Rheumatological patients undergoing immunosuppressive treatments and parasitic diseases: a review of the literature of clinical cases and perspectives to screen and follow-up active and latent chronic infections

Objective. Nowadays, several potent immunosuppressive drugs are available for patients with rheumatologic disorders. In general, these treatments are acceptably well tolerated. Nevertheless, in patients with rheumatic diseases, who are taking immunosuppressive drugs, an increased risk of bacterial, viral and fun gal, as well as parasitic infections, exists. Methods. We have reviewed literature, on PubMed library, on the topic parasitic infections in rheumatic disease patients treated with immunosuppressive drugs, including biological therapies. We used no language or time restrictions. Search was concluded on January 15th 2014. We grouped all parasitic events among rheumatologic, therapeutically immuosuppressed, patients to estimate the magnitude of this risk. Then we gave our viewpoint in the perspective to screen and follow-up for active and latent chronic parasitoses, developing an hypothetical flow-chart. Results. From data published in the literature the real burden of parasitoses, among patients with rheumatic diseases treated with immunosuppressive treatments, can not be estimated. Nevertheless, a positive trend on publication number exists, probably due to more than one reason: i) the increasing number of patients treated, especially with more than one immunosuppressive treatment, including new biological agents; ii) the increasing number of individuals who move from the north to the south of the world (endemic areas for parasitic infections) and viceversa, due to globalisation, and iii) the fact that more attention is paid for notification/publication of cases. Conclusions. Considering parasitic infections as emerging and potentially serious in their evolution, additional strategies for the prevention, careful screening and follow-up, with a high level of suspicion, identification, and pre-emptive therapy are necessary in candidate patients for biological agents.