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Opportunistic infections due to inflammatory bowel disease therapy.
[legionellosis]
The
use
of
biological
agents
and
immunomodulators
for
inflammatory
bowel
disease
(
IBD
)
has
remarkably
improved
disease
management
in
the
current
era
but
at
the
same
time
has
increased
the
risk
of
infectious
complications
.
Patients
with
IBD
on
corticosteroids
,
immunomodulators
,
and
biological
agents
are
considered
immunocompromised
and
are
at
risk
for
opportunistic
infections
.
These
are
infections
caused
by
organisms
that
take
advantage
of
a
weakened
immune
system
,
and
cause
disease
,
when
they
ordinarily
would
cause
mild
illness
or
no
disease
in
an
immunocompetent
host
.
Risk
factors
for
opportunistic
infections
include
malnutrition
,
older
age
,
congenital
immunodeficiency
,
HIV
infection
,
chronic
diseases
,
and
use
of
corticosteroids
,
immunomodulators
,
and
anti-
tumor
necrosis
factor
alpha
therapy
.
Apart
from
immunosuppressive
medications
and
older
age
,
there
is
only
indirect
evidence
for
above
risk
factors
contributing
directly
to
opportunistic
infection
risk
in
patients
with
IBD
.
Opportunistic
infections
in
patients
with
IBD
include
viral
infections
(
herpes
viruses
,
human
papillomavirus
,
influenza
virus
,
and
JC
virus
)
,
bacterial
infections
(
tuberculosis
,
nocardiosis
,
Clostridium
difficile
infection
,
pneumococcal
infection
,
legionellosis
,
and
listeriosis
)
,
fungal
infections
(
histoplasmosis
,
cryptococcosis
,
Pneumocystis
jirovecii
infection
,
aspergillosis
,
and
candidiasis
)
,
and
parasite
infections
(
Strongyloides
stercoralis
)
.
Although
these
infections
lead
to
high
morbidity
and
mortality
,
only
a
minority
of
patients
with
IBD
develop
opportunistic
infections
.
Currently
,
we
lack
a
test
to
accurately
predict
patients
at
risk
of
opportunistic
infection
,
and
future
research
needs
to
focus
on
biomarkers
or
predictive
models
for
risk
stratification
.
Until
such
a
test
is
developed
,
we
need
to
screen
,
prevent
,
diagnose
,
and
treat
opportunistic
infections
in
all
patients
with
IBD
in
a
timely
manner
.
Diseases
Validation
Diseases presenting
"bowel disease"
symptom
acute rheumatic fever
benign recurrent intrahepatic cholestasis
cholangiocarcinoma
familial mediterranean fever
hirschsprung disease
legionellosis
malignant atrophic papulosis
primary effusion lymphoma
severe combined immunodeficiency
typhoid
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