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The newest agents being used to treat collagen-vascular diseases are the tumor necrosis factor (TNF)-\u03b1 inhibitors. U.S. Food and Drug Administration\u2013approved TNF-\u03b1 inhibitors have differing effects on the immune system, reflecting their potency and mechanisms of action. They are particularly effective in breaking down granulomatous inflammation, which makes them effective treatment for sarcoidosis and Wegener's granulomatosis. This same property makes them likely to break down the host defense mechanism that normally contains pathogens such as mycobacteria and fungi in a dormant state, namely the physical and immunologic barrier formed by granulomas in the lung and elsewhere. The most common infection reported with the TNF-\u03b1 inhibitors has been tuberculosis, which may manifest as pulmonary and\/or extrapulmonary disease, with the latter being more common and severe than usual. Histoplasma capsulatum, Aspergillus, Cryptococcus neoformans, and Listeria monocytogenes have also been described in a number of cases, and their frequency is discussed.<\/jats:p>","DOI":"10.1513\/pats.200508-091js","type":"journal-article","created":{"date-parts":[[2005,12,1]],"date-time":"2005-12-01T18:12:18Z","timestamp":1133460738000},"page":"456-460","source":"Crossref","is-referenced-by-count":22,"title":["Immunosuppression Related to Collagen-Vascular Disease or Its Treatment"],"prefix":"10.1093","volume":"2","author":[{"given":"Carol Dukes","family":"Hamilton","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North 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