Abstract
The treatment of inflammatory bowel disease (IBD) has been revolutionised over the past decade by the increasing use of immunomodulators and biologic therapy. Immunosuppression associated with use of these agents introduces the potential for opportunistic infection, which is a key safety concern for IBD patients and their carers. An opportunistic infection is one that is caused by a microorganism that is not harmful under ordinary circumstances but which causes serious disease in a predisposed person with a reduced capacity to fight the infection. Viral, bacterial, parasitic and fungal infections have all been associated with the use of immunosuppressive therapy in IBD. Opportunistic infections in IBD are associated with appreciable morbidity and mortality, because they are often difficult to recognise, potentially serious, and hard to treat effectively. The IBD nurse can play an important role in preventing opportunistic infections, through identification of those patients at risk. Moreover, the IBD nurse is integral to the implementation of screening and vaccination programmes for opportunistic infections in IBD patients, as well as in providing education and counselling around this important topic.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
AASLD/IDSA HCV Guidance Panel (2015) Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology 62(3):932–954
Abitbol Y, Laharie D, Cosnes J et al (2016) Negative screening does not rule out the risk of tuberculosis in patients with inflammatory bowel disease undergoing anti-TNF treatment: a descriptive study on the GETAID cohort. J Crohns Colitis 10(10):1179–1185
Ananthakrishnan AN, McGinley EL (2013) Infection-related hospitalizations are associated with increased mortality in patients with inflammatory bowel diseases. J Crohns Colitis 7(2):107–112
Andrade P, Santos-Antunes J, Rodrigues S et al (2015) Treatment with infliximab or azathioprine negatively impact the efficacy of hepatitis B vaccine in inflammatory bowel disease patients. J Gastroenterol Hepatol 30(11):1591–1595
Australlian Technical Advisory Group on Immunisation (ATAGI) (2018) Australian immunisation handbook. Australian Government Department of Health, Canberra. immunisationhandbook.health.gov.au
Baaten GG, Geskus RB, Kint JA et al (2011) Symptoms of infectious diseases in immunocompromised travelers: a prospective study with matched controls. J Travel Med 18(5):318–326
Baniak N, Kanthan R (2016) Cytomegalovirus colitis: an uncommon mimicker of common colitides. Arch Pathol Lab Med 140(8):854–858
Beswick L, Ye B, van Langenberg DR (2016) Toward an algorithm for the diagnosis and management of CMV in patients with colitis. Inflamm Bowel Dis 22(12):2966–2976
Biank VF, Sheth MK, Talano J et al (2011) Association of Crohn’s disease, thiopurines, and primary epstein-barr virus infection with hemophagocytic lymphohistiocytosis. J Pediatr 159(5):808–812
Bloomgren G, Richman S, Hotermans C et al (2012) Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med 366(20):1870–1880
Bonta J, Zeitz J, Frei P et al (2016) Cytomegalovirus disease in inflammatory bowel disease: epidemiology and disease characteristics in a large single-Centre experience. Eur J Gastroenterol Hepatol 28(11):1329–1334
Brassard P, Bitton A, Suissa A et al (2014) Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases. Am J Gastroenterol 109(11):1795–1802
Byun JM, Lee CK, Rhee SY et al (2015) Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-alpha inhibitor. Scand J Gastroenterol 50(3):312–320
Chaudrey K, Salvaggio M, Ahmed A et al (2015) Updates in vaccination: recommendations for adult inflammatory bowel disease patients. World J Gastroenterol: WJG 21(11):3184–3196
Colombel JF, Sands BE, Rutgeerts P et al (2017) The safety of vedolizumab for ulcerative colitis and Crohn’s disease. Gut 66(5):839–851
Connell W, Andrews JM, Brown S et al (2010) Practical guidelines for treating inflammatory bowel disease safely with anti-tumour necrosis factor therapy in Australia. Intern Med J 40(2):139–149
Cottone M, Kohn A, Daperno M et al (2011) Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol 9(1):30–35
Cullen G, Baden RP, Cheifetz AS (2012) Varicella zoster virus infection in inflammatory bowel disease. Inflamm Bowel Dis 18(12):2392–2403
Damas OM, Deshpande AR, Avalos DJ et al (2015) Treating inflammatory bowel disease in pregnancy: the issues we face today. J Crohns Colitis 9(10):928–936
Doran MF, Crowson CS, Pond GR et al (2002) Predictors of infection in rheumatoid arthritis. Arthritis Rheum 46(9):2294–2300
Ford AC, Peyrin-Biroulet L (2013) Opportunistic infections with anti-tumor necrosis factor-alpha therapy in inflammatory bowel disease: meta-analysis of randomized controlled trials. Am J Gastroenterol 108(8):1268–1276
Gavazzi G, Krause KH (2002) Ageing and infection. Lancet Infect Dis 2(11):659–666
Gerasimidis K, McGrogan P, Edwards CA (2011) The aetiology and impact of malnutrition in paediatric inflammatory bowel disease. J Hum Nutr Diet 24(4):313–326
Gupta A, Macrae FA, Gibson PR (2011) Vaccination and screening for infections in patients with inflammatory bowel disease: a survey of Australian gastroenterologists. Intern Med J 41(6):462–467
Hagihara Y, Ohfuji S, Watanabe K et al (2014) Infliximab and/or immunomodulators inhibit immune responses to trivalent influenza vaccination in adults with inflammatory bowel disease. J Crohns Colitis 8(3):223–233
Hradsky O, Copova I, Zarubova K et al (2015) Seroprevalence of Epstein-Barr virus, cytomegalovirus, and polyomaviruses in children with inflammatory bowel disease. Dig Dis Sci 60(11):3399–3407
Kane S, Khatibi B, Reddy D (2008) Higher incidence of abnormal pap smears in women with inflammatory bowel disease. Am J Gastroenterol 103(3):631–636
Kopylov U, Levin A, Mendelson E et al (2012) Prior varicella zoster virus exposure in IBD patients treated by anti-TNFs and other immunomodulators: implications for serological testing and vaccination guidelines. Aliment Pharmacol Ther 36(2):145–150
Kotton CN (2010) Vaccines and inflammatory bowel disease. Dig Dis 28(3):525–535
Law CC, Tariq R, Khanna S et al (2017) Systematic review with meta-analysis: the impact of Clostridium difficile infection on the short- and long-term risks of colectomy in inflammatory bowel disease. Aliment Pharmacol Ther 45(8):1011–1020
Lichtenstein GR, Feagan BG, Cohen RD et al (2006) Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol 4(5):621–630
Lichtenstein GR, Feagan BG, Cohen RD et al (2012) Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT registry. Am J Gastroenterol 107(9):1409–1422
Linton MS, Kroeker K, Fedorak D et al (2013) Prevalence of Epstein-Barr virus in a population of patients with inflammatory bowel disease: a prospective cohort study. Aliment Pharmacol Ther 38(10):1248–1254
Long MD, Farraye FA, Okafor PN et al (2013) Increased risk of pneumocystis jiroveci pneumonia among patients with inflammatory bowel disease. Inflamm Bowel Dis 19(5):1018–1024
Luthra P, Peyrin-Biroulet L, Ford AC (2015) Systematic review and meta-analysis: opportunistic infections and malignancies during treatment with anti-integrin antibodies in inflammatory bowel disease. Aliment Pharmacol Ther 41(12):1227–1236
Madonia S, Orlando A, Scimeca D et al (2007) Occult hepatitis B and infliximab-induced HBV reactivation. Inflamm Bowel Dis 13(4):508–509
Mazzola G, Macaluso FS, Adamoli L et al (2017) Diagnostic and vaccine strategies to prevent infections in patients with inflammatory bowel disease. J Infect 74(5):433–441
Morisco F, Castiglione F, Rispo A et al (2011) Hepatitis B virus infection and immunosuppressive therapy in patients with inflammatory bowel disease. Dig Liver Dis 43(Suppl 1):S40–S48
Papay P, Primas C, Eser A et al (2012) Retesting for latent tuberculosis in patients with inflammatory bowel disease treated with TNF-alpha inhibitors. Aliment Pharmacol Ther 36(9):858–865
Post S, Betzler M, von Ditfurth B et al (1991) Risks of intestinal anastomoses in Crohn’s disease. Ann Surg 213(1):37–42
Rahier JF, Magro F, Abreu C et al (2014) Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 8(6):443–468
Romkens TE, Bulte GJ, Nissen LH et al (2016) Cytomegalovirus in inflammatory bowel disease: a systematic review. World J Gastroenterol 22(3):1321–1330
Sandborn WJ (2010) State-of-the-art: immunosuppression and biologic therapy. Dig Dis 28(3):536–542
Sandborn WJ, Colombel JF, Enns R et al (2005) Natalizumab induction and maintenance therapy for Crohn’s disease. N Engl J Med 353(18):1912–1925
Schneeweiss S, Korzenik J, Solomon DH et al (2009) Infliximab and other immunomodulating drugs in patients with inflammatory bowel disease and the risk of serious bacterial infections. Aliment Pharmacol Ther 30(3):253–264
Shah ED, Farida JP, Siegel CA et al (2017) Risk for overall infection with anti-TNF and anti-integrin agents used in IBD: a systematic review and meta-analysis. Inflamm Bowel Dis 23(4):570–577
Toruner M, Loftus EV Jr, Harmsen WS et al (2008) Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology 134(4):929–936
Trifan A, Stanciu C, Stoica O et al (2014) Impact of Clostridium difficile infection on inflammatory bowel disease outcome: a review. World J Gastroenterol 20(33):11736–11742
Uhlig HH (2013) Monogenic diseases associated with intestinal inflammation: implications for the understanding of inflammatory bowel disease. Gut 62(12):1795–1805
Valentini L, Schulzke JD (2011) Mundane, yet challenging: the assessment of malnutrition in inflammatory bowel disease. Eur J Intern Med 22(1):13–15
Vermeire S, O’Byrne S, Keir M et al (2014) Etrolizumab as induction therapy for ulcerative colitis: a randomised, controlled, phase 2 trial. Lancet 384(9940):309–318
Viazis N, Vlachogiannakos J, Georgiou O et al (2010) Course of inflammatory bowel disease in patients infected with human immunodeficiency virus. Inflamm Bowel Dis 16(3):507–511
Walsh AJ, Weltman M, Burger D et al (2013) Implementing guidelines on the prevention of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 7(10):e449–e456
Waterland P, Athanasiou T, Patel H (2016) Post-operative abdominal complications in Crohn’s disease in the biological era: systematic review and meta-analysis. World J Gastrointest Surg 8(3):274–283
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Martin, S.R., Bryant, R.V. (2019). Opportunistic Infections. In: Sturm, A., White, L. (eds) Inflammatory Bowel Disease Nursing Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-75022-4_21
Download citation
DOI: https://doi.org/10.1007/978-3-319-75022-4_21
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-75021-7
Online ISBN: 978-3-319-75022-4
eBook Packages: MedicineMedicine (R0)