BACKGROUND Tumor necrosis factor α inhibitors (TNFi) are commonly used to treat immune-mediated disorders, but they are associated with an increased risk of mycobacterial and fungal infections. We compared the outcomes of TNFi recipients screened for asymptomatic coccidioidomycosis with those of unscreened patients to compare the development of symptomatic coccidioidomycosis and to describe its outcomes for patients with abnormal coccidioidal screenings. METHODS We searched electronic health records from 4 September 2010 through 26 September 2016 for all patients receiving a TNFi for dermatologic, rheumatologic, or gastroenterologic diagnoses, then categorized patients by whether or not they had undergone coccidioidal serologic testing for screening or diagnostic purposes. RESULTS A total of 2793 patients had a TNFi prescribed. Of those, 1951 met the inclusion criteria: 1025/1951 (52.5%) never had coccidioidal screening; 925/1951 (47.4%) had serologic screening either before beginning TNFi therapy or annually, or both after beginning a TNFi. Symptomatic coccidioidomycosis developed in 35/1025 (3.4%) unscreened patients. Of those screened, 861/925 (93.1%) had negative serologic tests, of which 11/861 (1.3%) subsequently developed symptomatic coccidioidomycosis; 36/925 (3.9%) had coccidioidomycosis at screening (7, probable infection; 11, possible infection; 18, asymptomatic seropositive result); and 17 had only positive findings for immunoglobulin M antibodies and did not meet the definition for coccidioidomycosis. The unscreened cohort was more likely to have symptomatic coccidioidomycosis than the screened cohort (35/1025 vs 11/861, P < .01). CONCLUSIONS Screening for asymptomatic coccidioidomycosis within a Coccidioides-endemic area allowed for identifying and managing asymptomatic coccidioidomycosis before patients began TNFi therapy. Less symptomatic infection developed in the screened than the unscreened cohort.

中文翻译：

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在肿瘤坏死因子α抑制剂的接受者中筛查球孢菌病的效用。

背景技术肿瘤坏死因子α抑制剂（TNFi）通常用于治疗免疫介导的疾病，但是它们与分枝杆菌和真菌感染的风险增加相关。我们比较了无症状球虫病筛查的TNFi接受者和未筛查球虫病的接受者的结局，以比较症状性球虫病的发展并描述其对异常球虫病筛查患者的结局。方法我们检索了2010年9月4日至2016年9月26日的所有电子病历，以进行皮肤病，风湿病或胃肠病学诊断的所有接受TNFi的患者，然后根据是否接受球虫血清学检查进行筛查或诊断，对患者进行分类。结果共有2793例患者开具了TNFi处方。那些，1951年符合纳入标准：从未进行过球虫筛查的1025/1951年（52.5％）；925/1951（47.4％）在开始进行TNFi治疗之前或每年进行一次血清学筛查，或在开始进行TNFi治疗后均进行血清学筛查。有症状的球孢子菌病在35/1025（3.4％）未筛查的患者中发生。在筛查的人群中，861/925（93.1％）的血清学检查阴性，其中11/861（1.3％）随后出现了有症状的球孢子菌病。36/925（3.9％）的患者在筛查时有球虫菌病（7，可能的感染； 11，可能的感染； 18，无症状的血清阳性结果）；和17只对免疫球蛋白M抗体呈阳性结果，不符合球孢子菌病的定义。与未筛查队列相比，未筛查队列更有可能出现有症状的球孢子菌病（35/1025 vs 11/861，P <.01）。结论在球虫病流行区对无症状的球虫病进行筛查可以在患者开始TNFi治疗之前鉴定和处理无症状的球虫病。与未筛查的队列相比，筛查的症状性感染较少。