Pulmonary Infections in the Era of Biological Agents

Irene      S. Kourbeti; Kostas      Konstantopoulos

Abstract

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.