Infections in autoimmune pulmonary alveolar proteinosis: a large retrospective cohort - Archive ouverte HAL
Article Dans Une Revue Thorax Année : 2024

Infections in autoimmune pulmonary alveolar proteinosis: a large retrospective cohort

Gregoire Prevot
  • Fonction : Auteur
Martine Reynaud-Gaubert
  • Fonction : Auteur
Emmanuel Bergot
  • Fonction : Auteur
Jacques Cadranel
  • Fonction : Auteur
Anne Bergeron
  • Fonction : Auteur
Elodie Blanchard
  • Fonction : Auteur
Benjamin Bondue
  • Fonction : Auteur
Philippe Bonniaud
  • Fonction : Auteur
Pierre Regis Burgel
Sandrine Hirschi
  • Fonction : Auteur
Charles Hugo Marquette
Sébastien Quétant
  • Fonction : Auteur
Hilario Nunes
  • Fonction : Auteur
Cécile Chenivesse
  • Fonction : Auteur
Bruno Crestani
  • Fonction : Auteur

Résumé

Background: Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare disease, predisposing to an increased risk of infection. A complete picture of these infections is lacking.Research question: Describe the characteristics and clinical outcomes of patients diagnosed with aPAP, and to identify risk factors associated with opportunistic infections.Methods: We conducted a retrospective cohort including all patients diagnosed with aPAP between 2008 and 2018 in France and Belgium. Data were collected using a standardised questionnaire including demographics, comorbidities, imaging features, outcomes and microbiological data.Results: We included 104 patients, 2/3 were men and median age at diagnosis was 45 years. With a median follow-up of 3.4 years (IQR 1.7-6.6 years), 60 patients (58%), developed at least one infection, including 23 (22%) with opportunistic infections. Nocardia spp was the main pathogen identified (n=10). Thirty-five (34%) patients were hospitalised due to infection. In univariate analysis, male gender was associated with opportunistic infections (p=0.04, OR=3.88; 95% CI (1.02 to 22.06)). Anti-granulocyte macrophage colony-stimulating factor antibody titre at diagnosis was significantly higher among patients who developed nocardiosis (1058 (316-1591) vs 580 (200-1190), p=0.01). Nine patients had died (9%), but only one death was related to infection.Interpretation: Patients with aPAP often presented with opportunistic infections, especially nocardiosis, which highlights the importance of systematic search for slow-growing bacteria in bronchoalveolar lavage or whole lung lavage.
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Dates et versions

hal-04224072 , version 1 (02-10-2023)

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Axelle Mabo, Raphael Borie, Lidwine Wemeau-Stervinou, Yurdagül Uzunhan, Emmanuel Gomez, et al.. Infections in autoimmune pulmonary alveolar proteinosis: a large retrospective cohort. Thorax, 2024, 79 (1), pp.68-74. ⟨10.1136/thorax-2023-220040⟩. ⟨hal-04224072⟩
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