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Rev Iberoam Micol. 2020 Jan - Mar;37(1):5-16. doi: 10.1016/j.riam.2019.09.001. Epub 2019 Dec 14.

Fungal infections following treatment with monoclonal antibodies and other immunomodulatory therapies.

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Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos, Madrid, Spain. Electronic address:
Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos, Madrid, Spain.
Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain.
Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain.
Department of Clinical Microbiology and Infectious Diseases, University and Polytechnic Hospital La Fe, Valencia, Spain.
School of Medicine, Microbiology Department, National University of Colombia, Bogota, Colombia.


Tumor necrosis factor (TNF) is a proinflammatory cytokine involved in a wide range of important physiologic processes and has a pathologic role in some diseases. TNF antagonists (infliximab, adalimumab, etanercept) are effective in treating inflammatory conditions. Antilymphocyte biological agents (rituximab, alemtuzumab), integrin antagonists (natalizumab, etrolizumab and vedolizumab), interleukin (IL)-17A blockers (secukinumab, ixekizumab) and IL-2 antagonists (daclizumab, basiliximab) are widely used after transplantation and for gastroenterological, rheumatological, dermatological, neurological and hematological disorders. Given the putative role of these host defense elements against bacterial, viral and fungal agents, the risk of infection during a treatment with these antagonists is a concern. Fungal infections, both opportunistic and endemic, have been associated with these biological therapies, but the causative relationship is unclear, especially among patients with poor control of their underlying disease or who are undergoing steroid therapy. Potential recipients of these drugs should be screened for latent endemic fungal infections. Cotrimoxazole prophylaxis could be useful for preventing Pneumocystis jirovecii infection in patients over 65 years of age who are taking TNF antagonists, antilymphocyte biological agents or who have lymphopenia and are undergoing concomitant steroid therapy. As with other immunosuppressant drugs, TNF antagonists and antilymphocyte antibodies should be discontinued for patients with active infectious disease.


Anticuerpos monoclonales; Biologic therapies; Fungal infections; Infecciones fúngicas; Monoclonal antibodies; Terapias biológicas


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