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SLE and infections
Gisele Zandman-Goddard1, Yehuda Shoenfeld
1Center for Autoimmune Diseases and Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel 52621.
Abstract:
Infections are common in systemic lupus erythematosus (SLE), and remain a source of mortality. The types of infections (such as pneumonia, urinary tract infection, cellulitis, and sepsis) in SLE patients are similar to the general population and include the same pathogens (Gram-positive and Gram-negative). SLE patients may also develop opportunistic infections, especially when treated with immunosuppressive agents. As a high-risk population, identification and treatment of chronic infections such as tuberculosis, hepatitis B, or human immunodeficiency virus (HIV), are important prior to the institution of immunosuppression to prevent reactivation or exacerbation of the infection. A common caveat is to distinguish between a lupus flare and an acute infection; judicious use of corticosteroids and cytotoxic drugs is critical in limiting infectious complications. The risk factors associated with susceptibility to disease include severe flares, active renal disease, treatment with moderate or high doses of corticosteroids and/or immunosuppressive agents, and others. Genetic factors (complement deficiencies, mannose-binding lectin, Fcgamma III, granulocyte macrophage colony-stimulating factor [GM-CSF], osteopontin) may predispose certain SLE patients to develop infections. Parameters including C-reactive protein (CRP) and adhesion molecules may help to differentiate an infectious disease from an exacerbation of the disease. Finally, the mechanism of molecular mimicry by specific microbial agents may play a role in the induction of SLE.
Insights
Systemic lupus erythematosus (SLE) patients frequently experience infections, a major cause of mortality. Differentiating infections from lupus flares and managing risk factors are crucial for better patient outcomes.
Area of Science:
- Rheumatology
- Infectious Diseases
- Immunology
Background:
- Infections are a significant cause of mortality in patients with systemic lupus erythematosus (SLE).
- SLE patients face risks for common and opportunistic infections, particularly when on immunosuppressive therapy.
- Distinguishing between an infection and a lupus flare is a critical clinical challenge.
Purpose of the Study:
- To review the epidemiology, risk factors, and management of infections in SLE patients.
- To highlight the importance of identifying and treating chronic infections before immunosuppression.
- To discuss factors aiding in the differentiation of infection from disease flares.
Main Methods:
- Review of existing literature on infections in SLE.
- Analysis of common pathogens and opportunistic infections in SLE.
- Discussion of risk factors, including genetic predispositions and treatment modalities.
Main Results:
- Infections in SLE patients involve similar pathogens to the general population but carry higher mortality risk.
- Immunosuppressive agents and disease activity (e.g., renal disease, severe flares) increase infection susceptibility.
- Genetic factors and biomarkers like C-reactive protein (CRP) may influence infection risk and differentiation from flares.
Conclusions:
- Proactive screening for chronic infections (e.g., tuberculosis, hepatitis B, HIV) is essential before initiating immunosuppression.
- Careful management of corticosteroids and immunosuppressants is vital to minimize infectious complications.
- Understanding risk factors and utilizing diagnostic parameters can improve the management of infections in SLE.