Infection in systemic lupus erythematosus, similarities, and differences with lupus flare

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse manifestations, and its pathogenesis is unclear and complicated. Infection and SLE are similar in that they both cause inf lammatory reactions in the immune system; however, one functions to protect the body, whereas the other is activated to damage the body. Infection is known as one of the common trigger factors for SLE; there are a number of reports on infectious agents that provoke autoimmune response. Several viruses, bacteria, and protozoa were revealed to cause immune dysfunction by molecular mimicry, epitope spreading, and bystander activation. In contrast, certain pathogens were revealed to protect from immune dysregulation. Infection can be threatening to patients with SLE who have a compromised immune system, and it is regarded as one of the common causes of mortality in SLE. A clinical distinction between infection and lupus f lare up is required when patients with SLE present fevers. With a close-up assessment of symptoms and physical examination, C-reactive protein and disease activity markers play a major role in differentiating the different disease conditions. Vaccination is necessary because protection against infection is important in patients with SLE.

Increased Risk of Systemic Lupus Erythematosus in Patients With Helicobacter pylori Infection: A Nationwide Population-Based Cohort Study

“…Furthermore, before treatment with steroid or non-steroidal anti-inflammatory drugs (NSAIDs), testing for HP may be considered in patients with SLE and particularly in patients expected to be taking steroid continuously. HP induces autoimmunity by various mechanisms, such as molecular mimicry, polyclonal activation, epitope spreading, bystander activation, and superantigen (5). Amedei et al demonstrated that HP antigens can stimulate cross-reactive T cells and induce autoimmune gastritis by molecularly mimicking H+,K+-adenosine triphosphatase (22).…”

“…Several genetic and environmental factors might play a role in SLE pathogenesis (1,2). Among the known environmental factors, infections play a pivotal role in triggering the development of autoimmunity (3)(4)(5)(6). Exposure to certain environmental agents including bacteria, viruses, and protozoa in genetically susceptible people may act as the catalysts that initiate SLE.…”

Differential Parameters between Activity Flare and Acute Infection in Pediatric Patients with Systemic Lupus Erythematosus

“…Some infections may produce systemic manifestations mimicking SLE, either superimposed upon or triggering a are [8]. The interaction between infection and SLE is complicated, as viral, bacterial, parasitic, and fungal pathogens can trigger SLE disease activity through molecular mimicry [9]. The establishment of a causative link between infection and autoimmunity has been studied in detail, with the role of infectious agents in the induction as well as the progression or exacerbation of SLE con rmed [10].…”

Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis

“…In the face of autoimmune diseases, SLE patients are, somewhat paradoxically, at higher risk of infections, in particular bacterial infections, representing one of the leading causes of morbidity and mortality in disease (10). Infections account for 25-50% of overall mortality and half of SLE patients may experience severe infection, with more than 20% of hospitalizations being due to infections (11)(12)(13)(14).…”