Biological agents such as monoclonal antibodies, soluble receptors and molecular mimetics, offer the potential
to enhance or replace conventional therapies in the treatment of autoimmune diseases, multiple sclerosis, solid tumors and
hematological diseases. As tumor necrosis factor (TNF) plays an essential role in host defense, anti-TNF therapies have
increased the risk of serious infections, including mycobacterial and opportunistic infections. The increase in bacterial,
fungal and parasitic or viral infections has been well-documented. Lung involvement is expected in 20% of the serious
bacterial infections. Diagnosis of lung infections associated with biological agents can prove very difficult due to atypical
clinical and pathological features. Patients and physicians should be alerted on the importance of early symptom
recognition to avoid the delay in diagnosis. Pulmonary involvement presentation may often be dramatic with acute
respiratory failure and bilateral infiltrates. Vigilance is needed for rapid diagnosis with the institution of computer assisted
tomography and fiberoptic bronchoscopy.
In this review we summarize epidemiology, offending pathogens, and diagnostics of pulmonary infections associated with
the use of biological therapies. Measures that can be used for prophylaxis, such as vaccinations and latent infections
therapy, will also be reviewed.
Keywords: Biological agents, TNF-alpha inhibitors, infections, tuberculosis, tumor necrosis factor (TNF), pulmonary infections, anti-TNF therapies, tomography, fiberoptic bronchoscopy.
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