Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections

Abstract

Systemic rheumatic diseases have significant morbidity and mortality, due in large part to concurrent infections. The lung has been reported among the most frequent sites of infection in patients with rheumatic disease, who are susceptible to developing pneumonia sustained both by common pathogens and by opportunistic microorganisms. Patients with rheumatic disease show a peculiar vulnerability to infectious complications. This is due in part to intrinsic disease-related immune dysregulation and in part to the immunosuppressive treatments. Several therapeutic agents have been associated to a wide spectrum of infections, complicating the management of rheumatic diseases. This review discusses the most frequent pulmonary infections encountered in rheumatic diseases, focusing on opportunistic agents, consequent diagnostic challenges and appropriate therapeutic strategies.

Five year retrospective study of mortality in systemic inflammatory rheumatologic disorders

“…13,17,21 SLE patients have a predisposition to tuberculosis and bacterial infections especially respiratory urinary and skin infections, due to defective immune system and immunosuppressive therapies. 14,16,18,19 High disease activity and concomitant infections are known in SLE. 13,23 In keeping with the above study, present study, 72% patients succumbed to infection, bacterial pneumonia being most common.…”

Incidences and risk factors of serious infections among different rheumatic patients: a retrospective cohort study

“…Some researchers discovered that therapy with nonbiologic DMARDs represented an additional factor of increased risk of infections and the risk varied depending on the different nonbiologic DMARDs used [4]. For explorative purposes, the second analysis was conducted on the overall cohort by separating each nonbiologic DMARD to see their individual effect ( , and were associated with serious infections (mostly signi cant with p < 0.05 except for sulfasalazine with p = 0.3).…”

“…Systemic rheumatic diseases are associated with considerable morbidity and mortality, a signi cant proportion of which can be attributed to serious infections [1][2][3]. Possible causes of vulnerability of rheumatic patients towards infection include alterations of immunoregulation, disease severity, comorbid illnesses, and the use of immunosuppressive medications [4]. Therefore, to reduce serious infections, it is important to have a clear understanding of the disease progressions and potential risk factors.…”

Lower respiratory tract infections in rheumatic diseases

“…Основные антибактериальные препараты -макролиды, фторхинолоны, тетрациклины и рифампицин. При наличии кавитаций или тяжелого течения показано внутривенное введение моксифлоксацина или левофлоксацина и азитромицина в сочетании с рифампицином [34]. Летальный исход зафиксирован в 19% случаев [33].…”

“…В качестве альтернативы у клинически стабильных пациентов могут быть применены итраконазол, позаконазол, каспофунгин. Терапию продолжают в течение 4-6 мес до исчезновения клинических признаков заболевания, эрадикации возбудителя из очага инфекции, купирования рентгенологических признаков [34].…”