A systematic review and meta-analysis of mycobacterial infections in patients with idiopathic inflammatory myopathies. (1st February 2022)

• Record Type: Journal Article
• Authors: Haldule, Saloni; Chatterjee, Moumita; Goswami, Rudra Prosad; Vadsaria, Innara; Gaur, Prithvi; Kavadichanda, Chengappa; Misra, Durga Prasanna; Chinoy, Hector; Agarwal, Vikas; Aggarwal, Rohit; Gupta, Latika
• Is Part Of: Rheumatology. Volume 61:Number 9(2022)
• Page Start: 3521
• Page End: 3533
• Publication Date: 2022-02-01
• Subjects: rheumatology -- inflammatory myopathy -- polymyositis -- dermatomyositis -- tuberculosis -- mycobacterium tuberculosis -- non-tuberculous mycobacteria; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keac041
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: Infections including tuberculosis (TB) are a leading cause of morbidity and mortality in idiopathic inflammatory myopathies (IIM). We systematically reviewed the prevalence of mycobacterial infections in patients with IIM. Methods: We screened PUBMED, EMBASE and SCOPUS databases and conference abstracts (2015–20) for original articles using Covidence. Pooled estimates of prevalence were calculated. Results: Of 83 studies (28 cohort studies, two case control and 53 case reports), 19 were analysed. Of 14 043 IIM patients, DM (54.41%) was the most common subset among TB. Most studies were from Asia with high prevalence (5.86%, 2.33%–10.60%). Pooled prevalence of mycobacterial infections among IIM was 3.58% (95% CI: 2.17%, 5.85%, P < 0.01). Disseminated and extrapulmonary forms (46.58%; 95% CI: 39.02%, 54.31%, P = 1.00) were as common as pulmonary TB (49.07%; 95% CI: 41.43%, 56.75%, P =0.99) both for I 2 =0. Muscle involvement, an otherwise rare site, was frequently seen in case reports (24.14%). M. tuberculosis (28.84%) was the most common pathogen followed by Mycobacterium avium complex (3.25%). Non-tuberculous mycobacteria were less common overall (6.25; 95% CI: 3.49%, 10.93%) I 2 =0, P =0.94. Subgroup analysis and meta-regression based on high vs low TB regions found prevalence 6.61% (2.96%, 11.33%) in high TB regions vs 2.05% (0.90%, 3.56%) in low TB regions. While death due to TB was occasionally reported ( P =0.82), successful anti-tubercular treatment was common (13.95%). Conclusion: TB is common in IIM, particularly in endemic regions though current data is largely heterogeneous. Extra-pulmonary forms and atypical sites including the muscle are frequent. Limited data suggests fair outcomes, although larger prospective studies may offer better understanding.