Infektionen bei Immunsuppression

Zusammenfassung

Patienten mit entzündlich-rheumatischen Erkrankungen haben durch spezifische Autoimmunprozesse und eine mögliche immunsuppressive Therapie eine geschwächte Immunabwehr. Dies erhöht die Anfälligkeit für bakterielle, virale und Pilzinfektionen. Glukokortikoide, Disease modifying antirheumatic Drugs (DMARDs), Biologika und JAK-Inhibitoren steigern das Risiko für opportunistische Infektionen wie beispielsweise Tuberkulose, Herpes und Candida. Die Infektionsprävention umfasst eine ausführliche Anamnese, Screening, Impfungen und medikamentöse Prophylaxen. Bei Infektionen sind eine rasche Diagnostik und eine gezielte antimikrobielle Therapie essenziell.

Schlüsselwörter

Infektion - Immunsuppression - opportunistisch - Impfungen - Prophylaxe

Publikationsverlauf

Artikel online veröffentlicht:
29. August 2025

• Literatur

• 1 Kaplan MJ. Neutrophils in the pathogenesis and manifestations of SLE. Nat Rev Rheumatol 2011; 7: 691-699
• 2 Nakabo S, Romo-Tena J, Kaplan MJ. Neutrophils as Drivers of Immune Dysregulation in Autoimmune Diseases with Skin Manifestations. J Invest Dermatol 2022; 142 3 Pt B 823-833
• 3 Wright HL, Moots RJ, Edwards SW. The multifactorial role of neutrophils in rheumatoid arthritis. Nat Rev Rheumatol 2014; 10: 593-601
• 4 Theofilopoulos AN, Baccala R, Beutler B. et al. Type I Interferons in Immunity and Autoimmunity. Annu Rev Immunol 2005; 23: 307-336
• 5 Walport MJ. Complement and systemic lupus erythematosus. Arthritis Res 2002; 4 (Suppl. 3) S279-S293
• 6 Sakaguchi S, Miyara M, Constatino CM, Hafler DA. FOXP3+ regulatory T cells in the human immune system. Nat Rev Immunol 2010; 10: 490-500
• 7 Gracey E, Yao Y, Qaiyum Z. et al. Altered Cytotoxicity Profile of CD8+ T Cells in Ankylosing Spondylitis. Arthritis Rheumatol 2020; 72: 428-434
• 8 Dörner T, Jacobi AM, Lee J, Lipsky PE. Abnormalities of B cell subsets in patients with systemic lupus erythematosus. J Immunol Methods 2011; 363: 187-97
• 9 Faliti CE, Van Trinh TP, Anam FA. et al. Disease-associated B cells and immune endotypes shape adaptive immune responses to SARS-CoV-2 mRNA vaccination in human SLE. Nat Immunol 2025; 26: 131-145
• 10 Petri M. Infection in systemic lupus erythematosus. Rheum Dis Clin North Am 1998; 24: 423-56
• 11 Fox RI. Sjögren’s syndrome. Lancet 2005; 366: 321-331
• 12 Baliga S, Yadav S, Sagdeo P, Balakrishnan C. Invasive fungal infection in ANCA-associated vasculitis: Between the Devil and Deep blue sea. Case series and review of the literature. Clin Rheumatol 2024; 43: 785-797
• 13 Chastain DB, Spradlin M, Ahmad H. et al. Unintended Consequences: Risk of Opportunistic Infections Associated With Long-term Glucocorticoid Therapies in Adults. Clin Infect Dis 2024; 78: e37-e56
• 14 Wirsum C, Glaser C, Gutenberger S. et al. Secondary Antibody Deficiency in Glucocorticoid Therapy Clearly Differs from Primary Antibody Deficiency. J Clin Immunol 2016; 36: 406-412
• 15 Sierra CM, Daiya KC. Prophylaxis for Pneumocystis jirovecii pneumonia in patients with inflammatory bowel disease: a systematic review. Pharmacotherapy 2022; 42: 858-867
• 16 Park JW, Curtis JR, Kim MJ. et al. Pneumocystis pneumonia in patients with rheumatic diseases receiving prolonged, non-high-dose steroids-clinical implication of primary prophylaxis using trimethoprim-sulfamethoxazole. Arthritis Res Ther 2019; 21: 207
• 17 Vanni KMM, Lyu H, Solomon DH. Cytopenias among patients with rheumatic diseases using methotrexate: a meta-analysis of randomized controlled clinical trials. Rheumatology (Oxford) 2020; 59: 709-717
• 18 Ajmani S, Singh YP, Prasad S. et al. Methotrexate-induced pancytopenia: a case series of 46 patients. Int J Rheum Dis 2017; 20: 846-851
• 19 Rattay B, Benndorf RA. Drug-Induced Idiosyncratic Agranulocytosis – Infrequent but Dangerous. Front Pharmacol 2021; 12: 727717
• 20 Moreira PM, Correia AM, Cerqueira M. et al. Perioperative management of disease-modifying antirheumatic drugs and other immunomodulators. ARP Rheumatol 2022; 1: 218-224
• 21 Robert M, Miossec P. Reactivation of latent tuberculosis with TNF inhibitors: critical role of the beta 2 chain of the IL-12 receptor. Cell Mol Immunol 2021; 18: 1644-1651
• 22 Rutherford AI, Patarata E, Subesinghe S. et al. Opportunistic infections in rheumatoid arthritis patients exposed to biologic therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology (Oxford) 2018; 57: 997-1001
• 23 Rajakulendran S, Gadsby K, Allen D. et al. Neutropenia while receiving anti-tumour necrosis factor treatment for rheumatoid arthritis. Ann Rheum Dis 2006; 65: 1678-1679
• 24 Hastings R, Ding T, Butt S. et al. Neutropenia in patients receiving anti-tumor necrosis factor therapy. Arthritis Care Res (Hoboken) 2010; 62: 764-769
• 25 Davidson L, van den Reek JMPA, Bruno M. et al. Risk of candidiasis associated with interleukin-17 inhibitors: A real-world observational study of multiple independent sources. Lancet Reg Health Eur 2021; 13: 100226
• 26 Pawar A, Desai RJ, Solomon DH. et al. Risk of serious infections in tocilizumab versus other biologic drugs in patients with rheumatoid arthritis: a multidatabase cohort study. Ann Rheum Dis 2019; 78: 456-464
• 27 Patel V, Pulungan Z, Shah A. et al. Risk and cost of infection-related hospitalizations in medicare beneficiaries with comorbid rheumatoid arthritis treated with abatacept versus other targeted disease-modifying anti-rheumatic drugs. J Med Econ 2021; 24: 299-307
• 28 Takabayashi K, Ando F, Ikeda K. et al. Incidence of opportunistic infections in patients with rheumatoid arthritis treated with different molecular-targeted drugs: A population-based retrospective cohort study. Mod Rheumatology 2023; 33: 1078-1086
• 29 Bechman K, Subesinghe S, Norton S. et al. A systematic review and meta-analysis of infection risk with small molecule JAK inhibitors in rheumatoid arthritis. Rheumatology (Oxford) 2019; 58: 1755-1766
• 30 Roberts DM, Jones RB, Smith RM. et al. Rituximab-associated hypogammaglobulinemia: incidence, predictors and outcomes in patients with multi-system autoimmune disease. J Autoimmun 2015; 57: 60-65
• 31 Molloy ES, Calabrese LH. Progressive multifocal leukoencephalopathy associated with immunosuppressive therapy in rheumatic diseases: evolving role of biologic therapies. Arthritis Rheum 2012; 64: 3043-3051
• 32 Strangfeld A, Eveslage M, Schneider M. et al. Treatment benefit or survival of the fittest: what drives the time-dependent decrease in serious infection rates under TNF inhibition and what does this imply for the individual patient?. Ann Rheum Dis 2011; 70: 1914-1920
• 33 Cornberg M, Protzer U, Petersen J. et al. Prophylaxis, Diagnosis and Therapy of Hepatitis B Virus Infection – The German Guideline. Z Gastroenterol 2011; 49: 871-930
• 34 Stevens E, Weinblatt ME, Massarotti E. et al. Safety of the Zoster Vaccine Recombinant Adjuvanted in Rheumatoid Arthritis and Other Systemic Rheumatic Disease Patients: A Single Center’s Experience With 400 Patients. ACR Open Rheumatol 2020; 2: 357-361
• 35 Specker C, Aries P, Braun J. et al. Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic, including recommendations for COVID-19 vaccination. Z Rheumatol 2021; 80 (Suppl. 2) 33-48
• 36 De Nard F, Todoerti M, Grosso V. et al. Risk of hepatitis B virus reactivation in rheumatoid arthritis patients undergoing biologic treatment: Extending perspective from old to newer drugs. World J Hepatol 2015; 7: 344-361
• 37 Diel R, Hauer B, Loddenkemper R. et al. Empfehlungen für das Tuberkulosescreening vor Gabe von TNF-alpha-Inhibitoren bei rheumatischen Erkrankungen. Pneumologie 2009; 63: 329-334