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Tumor necrosis factor (TNF) blockers represent a major step forward in the treatment of many chronic inflammatory diseases. These agents are associated with increased risk for reactivating latent tuberculosis infection, but the risk for other serious infections is not as widely recognized.
The FDA recently announced that the manufacturers of TNF blockers must strengthen existing warnings and educate prescribers about the risk for fungal infections in patients treated with these agents. This announcement was based on 21 reports of initially unrecognized histoplasmosis that resulted in 12 deaths in patients who were being treated with TNF blockers; most of these patients lived in the Ohio and Mississippi River valleys, where histoplasmosis is …