunology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan; Dental School, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Naoya Ohara
- Dental School, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan; Department of Oral Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Haruo Watanabe
- School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita-shi, Chiba 286-8686, Japan
| | - Kazuo Kobayashi
- Division of Public Health, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka-shi, Osaka 537-0025, Japan
| | - Haruko Takeyama
- Research Organization for Nano and Life Innovation, Waseda University, 513 Waseda-tsurumaki-cho, Shinjuku-ku, Tokyo 162-0041, Japan; Computational Bio Big-Data Open Innovation Laboratory, National Institute of Advanced Industrial Science and Technology, 3-4-1 Okubo, Shinjuku-ku, Tokyo 169-8555, Japan; Institute for Advanced Research of Biosystem Dynamics, Waseda Research Institute for Science and Engineering, Waseda University, 2-2 Wakamatsu-cho, Shinjuku-ku, Tokyo 162-8480, Japan; Department of Life Science and Medical Bioscience, Waseda University, 2-2 Wakamatsu-cho, Shinjuku-ku, Tokyo 162-8480, Japan
| | - Sho Yamasaki
- Division of Molecular Immunology, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita-shi, Osaka 565-0871, Japan; Division of Molecular Immunology, Immunology Frontier Research Center (IFReC), Osaka University, 3-1 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
| | - Yoshimasa Takahashi
- Department of Immunology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Manabu Ato
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, 4-2-1 Aoba-cho, Higashimurayama-shi, Tokyo 189-0002, Japan
| |
Collapse
|
9
|
Manabe S, Yanagi H, Ozawa H, Takagi A. Necrotising soft tissue infection without systemic toxicity in a patient with rheumatoid arthritis treated with tocilizumab. BMJ Case Rep 2017; 2017:bcr-2017-222826. [PMID: 29248883 DOI: 10.1136/bcr-2017-222826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A Japanese woman aged 76 years with rheumatoid arthritis treated with prednisolone and tocilizumab presented with a 2-day history of redness and pain in her right thigh. She was hospitalised with a primary diagnosis of cellulitis and antimicrobial therapy was initiated. She had been stable until the fourth day of admission, when the swelling of her right thigh rapidly worsened and demonstrated purpura; she was subsequently unable to walk because of the pain. A diagnosis of necrotising soft tissue infection (NSTI) was made and extensive debridement was performed. Over the next 4 months, additional debridement was performed four times. Her condition improved significantly and she was able to walk later. Physicians should recognise that tocilizumab can mask systemic toxicities and inflammatory findings even in severe infections. To avoid delays in diagnosis and surgical intervention, clinicians should consider NSTIs when they encounter patients treated with tocilizumab, even if it mimics cellulitis.
Collapse
Affiliation(s)
- Saki Manabe
- Division of General Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Hidetaka Yanagi
- Division of General Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Hideki Ozawa
- Division of General Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Atsushi Takagi
- Division of General Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| |
Collapse
|
10
|
Rosa-Gonçalves D, Bernardes M, Costa L. Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis - Case report. ACTA ACUST UNITED AC 2016; 14:168-170. [PMID: 28041910 DOI: 10.1016/j.reuma.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/18/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement.
Collapse
Affiliation(s)
| | | | - Lúcia Costa
- Rheumatology Department, Centro Hospitalar São João, Portugal
| |
Collapse
|
11
|
LaRock CN, Todd J, LaRock DL, Olson J, O'Donoghue AJ, Robertson AAB, Cooper MA, Hoffman HM, Nizet V. IL-1β is an innate immune sensor of microbial proteolysis. Sci Immunol 2016; 1. [PMID: 28331908 DOI: 10.1126/sciimmunol.aah3539] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Interleukin-1β (IL-1β) is a key proinflammatory cytokine that drives antimicrobial immune responses. IL-1β is aberrantly activated in autoimmune diseases, and IL-1β inhibitors are used as therapeutic agents to treat patients with certain autoimmune disorders. Review of postmarketing surveillance of patients receiving IL-1β inhibitors found a disproportionate reporting of invasive infections by group A Streptococcus (GAS). IL-1β inhibition increased mouse susceptibility to GAS infection, but IL-1β was produced independent of canonical inflammasomes. Newly synthesized IL-1β has an amino-terminal prodomain that blocks signaling activity, which is usually proteolytically removed by caspase-1, a protease activated within the inflammasome structure. In place of host caspases, the secreted GAS cysteine protease SpeB generated mature IL-1β. During invasive infection, GAS isolates may acquire pathoadaptive mutations eliminating SpeB expression to evade detection by IL-1β. Pharmacological IL-1β inhibition alleviates this selective pressure, allowing invasive infection by nonpathoadapted GAS. Thus, IL-1β is a sensor that directly detects pathogen-associated proteolysis through an independent pathway operating in parallel with host inflammasomes. Because IL-1β function is maintained across species, yet cleavage by caspases does not appear to be, detection of microbial proteases may represent an ancestral system of innate immune regulation.
Collapse
Affiliation(s)
- Christopher N LaRock
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Jordan Todd
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Doris L LaRock
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Joshua Olson
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Anthony J O'Donoghue
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, La Jolla, CA 92093, USA
| | - Avril A B Robertson
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland 4072, Australia
| | - Matthew A Cooper
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland 4072, Australia
| | - Hal M Hoffman
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Victor Nizet
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, La Jolla, CA 92093, USA
| |
Collapse
|
12
|
Douglass E, Mondy K, Huth RG. Salmonella Epidural Abscess in a Patient With Rheumatoid Arthritis Treated With Tocilizumab. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Matsuo H, Kosaka K, Iwata K, Ohji G. [Necrotizing Soft Tissue Infection Caused by Serratia marcescens in a Patient Treated with Tocilizumab]. ACTA ACUST UNITED AC 2015; 89:53-5. [PMID: 26548297 DOI: 10.11150/kansenshogakuzasshi.89.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report herein on a case of community-acquired necrotizing soft tissue infection caused by Serratia marcescens. The patient had been treated with prednisolone, tocilizumab and tacrolimus for rheumatoid arthritis. Since Gram staining of the tissue revealed Gram negative rod bacteria, ceftriaxone and clindamycin were administered as empiric therapy. Tissue culture revealed S. marcescens. Ceftriaxone was continued according to the antibiotic sensitivity. She underwent debridement of necrotic tissue and continued ceftriaxone for 17 days. She recovered and was discharged after skin grafting.
Collapse
|
14
|
Mota LMHD, Cruz BA, Brenol CV, Pollak DF, Pinheiro GDRC, Laurindo IMM, Pereira IA, Carvalho JFD, Bertolo MB, Pinheiro MDM, Freitas MVC, Silva NAD, Louzada‐Júnior P, Sampaio‐Barros PD, Giorgi RDN, Lima RAC, Andrade LEC. Segurança do uso de terapias biológicas para o tratamento de artrite reumatoide e espondiloartrites. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:281-309. [DOI: 10.1016/j.rbr.2014.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 05/25/2014] [Accepted: 06/30/2014] [Indexed: 02/07/2023] Open
|
15
|
Lai SW, Huang TC, Ye RH, Wu YY. Necrotizing fasciitis in two patients with myelodysplastic syndrome treated with azacitidine. Eur J Haematol 2014; 94:273-6. [DOI: 10.1111/ejh.12365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Shiue-Wei Lai
- Division of Hematology and Oncology; Department of Internal Medicine; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Tzu-Chuan Huang
- Division of Hematology and Oncology; Department of Internal Medicine; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Ren-Hua Ye
- Division of Hematology and Oncology; Department of Internal Medicine; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Yi-Ying Wu
- Division of Hematology and Oncology; Department of Internal Medicine; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Life Sciences; National Defense Medical Center; Taipei Taiwan
| |
Collapse
|
16
|
|
17
|
Mokuda S, Murata Y, Sawada N, Matoba K, Yamada A, Onishi M, Okuda Y, Jouyama K, Sugiyama E, Takasugi K. Tocilizumab induced acquired factor XIII deficiency in patients with rheumatoid arthritis. PLoS One 2013; 8:e69944. [PMID: 23936360 PMCID: PMC3731329 DOI: 10.1371/journal.pone.0069944] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/18/2013] [Indexed: 11/18/2022] Open
Abstract
Factor XIII is one of the twelve coagulation factors and also known as a fibrin-stabilizing factor. In 2012, we encountered a male RA patient with hemorrhagic factor XIII deficiency who had been treated with tocilizumab for two years. There are few reports regarding the relationship between tocilizumab (a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R)) and factor XIII. We measured the factor XIII activity levels in the plasma of 40 RA patients (10 patients treated without biologics, 30 patients treated with biologics (15 patients treated with necrosis factor inhibitors and 15 patients treated with tocilizumab)) and 19 healthy controls. Consequently, the tocilizumab group exhibited lower levels than the other three groups according to the Steel-Dwass test (P<0.01). Furthermore, we compared the plasma factor XIII activity levels and the plasma factor XIII concentrations in the RA patients treated with biologics. Pearson's correlation test was used to assess the relationship between the factor XIII activity levels and the plasma factor XIII concentrations (r = 0.449, P = 0.019). According to the multiple regression analysis, the treatment with tocilizumab is an independent risk factor for plasma factor XIII reduction in RA patients. In conclusion, RA patients treated with tocilizumab, an IL-6R blocker, are at risk of developing acquired factor XIII deficiency. The mechanisms underlying the reduced factor XIII activity observed in RA patients treated with tocilizumab may result from the quantitative reduction in the plasma. These data imply that IL-6 plays an important role in maintaining the factor XIII activity level.
Collapse
Affiliation(s)
- Sho Mokuda
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima City, Hiroshima, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Landman G, Arend S, van Dissel J. Ruxolitinib can mask symptoms and signs of necrotizing fasciitis. J Infect 2013. [DOI: 10.1016/j.jinf.2012.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
Nguyen MTT, Pødenphant J, Ravn P. Three cases of severely disseminated Staphylococcus aureus infection in patients treated with tocilizumab. BMJ Case Rep 2013; 2013:bcr-2012-007413. [PMID: 23283607 DOI: 10.1136/bcr-2012-007413] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report three cases of severe disseminated Staphylococcus aureus infection in patients with rheumatoid arthritis (RA) treated with tocilizumab. Tocilizumab is a new drug, unknown to most internists, and injections given weeks before admission may not be considered by the patient as part of their 'current medical treatment', and the physician may not be aware that the patient is severely immunosuppressed. Severe infections in RA patients treated with tocilizumab may present with mild symptoms despite severe and disseminated infection and, as these patients are severely immunodeficient-intensive diagnostic work-up and early treatment should be performed. Systematic postmarketing studies are needed to clarify if there is a true increased risk of disseminated S aureus infections. We suggest caution when prescribing tocilizumab to patients with prosthetic joints and/or prior invasive S aureus infections and that patients are taught to inform health staff about their medication history and their increased risk of infection.
Collapse
Affiliation(s)
- Mai T T Nguyen
- Department of Infectious Diseases, University Hospital, Odense, Denmark
| | | | | |
Collapse
|