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Serious Infections in Chronic Inflammatory Rheumatic Disease Patients Treated with Immunosuppressive Drugs at Douala General Hospital – Cameroon

ABSTRACT BACKGROUND There is increasing use of immunosuppressive drugs (ID) in sub-Saharan Africa as new indications emerge in this region, known for its high infection rates. Few data are available on infectious complications of ID in chronic rheumatic diseases (CRD) in Africa OBJECTIVES To describe the pattern of serious infections (SI) in CRD patients treated with ID in the Douala General Hospital, Cameroon PATIENTS AND METHODS After prior ethical clearance, we reviewed medical records of adult patients treated with ID for at least 6 months in the rheumatology unit of the Douala General Hospital from January 1999 to December 2009. The types of ID, dosage, and treatment duration as well as the indication were recorded. All cases of serious infections were identified. SI were defined as requiring hospitalization, intravenous antibiotic, withdrawal of the drugs or resulting in death. RESULTS Sixty-four patients (43 females and 21 male) were enrolled. Indications for use of ID included rheumatoid arthritis, systemic lupus erythematosus and dermatomyositis. ID used included Prednisone (used in all the patients), Methotrexate, Cyclophosphamide, and Azathioprine. Seventeen (26.6%) patients developed at least one SI: pulmonary tuberculosis (n=5), non-tuberculous pneumonia (n=6), febrile enteritis (n=5), and upper respiratory tract (n=2). Five patients presented more than one infection. Infections were increased for patients aged more than 60, cumulated dose of Prednisone more than 700 mg, combination of prednisone and Methotrexate. CONCLUSION Pulmonary infections are frequent in CRD patients treated by ID. Prospective studies are needed to better evaluate the burden and risk factors of this complication in sub-Saharan Africa RESUME INTRODUCTION Le risque d’infections severes (IS) est augmente sous traitement immunosuppresseur (TI), chez les patients souffrant de rhumatismes inflammatoires chroniques (RIC). OBJECTIF Identifier et decrire les aspects cliniques des IS chez les patients atteints de RIC et traites par immunosuppresseurs. A l’Hopital General de Douala. METHODOLOGIE Etude transversale descriptive incluant tous les patients souffrant de RIC suivis a l’HGD de janvier 1999 a decembre 2009 et traites par TI pendant au moins 06 mois. Etaient recueillis et analyses : le type, la duree, la dose et l’indication du TI ; la survenue d’une IS. L’IS etait definie comme infection necessitant une hospitalisation, un traitement antibiotique par voie parenterale, l’arret du TI, et/ou responsable du deces du patient. RESULTATS 64 patients (43 femmes et 21 hommes) ont ete inclus. Les RIC recenses etaient : Polyarthrite rhumatoide, lupus erythemateux systemique et dermatomyosite. Les TI utilises comportaient : Prednisone (n=64) ; Methotrexate (n=49) ; Cyclophosphamide (n=7) ; azathioprine (n= 3). Treize (25,5%) patients ont developpe au moins une IS ; les IS recensees etaient : tuberculose pulmonaire (n=7), pneumopathie non tuberculeuse (n=7), enterite febrile (n=5), infections des voies respiratoires hautes (n=2). Les infections etaient plus frequentes chez les sujets de plus de 60 ans, une dose cumulee de prednisone >700 mg, l’association methotrexate et prednisone. Cinq patients ont developpe plus d’une IS. CONCLUSION Les IS pulmonaires sont frequentes chez les patients souffrant de RIC et traites par TI. La prevention et la prise en charge des complications liees a ces traitements sont essentielles. Des etudes prospectives sont necessaires en Afrique ou le contexte infectieux endemique pourrait induire une augmentation du risque infectieux lie aux TI.