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In the U.S., three biologic agents (infliximab, etanercept, and adalimumab) are used to target tumor necrosis factor α (TNF-α) for treatment of psoriasis and other disorders. Because TNF-α may be involved in host defense, patients and physicians worry that severe, invasive, and even life-threatening infections might occur, and sometimes they do.
These authors searched the literature and found 281 cases of invasive fungal infections associated with anti–TNF-α therapies, including histoplasmosis (84 infections), candidiasis (64), aspergillosis (64), and infections with Cryptococcus (28) and Coccidioides species (27). Eighty percent of infections occurred in infliximab recipients (median number of infusions before infection, 3); 44 patients (16…