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Purpose: The aim of this study was to detect infections requiring hospitalization in patients with ANCA-associated vasculitis (AAV).Materials and Methods: This is a single-center, retrospective study conducted in Turkish patients with AAV. Infection episodes requiring hospitalization, reproducing pathogens, laboratory findings, immunosuppressive treatments given for the treatment of vasculitis, and the relationship with the infection were evaluated.Results: Seventy-four patients diagnosed with AAV were included in the study. Hospitalization due to infection was observed in 36 of the patients. The coexistence of diabetes mellitus (DM) was found to be significantly higher in the infected patient group. Cyclophosphamide (CYC) treatment found to increase risk of infection. More than 80% of the infected patient group presented with renal involvement (80.6%). A total of 68 infectious episodes were seen in 36 patients. The most common involvement of infection was the respiratory tract with a rate of 70.6%. Gram-negative bacteria were the most common pathogen, especially Pseudomonas aeruginosa. With the effect of the pandemic, SARS-CoV-2 has come to the fore among viral infections. Aspergillosis was the most frequently detected among fungal infections. Besides, aspergillosis was the cause of 85.7% (6 episodes) of fungal infections. Lymphopenia was observed in 76.5% of the infection episodes. 57.4% of infections developed in the first year of the induction therapy. The most frequently used immunosuppressive therapy for the treatment of vasculitis in infectious episodes was CYC (41.2%).Conclusion: Managing infections during the vasculitis treatment is crucially important. Lymphopenia, kidney involvement, DM and immunosuppressive therapy are factors that increase the risk of infection. Clinicians should take preventive measure especially for respiratory tract infections and gram-negative bacteria as pathogens.
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Introduction: Ocrelizumab, which is approved for the treatment of progressive and relapsing forms of MS, is a CD-20 monoclonal antibody. Susceptibility to hypogammaglobulinemia has recently gained importance in patients under B-cell depleting therapies. Objectives and Aims: We aimed to evaluate the changes in immunoglobulin levels and their effect on the COVID-19 infection in a group of MS patients under ocrelizumab therapy. Methods: Patients under ocrelizumab therapy from December 2017 - May 2021 were included in the study. Immunoglobulin M (IgM), immunoglobulin G (IgG), CD19, CD20 levels were obtained cross-sectionally before the last infusion of ocrelizumab. We also evaluated COVID-19 infection ratio and severity. Results: Among 320 ocrelizumab-treated patients, we included 131 patients who had been tested for IgG, IgM, CD19 and CD20 levels. The female to male ratio was 1.4: 1 and mean age was 44.3 years. While the mean disease duration was 11 years, the mean follow-up period of patients under ocrelizumab treatment was 21 months. 13 (10%) patients had lower serum IgG levels (serum IgG<750mg/dl). Serum IgM levels were found to be low in 33 (25%) of the patients with the mean of 31.85 mg/dl (±12.1). 15 had COVID-19 infection (COVID+ group). The mean serum IgM level of the COVID+ group was 78.03mg/dl (±84.70), 101 mg/dl (±73.03) in the COVID- group (p=0.262). IgG levels of the COVID+ and COVD- groups were 948.3 (±243.4) and 1073 (±256.7) mg/dl respectively (p=0.078). Only 3 patients needed hospitalization because of COVID-19. Two of them had low IgM levels. None of the patients had been needed intensive care or mechanical ventilation. Conclusions: Almost a quarter of our patients had a low level of Ig's as expected. Ig levels should be routinely evaluated to avoid infectious complications.