Factors Associated with Candidiasis in Pemphigus Vulgaris Patients: Results from a Retrospective Study in Two Second-Care Level Hospitals in Mexico
Abstract
:1. Introduction
2. Material and Methods
Statistical Analysis
3. Results
3.1. Demographic, Clinical, and Treatment Characteristics
3.2. Candida Species Distribution
3.3. Comparative Characteristics in Patients with Pemphigus Vulgaris with and without Candidiasis
3.4. Underlying Comorbidities
3.5. Identified Risk Factors
3.6. Source of Candidiasis
3.7. Mortality in Pemphigus Vulgaris with Candidiasis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics | Distribution (n = 100) |
---|---|
Age, years, mean ± SD (range) | 47.94 ± 10.42 (28–68) |
Male/female, n (%) | 38 (38)/62 (62) |
Patients who relapsed, n (%) | 20 (20) |
Patients with active disease * | 40 (40) |
Patients in remission, n (%) | 40 (40) |
Characteristic | Distribution, n = 79 (%) |
---|---|
Candida species (85 isolates in 79 patients) | |
C. albicans | 40 (47) |
C. glabrata | 8 (9) |
C. tropicalis | 4 (5) |
C. parapsilosis | 4 (5) |
C. krusei | 2 (2) |
Candida sp. | 27 (32) |
Antifungal agents (n = 79) | |
Topical antifulgal | 20 (25) |
Fluconazole | 27 (34) |
Itraconazole | 25 (32) |
Voriconazole | 7 (9) |
Variables | All Patients (n = 100) | Candidiasis | p-Value | |
---|---|---|---|---|
Absent (n = 21) | Present (n = 79) | |||
Age, mean ± SD | 47.94 ± 10.42 | 50.38 ± 10.75 | 46.17 ± 9.99 | NS |
Gender, female | 62 (62) | 14 (67) | 50 (63) | NS |
Any comorbidity | 46 (46) | 9 (43) | 37 (47) | NS |
Diabetes | 28 (28) | 8 (38) | 20 (25) | NS |
Hypertension | 37 (37) | 8 (38) | 29 (37) | NS |
Coronary artery disease | 12 (12) | 4 (19) | 8 (10) | NS |
Chronic renal disease | 15 (15) | 7 (33) | 8 (10) | NS |
Malignancy | 10 (10) | 3 (14) | 7 (9) | NS |
Cerebrovascular events | 5 (5) | 1 (5) | 4 (5) | NS |
NLR, mean ± SD | 3.6 ± 2.9 | 2.68 ± 0.91 | 4.16 ± 1.14 | 0.001 |
PLR, mean ± SD | 183.23 ± 89.4 | 155.25 ± 49.7 | 237.55 ± 63.16 | 0.002 |
PNR, mean ± SD | 60.25 ± 18.35 | 59.78 ± 12.84 | 57.38 ± 5.17 | NS |
Sepsis | 24 (24) | 5 (24) | 19 (24) | NS |
Candida spp. in oral cavity | 36 (36) | 36 (45) | ||
Candida spp. in genital mucosae | 35 (35) | 35 (44) | ||
Candida spp. in skin | 29 (29) | 29 (37) | ||
Candida spp. in urine sample | 15 (15) | 15 (19) | ||
Candidemia | 14 (14) | 14 (18) | ||
Prior antibiotic use, including extended spectrum antibiotics | 39 (39) | 5 (24) | 34 (43) | 0.015 |
Prior antifungal agent use | 27 (27) | 3 (14) | 24 (30) | 0.019 |
Pulse corticosteroid therapy | 46 (46) | 3 (14) | 43 (54) | 0.001 |
Maximum dose of corticosteroid (mg/day) | 55.32 ± 18.49 | 51.9 ± 5.58 | 67.67 ± 12.09 | 0.012 |
Latest dose of corticosteroid (mg/day) | 15.28 ± 8.33 | 6.07 ± 2.02 | 17.83 ± 7.6 | 0.001 |
3 months’ cumulative dose of corticosteroid (mg) | 3249 ± 1523 | 2602.1 ± 482.72 | 3602.17 ± 886.26 | 0.012 |
Rituximab | 30 (30) | 6 (28) | 24 (30) | NS |
Azathioprine | 88 (88) | 18 (86) | 70 (89) | NS |
Mofetil mycofenolate | 38 (38) | 7 (33) | 31 (39) | NS |
Overall death | 12 (12) | 1 (5) | 11 (14) | 0.025 |
Variable | OR | 95%CI | p-Value |
---|---|---|---|
Age (≥65 years) | 1.5 | 0.92–3.23 | 0.038 |
Gender (female) | 1.45 | 1.23–3.38 | 0.025 |
Comorbidity | 0.58 | 0.26–1.38 | 0.078 |
Diabetes mellitus | 0.78 | 0.4–1.86 | 0.123 |
Hypertension | 0.85 | 0.71–1.89 | 0.14 |
Coronary artery disease | 0.45 | 0.28–1.39 | 0.33 |
Chronic renal disease | 0.38 | 0.27–2.22 | 0.146 |
Malignancy | 1.28 | 0.42–3.84 | 0.066 |
Cerebrovascular event | 1.65 | 0.19–4.58 | 0.079 |
Sepsis | 2.78 | 1.25–7.36 | 0.025 |
PV relapse | 3.25 | 1.89–7.23 | 0.015 |
Active PV | 2.89 | 1.15–4.35 | 0.028 |
PV severity (≥15% BSA) | 3.18 | 1.25–4.2 | 0.01 |
Maximum corticosteroid dose (≥50 mg/day) | 4.85 | 1.87–6.43 | 0.001 |
Pulse corticosteroid therapy | 3.59 | 2.23–4.89 | 0.002 |
Prior antibiotic use | 6.48 | 1.12–7.23 | 0.042 |
Prior antifungal use | 3.45 | 1.22–3.33 | 0.035 |
Mycophenolate mofetil | 0.65 | 0.33–0.98 | 0.04 * |
Rituximab | 1.1 | 0.45–1.23 | 0.13 |
NLR (≥2) | 3.38 | 1.27–4.59 | 0.001 |
PLR (≥150) | 2.85 | 1.84–3.59 | 0.001 |
PNR (≥50) | 1.12 | 0.24–2.23 | 0.057 |
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Tirado-Sánchez, A.; Bonifaz, A.; Frías De León, M.G. Factors Associated with Candidiasis in Pemphigus Vulgaris Patients: Results from a Retrospective Study in Two Second-Care Level Hospitals in Mexico. Trop. Med. Infect. Dis. 2023, 8, 521. https://doi.org/10.3390/tropicalmed8120521
Tirado-Sánchez A, Bonifaz A, Frías De León MG. Factors Associated with Candidiasis in Pemphigus Vulgaris Patients: Results from a Retrospective Study in Two Second-Care Level Hospitals in Mexico. Tropical Medicine and Infectious Disease. 2023; 8(12):521. https://doi.org/10.3390/tropicalmed8120521
Chicago/Turabian StyleTirado-Sánchez, Andrés, Alexandro Bonifaz, and María Guadalupe Frías De León. 2023. "Factors Associated with Candidiasis in Pemphigus Vulgaris Patients: Results from a Retrospective Study in Two Second-Care Level Hospitals in Mexico" Tropical Medicine and Infectious Disease 8, no. 12: 521. https://doi.org/10.3390/tropicalmed8120521