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Epidemiology of Opportunistic Fungal Infections in Patients of Inflammatory Bowel Disease: National Inpatient Sample Analysis 2002-2014


Khan, Zubair MD; Darr, Umar MD; Javaid, Toseef MD; Renno, Anas MD; Hasan, Syed DO; Alastal, Yaseen MD; Siddiqui, Nauman MD; Sodeman, Thomas MD; Nawras, Ali MD, FACP, FACG, FASGE

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S407-S410
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Introduction: Immunosuppressive therapy is being increasingly used in the management of inflammatory bowel disease which comprises of ulcerative colitis (UC) and crohn's disease (CD). Patients on immunosuppressive therapy are at increased risk of developing opportunistic fungal infections. We conducted this analysis to describe the epidemiology of opportunistic fungal infections in this cohort.

Methods: We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of IBD (Ulcerative Colitis and Crohn's disease) & Fungal infections (Histoplasmosis, Pneumocystosis, Cryptococcosis, Aspergillosis, Blastomycosis, candidiasis, Coccidiodomycosis) as primary or secondary diagnosis via ICD 9 codes during the period from 2002-2014. All analyses were performed with the use of PROC SURVEYMEANS, SURVEYFREQUENCY and SURVEYLOGISTIC procedures of SAS, version 9.4 (SAS Institute).

Results: In UC, the incidence of all fungal infections was more in age above 50 (except for pneumoconiosis) male gender (except Candidiasis) and in Caucasians. In CD, the incidence was more in age above 50 (except Pneumocystosis, Blastomycosis & Coccidiodomycosis), female gender (except Histoplasmosis, Pneumocystosis & Cryptococcosis) and in Caucasians. Histoplasmosis & Blastomycosis was more prevalent in Midwest, Cryptococcosis & Candidiasis in south, Coccidiodomycosis in west in both UC and CD (Table 1). Age above 50, south region, HIV, Congestive heart failure, underlying malignancies, diabetes mellitus with complications, chronic pulmonary disease, anemia, rheumatoid arthritis, collagen vascular disease, pulm circulation disorders, weight loss were significant predictors of fungal infections in IBD (Table 2). The yearly trend showed a consistent small rise in incidence, and the mortality dropped till 2006 to peak again in 2008 with a subsequent decline.

Demographics of Fungal Infections in Ulcerative Colitis.
Demographics of Fungal Infections in Crohn's disease.

Conclusion: Our study is the first one to describe the basic demographic features and characteristics of opportunistic fungal infections in hospitalized patients of IBD. The yearly incidence of fungal infections didn't show a significant rise. The mortality increased between 2006 to 2008 and a significant difference remains between IBD patients with and without Fungal infections. One explanation of rise in mortality but a consistent incidence could be the use of biologics that didn't increase the incidence but compromised the ability of IBD patients to fight opportunistic infections.

Predictors of Fungal Infections in IBD.
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