Charlier et al identified risk factors for major infections in a patient with Wegener's granulomatosis. These can help to identify a patient who may benefit from more aggressive management. The authors are from Hopital Cochin and Universite Paris Descartes in Paris.
Patient selection: Wegener's granulomatosis
Major infections included:
(1) bronchopneumonia
(2) reactivation of Herpes zoster
(3) cellulitis
(4) sepsis
(5) septic arthritis
(6) disseminated cytomegalovirus infections
(7) Herpes simplex virus infections
(8) esophageal Candidiasis
(9) reactivation of viral hepatitis B
Risk factors for infection:
(1) high cumulative doses of cyclophosphamide
(2) high dose corticosteroids (> 20 mg/day; not specified but presumably prednisone equivalent)
(3) failure to use adequate prophylaxis and/or vaccinations
Delay in diagnosis and initiation of appropriate therapy was associated with worse outcomes.
Prophylaxis during periods of immunosuppression:
(1) anti-pneumocystis (cotrimoxazole daily or pentamidine monthyl)
Vaccinations:
(1) influenza
(2) pneumococcal
(3) Herpes zoster
