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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
"chronic diseases"
symptom
allergic bronchopulmonary aspergillosis
legionellosis
thoracic outlet syndrome
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