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Infections and SLE.

Gisele Zandman-Goddard1, Yehuda Shoenfeld

  • 1Center for Autoimmune Diseases and Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel.

Autoimmunity
|December 24, 2005
PubMed
Summary
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Infections can trigger or worsen systemic lupus erythematosus (SLE) in susceptible individuals. SLE patients face higher infection risks due to immune defects and treatments, necessitating careful infection management.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Rheumatology

Background:

  • Viral and bacterial infections are potential environmental triggers for systemic lupus erythematosus (SLE) development or exacerbation in genetically predisposed individuals.
  • Systemic lupus erythematosus patients exhibit increased susceptibility to common, chronic, and opportunistic infections due to inherent genetic/immunologic defects and immunosuppressive therapies.
  • Distinguishing between SLE flares and acute infections is challenging, though elevated C-reactive protein (CRP) and adhesion molecules may assist diagnosis.

Purpose of the Study:

  • To explore the intricate relationship between infections and systemic lupus erythematosus (SLE).
  • To highlight the increased susceptibility of SLE patients to various infections.
  • To emphasize the importance of pre-emptive infection management in SLE patients.

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Main Methods:

  • Review of existing literature on infections in SLE patients.
  • Analysis of immunologic defects and therapeutic interventions contributing to infection risk.
  • Discussion of diagnostic challenges and potential biomarkers for differentiating infection from SLE flares.

Main Results:

  • Infections significantly contribute to morbidity and mortality in SLE patients.
  • Genetic factors (e.g., MBL polymorphisms) and immunosuppressive treatments exacerbate infection risk.
  • Epstein-Barr virus (EBV) infection is implicated in molecular mimicry, B cell aberrations, and apoptosis, potentially perpetuating immune responses in SLE.

Conclusions:

  • Systemic lupus erythematosus patients represent a high-risk population requiring vigilant infection surveillance and management.
  • Early identification and treatment of chronic infections (e.g., tuberculosis, hepatitis B, HIV) are crucial before initiating immunosuppression.
  • Further research into the role of specific infections like EBV in SLE pathogenesis is warranted.