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Incidence and risk factors of Legionella pneumophila pneumonia during anti-tumor necrosis factor therapy: a prospective French study.
[legionellosis]
Our
objective
was
to
describe
the
incidence
and
risk
factors
of
legionellosis
associated
with
tumor
necrosis
factor
(
TNF
)
-
α
antagonist
use
.
From
February
1
,
2004
,
to
January
31
,
2007
,
we
prospectively
collected
all
cases
of
legionellosis
among
French
patients
receiving
TNF
-α
antagonists
in
the
Research
Axed
on
Tolerance
of
Biotherapies
(
RATIO
)
national
registry
.
We
conducted
an
incidence
study
with
the
French
population
as
a
reference
and
a
case-control
analysis
with
four
control
subjects
receiving
TNF
-α
antagonists
per
case
of
legionellosis
.
Twenty
-
seven
cases
of
legionellosis
were
reported
.
The
overall
annual
incidence
rate
of
legionellosis
for
patients
receiving
TNF
-α
antagonists
,
adjusted
for
age
and
sex
,
was
46
.
7
(
95
%
CI
,
0
.
0
-
125
.
7
)
per
100
,
000
patient-
years
.
The
overall
standardized
incidence
ratio
(
SIR
)
was
13
.
1
(
95
%
CI
,
9
.
0
-
19
.
1
;
P
&
lt
;
.
0001
)
and
was
higher
for
patients
receiving
infliximab
(
SIR
,
15
.
3
[
95
%
CI
,
8
.
5
-
27
.
6
;
P
&
lt
;
.
0001
]
)
or
adalimumab
(
SIR
,
37
.
7
[
95
%
CI
,
21
.
9
-
64
.
9
;
P
&
lt
;
.
0001
]
)
than
etanercept
(
SIR
,
3
.
0
[
95
%
CI
,
1
.
00
-
9
.
2
;
P
=
.
06
]
)
.
In
the
case-control
analysis
,
exposure
to
adalimumab
(
OR
,
8
.
7
[
95
%
CI
,
2
.
1
-
35
.
1
]
)
or
infliximab
(
OR
,
9
.
2
[
95
%
CI
,
1
.
9
-
45
.
4
]
)
vs
etanercept
was
an
independent
risk
factor
for
legionellosis
.
The
incidence
rate
of
legionellosis
for
patients
receiving
TNF
-α
antagonists
is
high
,
and
the
risk
is
higher
for
patients
receiving
anti-
TNF
-α
monoclonal
antibodies
than
soluble
TNF
-receptor
therapy
.
In
case
of
pneumonia
occurring
during
TNF
-α
antagonist
therapy
,
specific
urine
antigen
detection
should
be
performed
and
antibiotic
therapy
should
cover
legionellosis
.
ClinicalTrials
.
gov
;
No
.
:
NCT
00224562
;
URL
:
www
.
clinicaltrials
.
gov
.
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Diseases presenting
"factor for legionellosis"
symptom
legionellosis
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