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
Subject(s)
Hospitals , Immunosuppressive Agents , Infections , Rheumatic DiseasesABSTRACT
Atopic dermatitis (AD); the dermatological manifestation of the atopic diathesis; has a variety of clinical presentations. It is a chronic and relapsing inflammatory disorder; requiring a multifaceted treatment approach. Topical corticosteroids are the backbone of therapy. However; concerns over adverse drug reactions associated with their long-term application limit their use.Tacrolimus; on the other hand; has been shown to be effective in stabilising the symptoms of AD in the long-term setting; without the side-effects that hamper the use of topical corticosteroids. Long-term safety data up to ten years are available in the literature. Despite this; the US Food and Drug Administration (FDA) black box warning of possible malignancies has resulted in much debate among experts.The main focus of this article is to compare the safety and efficacy of topical corticosteroids to calcineurin inhibitors; particularly tacrolimus. Furthermore; the aim is to evaluate the place of tacrolimus in AD therapy. A brief overview of the condition and other treatment modalities will also be discussed