IMUNOSUPRESIJA I VIRUSNE INFEKCIJE U REUMATSKIM BOLESTIMA

Adriana Vince, Davorka Dušek

Infections are one of the leading causes of morbidity and mortality in patients with rheumatic diseases. Although bacterial pathogens are the most common cause of infections, a wide variety of viral pathogens can also cause serious clinical manifestations mostly due to immunosupressive therapy primarily targeting cellular immunitiy (steroids, cyclosporins, cyclophosphamid, lefl unomid, TNF-alfa antagonists etc.). Depleted cellular immunity can lead to reactivation of latent viruses such as members of Herpesvirus family, or hepatitis B and C viruses. Symptoms of viral infection may mimic exacerbation of rheumatic disease. In this paper authors present the main clinical characteristics, diagnostics and tretment possibilities for most common viral infections in immunosupressed host with a rheumatic disease.

Infekcije su jedan od vodećih uzroka mortbiditeta i mortaliteta u bolesnika s reumatskim bolestima. Iako su bakterije najčešći uzroci infekcija u tih bolesnika, imunosupresivna terapija koja poglavito djeluje na staničnu imunost (kortikosteroidi, ciklosporin, ciklofosfamid, leflumomid dijelom TNF alfa antagonisti), suvremena monoklonska protutijela), može dovesti do reaktivacije i teških kliničkih slika uzrokovanih latentnim virusima kao što su predstavnici porodice Herpesvirusa te hepatitis B i C virus. Osobit problem ovih infekcija je diferencijalno dijagnostička mogućnost zamjene s egzacerbacijom osnovne bolesti. U radu se ukratko prikazuju glavna klinička obilježja, dijagnostički i terapijski pristupi najčešćim virusnim infekcijama u imunosprimiranih reumatskih bolesnika.