Infections in systemic lupus erythematosus: a prospective and controlled study of 110 patients

Abstract

We decided to analyse the incidence and characteristics of infection in systemic lupus erythematosus (SLE) and determine the related risks factors. One-hundred and ten SLE patients and 220 controls were prospectively followed up over three years and all the infectious episodes were recorded. A case-control design was established to identify risk factors of infection. Thirty-nine SLE patients suffered at least one infection (36%) versus 53 controls (22%), RR = 1.63 (P < 0.05). The incidence of urinary infections, pneumonia and bacteraemia without known focus was significantly greater in SLE. E. coli was the chief isolated microorganism (21.3%). In the univariate analysis, nephritis, SLE activity, leucopenia, anti-dsDNA levels above 20 IU/mL, CH50 levels under 300 IU/mL, ever use of steroids, daily dose of prednisone higher than 10 mg and ever use of cyclophosphamide were significantly associated with infection. In the multivariate analysis, total serum complement levels below 300 UU/mL and a daily dose of prednisone above 20 mg during at least one month plus ever use of cyclophosphamide were found to be significant (P < 0.0001). We conclude that patients with SLE have an increased overall risk for infection and they are especially prone to develop urinary infection, pneumonia and bacteraemia without focus. Hypocomplementaemia represents an independent predictive factor for infection. It seems mandatory to closely follow up SLE patients with low complement levels and instruct them to report any suspicious sign of infection, especially in those receiving more than 20 mg/day of prednisone who have also been administered cyclophosphamide.

Management of infection in systemic lupus erythematosus

“…Prednisone treatment, even at moderate doses, increases the risk, whilst antimalarials have a protective effect [13]. In detail, it was shown that the prednisone dose at the time of the event had a facilitating effect on infections, in agreement with previous studies [9], [10] and [11]. Moreover, it is worthy of note that the median dose of patients with major infections was only 7.5 mg day−1, with an 11-times higher risk of suffering a serious infection for each increase of 10-mg day−1 prednisone.…”

“…Several studies have analysed the prevalence and associated clinical and laboratory features of infection in SLE *[8], [9], [10] and [11]. Common themes are medications, including use of steroids and/or cyclophosphamide or high-disease activity as measured by the SLE Disease Activity Index [12].…”

Influenza Vaccination in Autoimmune Rheumatic Disease Patients

“…Patients suffering from systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and other autoimmune rheumatic diseases have a significantly higher risk of developing various infections compared to the healthy population (Bosch et al 2006;Glück and Müller-Ladner 2008). Infections are one of the leading causes of mortality in these patients (Doran et al 2002;Cervera et al 2003;Falagas et al 2007).…”

Clinical manifestations, courses, and outcomes of systemic lupus erythematosus in the dwellers of Kyrgyzstan

“…В последние годы все большее внимание привлекает проблема пневмоний, вызванных Pneumocystis jirovecii. По данным метаанализа, пневмоци-стная пневмония была обнаружена у 5% больных СКВ [42]. Предполагается, что в качестве факторов риска раз-вития пневмоцистной пневмонии среди пациентов с СКВ следует рассматривать высокую активность, пато-логию почек, интерстициальный легочный фиброз, большую суточную дозу ГК.…”