Infections in systemic lupus erythematosus patients

Infection is a frequent problem in patients with systemic lupus erythematosus (SLE), especially in those hospitalised with complications of disease. Infections contribute greatly to the morbidity of patients and are one of the commonest causes of death. The high frequency and unusual spectrum of infections can be attributed to the multiple disturbances of immune function in SLE in combination with the effects of immunosuppressive therapy. High doses of corticosteroids are particularly implicated as a risk factor for infection, although cyclophosphamide may also play a role. The majority of infections where a pathogen can be identified are due to typical gram-positive and negative bacteria. However, there is increasing evidence to indicate that opportunistic infections make a large contribution to the infectious mortality in SLE. Opportunistic infections are considerably under-reported due to difficulties in diagnosis pre-mortem and the fact that they can mimic or be superimposed upon active lupus. The presenting features of tuberculosis, listeriosis, nocardiosis, candidiasis, cryptococcal meningitis, Pneumocystis carinii pneumonia and invasive aspergillosis in patients with SLE are discussed in this review, with particular attention to presentation in SLE patients in Asia. Heightened awareness of the potential for opportunistic pathogens to infect SLE patients, together with earlier investigation and appropriate therapy for such infections, are likely to make a significant contribution to decreasing the mortality in patients with SLE.