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Abstract

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


RÉSUMÉ
INTRODUCTION
Le risque d’infections sévères (IS) est augmenté sous traitement immunosuppresseur (TI), chez les patients souffrant de rhumatismes inflammatoires chroniques (RIC). OBJECTIF
Identifier et décrire les aspects cliniques des IS chez les patients atteints de RIC et traités par immunosuppresseurs. A l’Hôpital Général de Douala.
METHODOLOGIE
Etude transversale descriptive incluant tous les patients souffrant de RIC suivis à l’HGD de janvier 1999 à décembre 2009 et traités par TI pendant au moins 06 mois. Etaient recueillis et analysés : le type, la durée, la dose et l’indication du TI ; la survenue d’une IS. L’IS était définie comme infection nécessitant une hospitalisation, un traitement antibiotique par voie parentérale, l’arrêt du TI, et/ou responsable du décès du patient.
RESULTATS
64 patients (43 femmes et 21 hommes) ont été inclus. Les RIC recensés étaient : Polyarthrite rhumatoïde, lupus érythémateux systémique et dermatomyosite. Les TI utilisés comportaient : Prednisone (n=64) ; Méthotrexate (n=49) ; Cyclophosphamide (n=7) ; azathioprine (n= 3).
Treize (25,5%) patients ont développé au moins une IS ; les IS recensées étaient : tuberculose pulmonaire (n=7), pneumopathie non tuberculeuse (n=7), entérite fébrile (n=5), infections des voies respiratoires hautes (n=2). Les infections étaient plus fréquentes chez les sujets de plus de 60 ans, une dose cumulée de prednisone >700 mg, l’association méthotrexate et prednisone. Cinq patients ont développé plus d’une IS.
CONCLUSION
Les IS pulmonaires sont fréquentes chez les patients souffrant de RIC et traités par TI. La prévention et la prise en charge des complications liées à ces traitements sont essentielles. Des études prospectives sont nécessaires en Afrique où le contexte infectieux endémique pourrait induire une augmentation du risque infectieux lié aux TI.

 

Keywords

Key words Chronic rheumatic disease infections immunosuppressive therapies.

Article Details

Author Biography

Marie DOUALLA BIJA, Faculty of Medicine and Biomedical Sciences

Internal medicine Department

Senior lecturer

How to Cite
DOUALLA BIJA, M., ASHUNTANTANG, G., NGANDEU SINGWE, M., LUMA NAMME, H., KEMTA LEKPA, F., NZAMEYO MBA, N., & NJAMNSHI, A. K. (2014). Serious Infections in Chronic Inflammatory Rheumatic Disease Patients Treated with Immunosuppressive Drugs at Douala General Hospital – Cameroon. HEALTH SCIENCES AND DISEASE, 15(4). https://doi.org/10.5281/hsd.v15i4.396
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