Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Molooghi, Kasra; Sheybani, Fereshte; Naderi, HamidReza; Mirfeizi, Zahra; Morovatdar, Negar; Baradaran, Ashkan

doi:10.1136/lupus-2021-000560

Cited by 9 publications

(17 citation statements)

References 66 publications

(68 reference statements)

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“…Signs of meningeal irritation were observed in less than half of the cases (49.4%). 56 Epileptic seizures (29%) and the presence of focal neurological signs (20%) occurred in smaller proportions. 56 A longer disease duration, higher doses of corticosteroids, and lower disease activity are risk factors.…”

Section: Cns Infectionsmentioning

confidence: 99%

“…56 Epileptic seizures (29%) and the presence of focal neurological signs (20%) occurred in smaller proportions. 56 A longer disease duration, higher doses of corticosteroids, and lower disease activity are risk factors. [57][58][59] Only 7.6% of patients with neuroinfection were not using any immunosuppressants.…”

Section: Cns Infectionsmentioning

confidence: 99%

“…55,56 A meta-analysis published in 2022 that included six studies involving 17,751 patients with SLE reported a frequency of neuroinfection of 0.012 (95% confidence interval [CI] 0.008-0.018). 56 Headache was present in 90.4%-100% of patients and tended to be more intense and prolonged compared to patients with no neuroinfection. 57 In addition, high fever and vomiting may also be expected.…”

Section: Cns Infectionsmentioning

confidence: 99%

“…[57][58][59] Only 7.6% of patients with neuroinfection were not using any immunosuppressants. 56 Increased C-reactive protein and hypoalbuminemia favor neuroinfection, while hypocomplementemia suggests non-infectious neurological complications. 57,58 In the CSF assessment, an increased opening pressure, pleocytosis, a predominance of neutrophils, increased protein, and reduced glucose levels suggest the presence of infection.…”

Section: Cns Infectionsmentioning

confidence: 99%

“…60 The main etiological agents found in patients with SLE were Cryptococcus neoformans, Mycobacterium tuberculosis, Listeria monocytogenes, Streptococcus pneumonia, and Nocardia asteroides. 56 When neuroinfection is suspected, empirical treatment should be considered before confirming the etiology due to the high morbidity and mortality rate; however, due to the high toxicity associated with antifungal treatment, the recommendation is to use tests faster than cultures, such as cryptococcal antigen, for an improved therapeutic definition. 56…”

Section: Cns Infectionsmentioning

confidence: 99%

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Headache and systemic lupus erythematosus: A narrative review

Oliveira

Rocha-Filho

2023

Headache

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Objective To review the epidemiology, the differential diagnosis, and the clinical and laboratory factors associated with the care management of headaches in patients with systemic lupus erythematosus (SLE). Background SLE is a chronic autoimmune disease and in 12%–95% of patients, the nervous system is involved. Headache is a frequently reported, although nonspecific, symptom that may potentially represent serious underlying diagnoses. Primary headaches may also occur in these patients, thereby causing a negative and significant impact on their quality of life. Methods This is a narrative review. A literature review was conducted on the PubMed platform using the following terms: (1) headache and (2) lupus. All articles considered relevant were included. No limitations were imposed for the publication date. Results Headache is a frequent symptom in patients with SLE. Although its prevalence is similar to the general population, headaches nonetheless tend to have a greater negative impact on these patients. Patients with SLE are more likely to experience headache due to vascular diseases such as cerebral venous sinus thrombosis, stroke, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and vasculitis. Aseptic meningitis, neuroinfections, intracranial neoplasms, and intracranial hypertension or hypotension may also be a cause of headache in these patients. Although used in disease activity scores, the concept of lupus headache is controversial. Conclusions Headache is a frequent symptom in patients with SLE. An appropriate approach enables the potentially serious conditions, which are the causes of secondary headaches, to be recognized and treated, together with an appropriate diagnosis and treatment of primary headaches.

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Section: Cns Infectionsmentioning

confidence: 99%

Section: Cns Infectionsmentioning

confidence: 99%

Section: Cns Infectionsmentioning

confidence: 99%

Section: Cns Infectionsmentioning

confidence: 99%

Section: Cns Infectionsmentioning

confidence: 99%

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Headache and systemic lupus erythematosus: A narrative review

Oliveira

Rocha-Filho

2023

Headache

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Systemic Lupus Erythematosus

Siegel,

Sammaritano

2024

JAMA

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ImportanceSystemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by inflammation and immune-mediated injury to multiple organ systems, including the mucocutaneous, musculoskeletal, hematologic, and kidney systems. Approximately 3.4 million people worldwide have received a diagnosis of SLE.ObservationsApproximately 90% of people with SLE are female. Although there are no uniformly accepted diagnostic criteria for SLE, the 2019 European Alliance of Associations for Rheumatology (formerly the European League Against Rheumatism)/American College of Rheumatology classification criteria developed for scientific study are an estimated 96.1% sensitive and 93.4% specific for SLE. These classification criteria include both clinical factors, such as fever, cytopenia, rash, arthritis, and proteinuria, which may be indicative of lupus nephritis; and immunologic measures, such as SLE-specific autoantibodies and low complement levels. Approximately 40% of people with SLE develop lupus nephritis, and an estimated 10% of people with lupus nephritis develop end-stage kidney disease after 10 years. The primary goal of treatment is to achieve disease remission or quiescence, defined by minimal symptoms, low levels of autoimmune inflammatory markers, and minimal systemic glucocorticoid requirement while the patient is treated with maintenance doses of immunomodulatory or immunosuppressive medications. Treatment goals include reducing disease exacerbations, hospitalizations, and organ damage due to the disease or treatment toxicity. Hydroxychloroquine is standard of care for SLE and has been associated with a significant reduction in mortality. Treatments in addition to hydroxychloroquine are individualized, with immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, typically used for treating moderate to severe disease. Three SLE medications were recently approved by the Food and Drug Administration: belimumab (for active SLE in 2011 and for lupus nephritis in 2020), voclosporin (for lupus nephritis), and anifrolumab (for active SLE).Conclusions and RelevanceSystemic lupus erythematosus is associated with immune-mediated damage to multiple organs and increased mortality. Hydroxychloroquine is first-line therapy and reduces disease activity, morbidity, and mortality. When needed, additional immunosuppressive and biologic therapies include azathioprine, mycophenolate mofetil, cyclophosphamide, belimumab, voclosporin, and anifrolumab.

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Tuberculosis remains a leading contributor to morbidity due to serious infections in Indian patients of SLE

et al. 2023

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Introduction Infections are a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in SLE in India. Methods A retrospective review of a cohort of 1354 patients of adult SLE (ACR 1997 criteria) seen between 2000 and 2021 at a single center was conducted. Serious infections (need for hospitalisation, prolonged intravenous antibiotics, disability, or death) were recorded. Cox regression was used to determine factors associated with serious infection and the effects of serious infection on survival and damage. Results Among the 1354 patients (1258 females, mean age of 30.3 years, follow-up of 7127.89 person-years), there were 439 serious infections in 339 patients (61.6 per 1000 person-years follow-up). Bacterial infections ( N = 226) were the most common infection followed by mycobacterial infections ( n = 81), viral ( n = 35), and then invasive fungal infections ( N = 13). Mycobacterium tuberculosis was the single most common microbiologically confirmed organism with incidence of 1136.4/100,000 person-years with 72.8% of them being extrapulmonary. Infection free survival at 1 year and 5 years was 82.9% and 73.8%. There were 119 deaths with infection attributable mortality in 65 (54.6%). On multivariable Cox regression analysis, higher baseline activity (HR 1.02, 1.01–1.05), gastrointestinal involvement (HR 2.75, 1.65–4.69), current steroid dose (HR 1.65, 1.55–1.76), and average cumulative steroid dose per year (HR 1.007, 1.005–1.009) were associated with serious infection and higher albumin (HR 0.65, 0.56–0.76) was protective. Serious infections led to greater damage accrual (median SLICC damage index of 1 vs. 0) and mortality (HR was 18.2, 32.7 and 81.6 for the first, second, and third infections). Conclusion Serious infections remain a major cause of mortality and damage accrual in SLE and higher disease activity, gastrointestinal involvement, hypoalbuminemia, current steroid dose, and cumulative steroid dose are the risk factors for it. Key Points • Tuberculosis is still a major cause of morbidity in South Asian patients of SLE. • Serious infections are associated with higher damage accrual and mortality in patients with SLE. • Higher disease activity, gastrointestinal involvement, hypoalbuminemia, and current steroid dose were associated with increased risk of infection. • This study provides data to enable specific recommendations for infection prevention in SLE for the South Asian region. Supplementary information The online version contains supplementary material available at 10.1007/s10067-023-06592-x.

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Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Cited by 9 publications

References 66 publications

Headache and systemic lupus erythematosus: A narrative review

Headache and systemic lupus erythematosus: A narrative review

Systemic Lupus Erythematosus

Tuberculosis remains a leading contributor to morbidity due to serious infections in Indian patients of SLE

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