Published: September 2010

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Beware of systemic fungal infections in patients taking monoclonal antibodies

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Prescriber Update 31(3): 23
September 2010

Monoclonal antibodies (Mabs), designed to suppress part of the immune system, can cause profound immunosupression in some patients.

These patients are at risk of developing invasive fungal infections such as histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis and pneumocystosis. These infections can go unrecognised unless a high index of suspicion is maintained. Delays in treatment can result in serious adverse outcomes.

Healthcare professionals are reminded to monitor patients closely during and after treatment for the development of signs and symptoms of systemic fungal infection. Symptoms include fever, malaise, weight loss, sweats, cough, dyspnoea, pulmonary infiltrates on x-ray or serious systemic illness.

Patients who develop a systemic fungal infection should have their Mab therapy reviewed and be appropriately treated. If Mab therapy is discontinued it can be restarted on recovery; however a re-evaluation of the benefits and risks of treatment should be discussed with the patient.

Further information on systemic fungal infections can be found at: http://dermnetnz.org/fungal/ systemic-mycoses.html Further information on individual medicines can be found on the Medsafe website: www.medsafe.govt.nz/Medicines/infoSearch.asp

Healthcare professionals are reminded to continue to report any suspected adverse reactions associated with these medicines to CARM.