{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:35:31Z","timestamp":1792445731063,"version":"4.5.0"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>TNF\u2010\u03b1 inhibitors, including infliximab, adalimumab and etanercept, are used to treat various inflammatory diseases, such as arthritis, psoriasis and ankylosing spondylitis. However, these treatments may predispose patients to fungal infections, including histoplasmosis, candidiasis and aspergillosis. In this study, we systematically reviewed case reports to critically examine the correlations between anti\u2010TNF\u2010\u03b1 therapies and the occurrence of invasive and superficial fungal infections. Infliximab was the most commonly used TNF\u2010\u03b1 inhibitor (50.65%). The highest number of fungal infections during anti\u2010TNF34 \u03b1 therapy was reported in the USA (84.25%). The conditions treated primarily included rheumatoid arthritis. A total of 517 invasive fungal infections were identified, including histoplasmosis, invasive candidiasis and aspergillosis, with histoplasmosis being the most common. Most studies were conducted in higher\u2010income countries, highlighting the critical lack of research on the use of immunobiologicals in relation to fungal diseases in African countries, which requires further attention. Logistic regression analysis revealed significant associations between adalimumab use and increased risks of candidiasis, coccidioidomycosis, onychomycosis and pityriasis versicolor. For etanercept, significant associations were found with aspergillosis, coccidioidomycosis, cryptococcosis, dermatophytosis, invasive candidiasis, pityriasis versicolor and onychomycosis. Infliximab use was significantly associated with coccidioidomycosis, onychomycosis, aspergillosis, cryptococcosis, histoplasmosis and invasive candidiasis. The data presented in this study clearly demonstrate an association between the use of TNF\u2010\u03b1 inhibitors and an increased risk of fungal infections. It is imperative that healthcare professionals maintain a high level of vigilance when managing patients on these medications. Regular monitoring and proactive management strategies are essential to mitigate risks and ensure patient safety.<\/jats:p>","DOI":"10.1111\/myc.70040","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T04:40:44Z","timestamp":1741668044000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Fungal Infections Associated With\n                    <scp>TNF<\/scp>\n                    \u2010Inhibitors: A 20\u2010Year of a Systematic Review Fungal Infections and\n                    <scp>TNF<\/scp>\n                    \u2010Inhibitors"],"prefix":"10.1111","volume":"68","author":[{"given":"Layala Stefane de Paula","family":"Barbosa","sequence":"first","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade (FCS), Rodovia Dourados\/Itahum Federal University of Grande Dourados (UFGD)  Dourados Mato Grosso do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina Miranda","family":"Ely","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade (FCS), Rodovia Dourados\/Itahum Federal University of Grande Dourados (UFGD)  Dourados Mato Grosso do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T\u00falio M\u00e1ximo","family":"Salom\u00e9","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade (FCS), Rodovia Dourados\/Itahum Federal University of Grande Dourados (UFGD)  Dourados Mato Grosso do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gleyce Hellen","family":"de Almeida de Souza","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade (FCS), Rodovia Dourados\/Itahum Federal University of Grande Dourados (UFGD)  Dourados Mato Grosso do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1108-5666","authenticated-orcid":false,"given":"Daniel Assis","family":"Santos","sequence":"additional","affiliation":[{"name":"Departamento de Microbiologia, Instituto de Ci\u00eancias Biol\u00f3gicas Universidade Federal de Minas Gerais  Belo Horizonte Minas Gerais Brazil"},{"name":"National Institute of Science and Technology in Human Pathogenic Fungi  Ribeir\u00e3o Preto S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Wesley","family":"Bastos","sequence":"additional","affiliation":[{"name":"National Institute of Science and Technology in Human Pathogenic Fungi  Ribeir\u00e3o Preto S\u00e3o Paulo Brazil"},{"name":"Laborat\u00f3rio de Uso Comum, Centro de Bioci\u00eancias Universidade Federal do Rio Grande do Norte  Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana","family":"Rossato","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade (FCS), Rodovia Dourados\/Itahum Federal University of Grande Dourados (UFGD)  Dourados Mato Grosso do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11882-007-0013-3"},{"key":"e_1_2_9_3_1","first-page":"1","volume-title":"Encyclopedia of Inflammatory Diseases","author":"Pile K. 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