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.

肿瘤坏死因子（TNF）是一种促炎性细胞因子，参与多种重要的生理过程，在某些疾病中具有病理作用。TNF拮抗剂（英夫利昔单抗，阿达木单抗，依那西普）可有效治疗炎症。抗淋巴细胞生物学剂（利妥昔单抗，阿仑单抗），整联蛋白拮抗剂（那他珠单抗，埃特罗珠单抗和维多珠单抗），白介素（IL）-17A阻滞剂（苏金单抗，依西珠单抗）和IL-2拮抗剂（达克珠单抗，巴利昔单抗）在移植后广泛使用，用于胃肠道风湿病，皮肤病，神经病学和血液学疾病。考虑到这些宿主防御元件针对细菌，病毒和真菌试剂的推定作用，使用这些拮抗剂治疗期间感染的风险令人担忧。真菌感染 这些生物疗法均涉及机会性和地方性两种，但因果关系尚不清楚，尤其是在对其基础疾病控制不佳或正在接受类固醇治疗的患者中。这些药物的潜在接受者应筛选潜在的地方性真菌感染。复方新诺明预防可能有助于预防接受TNF拮抗剂，抗淋巴细胞生物学药物或患有淋巴细胞减少症并接受类固醇治疗的65岁以上患者的初次肺孢子菌感染。与其他免疫抑制剂药物一样，对于活动性传染病患者，应停止使用TNF拮抗剂和抗淋巴细胞抗体。