Infections (General)

Large-scale studies and reviews, providing science-based evidence implicating infectious agents in both polymyositis and dermatomyositis in adult and pediatric populations.

State of the Art: What We Know About Infectious Agents and Myositis. Bacteria, Fungi, Parasites, and Idiopathic Inflammatory Myopathy. Curr Opin Rheumatol. 2011;23(6):585-594.

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Opinion-based review of the types of infections that have been identified in inflammatory myopathies, including borrelia burgdorferi, toxoplasma gondii, mycobacterium tuberculosis, streptococcus, Candida albicans, and a nematode infection, Caenorhabditis elegans.

History of infection before the onset of juvenile dermatomyositis: Results from the National Institute of Arthritis and Musculoskeletal and Skin Diseases Research Registry. Arthritis Care & Research; Volume 53, Issue 2, pages 166–172, 15 April 2005

An extensive data collection survey of children with juvenile dermatomyositis to determine if infection precedes disease onset. Findings conclude evidence for various microbes, including Borrelia burgdorferi, staphylococcus, toxoplasma gondii, and Group A hemolytic streptococcus infection, in addition to numerous viruses, prior to juvenile dermatomyositis diagnosis.

Polymyositis–dermatomyositis and infections. Autoimmunity Vol. 39, Iss. 3,2006 Pages 191-196 | Published online: 07 Jul 2009

A review of the possible role of infectious triggers of dermatomyositis and polymyositis in genetically predisposed individuals, based upon epidemiological studies, clinical and experimental findings that point to bacterial, viral and parasitic infections as a cause. This review also discusses the high rate of complications due to infections that arise as a result of immune response abnormalities and the immune-suppressive medications used to treat these rheumatic diseases.

Chronological evaluation of the onset of histologically confirmed interstitial pneumonia associated with polymyositis/dermatomyositis. Intern Med. 2002 Dec;41(12):1135-41.

In a study of 94 dermatomyositis/polymyositis patients with interstitial pneumonia, it was determined that that in 35 of 87 evaluable cases, lung involvement preceded the rheumatic disease diagnosis.

Investigation into the cause of mortality in 49 cases of idiopathic inflammatory myopathy: A single center study. Exp Ther Med. 2016 Mar;11(3):885-889. Epub 2016 Jan 18.

Of 676 patients admitted, between 2001-2015, to Xiangya Hospital, in China, with idiopathic inflammatory myopathy, there were 49 patient mortalities (7.2% of cases) of which 34 cases were related to overwhelming infection. Authors attribute these deaths to “… the ubiquitous application of glucocorticoids and immunosuppressants” and recommend that “… infection should receive increased attention during clinical practice.”

Long-term follow-up of patients with idiopathic inflammatory myopathy at Waitemata District Health Board. N Z Med J. 2016 Jan 29;129(1429):50-6.

New Zealand study authors attribute infection as the cause of a significant mortality rate in 20 dermatomyositis/polymyositis patients, 95% of whom were prescribed steroids, who were followed for a median duration of 9 years.  Authors also noted a high incidence of steroid-related complications, in particular osteoporosis.

[Infections in polymyositis and in dermatomyositis]. Presse Med. 2009 Feb;38(2):303-16. doi: 10.1016/j.lpm.2008.09.021. Epub 2008 Dec 11.

Due to the heightened risk of infections and mortality rates relative to the wide array of opportunistic microbes and fungi to which polymyositis/dermatomyositis patients  are subject to due to compromised immunity and the use of immune-suppressive therapies, Internal Medicine expert, I. Marie, of the Département de médecine interne, CHU Rouen, in France, recommends initiating  prophylactic antimicrobial treatment, particularly to prevent Pneumocystis jirovecipneumonia  to offset this risk in patients with low CD4-cell counts.

Infectious complications in polymyositis and dermatomyositis: a series of 279 patients. Semin Arthritis Rheum. 2011 Aug;41(1):48-60. doi: 10.1016/j.semarthrit.2010.08.003. Epub 2010 Nov 2.

In a study of 279 polymyositis/dermatomyositis patients in 3 medical health centers, 104 serious infections occurred in 37.3% of the patient population, underscoring the wide spectrum of opportunistic microbes and fungi to which this patient population is predisposed and the resulting increased mortality rate. Authors state the difficulty in predicting which infections may threaten these patients, thereby making primary prophylaxis against all possible infections difficult to initiate.







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