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Vol. 27, No. 4, 2009
Issue release date: November 2009
Section title: Treatment Algorithms in IBD (1)
Dig Dis 2009;27:555–559
(DOI:10.1159/000233297)

Therapy- and Non-Therapy-Dependent Infectious Complications in Inflammatory Bowel Disease

Epple H.-J.
Medical Clinic I, Gastroenterology, Rheumatology, Infectiology, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

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Article / Publication Details

First-Page Preview
Abstract of Treatment Algorithms in IBD (1)

Published online: 11/4/2009

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 2

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI

Abstract

Background: Patients with inflammatory bowel disease (IBD) are susceptible to infections. Results: Independently from immunomodulatory therapy, IBD predisposes to infectious complications. Thus, the incidence of Clostridium difficile infection is increased in IBD patients, and a significant proportion of these patients contracts C. difficile infection outside the hospital and without precedent antibiotic use. Cytomegalovirus infection has been reported in cortico- steroid-naive patients with ulcerative colitis, and infectious gastroenteritis has been linked to initiation and exacerbation of IBD. Finally, in Crohn’s disease there is a substantial risk for abscess formation, and urinary tract infections occur more frequently than in a non-IBD control population. Apart from the disease process itself, factors that predispose to infectious complications in IBD are malnutrition, advanced age, immunosuppressive medications, leukopenia from immunosuppressive medications, and surgery. However, the main risk for infections is clearly related to the use of immunosuppressive agents such as corticosteroids, azathioprine, methotrexate, cyclosporine, and TNF-blocking biologicals. A wide spectrum of infectious complications has been reported in patients treated with these medications, including viral (e.g. CMV, VZV, EBV), bacterial (e.g. Mycobacteria, Listeria, staphylococci), fungal (e.g. Pneumocystis jiroveci, Aspergillus, Candida, Cryptococcus) and protozoal (Toxoplasma) pathogens. The greatest risks obviously relate to the combined use of immunomodulating agents rather than to individual drugs. The risk of infections is also aggravated by an insufficient immunization status as frequently observed in patients with IBD. Conclusion: Physicians treating patients with IBD must be aware of the risk for infectious complications in these patients as well as of strategies to minimize them.


  

Author Contacts

Dr. med. Hans-Jörg Epple
Medical Clinic I, Gastroenterology, Rheumatology, Infectiology
Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin
Hindenburgdamm 30, DE–12200 Berlin (Germany)
Tel. +49 30 8445 2347, Fax +49 30 8445 4481, E-Mail hans-joerg.epple@charite.de

  

Article Information

Published online: November 04, 2009
Number of Print Pages : 5
Number of Figures : 1, Number of Tables : 2, Number of References : 28

  

Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 27, No. 4, Year 2009 (Cover Date: November 2009)

Journal Editor: Malfertheiner P. (Magdeburg)
ISSN: 0257-2753 (Print), eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI


Article / Publication Details

First-Page Preview
Abstract of Treatment Algorithms in IBD (1)

Published online: 11/4/2009

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 2

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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