Pathophysiology and Clinical Spectrum of Infections in Systemic Lupus Erythematosus
Section snippets
Bacterial infection
About 80% of SLE infections are caused by bacteria. The most frequent sites of infection are skin, respiratory tract, and urinary tract, accounting for more than two thirds of the infections seen in SLE (Box 2).39, 40, 41, 42
Depressed IL-12 production by polymorph nuclear cells (PMNs) in patients who have SLE could be of significance in acute infections, such as bacterial pneumonia, candidiasis, and urinary tract infection.43 Several risk factors predispose patients who have lupus to
Viral infections in systemic lupus erythematosus
Acute viral infections in children and adults induce transient autoimmune responses, including generation of autoantibodies in low titers with a transient course, but the progression into an established autoimmune disease is rare.64, 65 The most common viral infections in patients who have SLE are parvovirus B19 (there are more than 30 reports of primary B19 infection reported as lupus-like syndrome)66, 67, 68, 69, 70 and cytomegalovirus (CMV, predominantly presenting in severely
Fungal Infections
Cases of SLE with fungemia or invasive fungal infection have seldom been described. During the past 35 years, only case reports (the largest consisting of three cases) have described fungal infections in patients who had SLE. Sieving and colleagues108 reported three SLE cases who had deep fungal infections and reviewed 30 cases in the literature; most patients were young females. Among these 30 patients, the most common infection was Candida spp (n = 13), C neoformans in 10 and Aspergillus spp
Mycobacterial infections
Nontuberculous mycobacterium (NTM) infections have been described in patients who have autoimmune diseases in isolated case reports, especially in those who have SLE.116, 117, 118, 119 Mok and colleagues120 examined the clinical manifestations of NTM infections with those of M tuberculosis (MTB) infections in 725 patients who had SLE. Eleven cases were identified (prevalence 1.5%). The mean ± SD age at the time of infection was 42.8 ± 13.9 years, 9.3 ± 5.8 years after the onset of SLE. The mean
Is there any association between immunosuppressive therapy and increased morbidity and mortality due to infections in systemic lupus erythematosus?
The use of immunosuppressive therapies in SLE carries a significantly increased risk for developing infections, especially in patients treated with high-dose corticosteroids and cyclophosphamide. Infections in immunosuppressed patients are usually caused by bacteria, but patients may also develop severe viral infections. Patients who had viral infections who had received cyclophosphamide had a poorer survival. Staples and colleagues128, 129, 130 suggested that the incidence of infection among
Common Variable Immunodeficiency
Hypogammaglobulinemia in SLE may occur as part of common variable immunodeficiency (CVID).132, 133, 134, 135, 136 Patients who have CVID develop recurrent respiratory and sinus infections; a subset of these patients can also develop features suggestive of immune dysregulation, including autoimmunity (usually cytopenias and SLE); granulomatous inflammation, which can affect liver, spleen, and lungs; and bowel disease. Transition from one state to the other is clearly unusual.137, 138 Whether
Immunizations
SLE exacerbation and onset with pneumococcal vaccination, tetanus toxoid, H influenza B vaccines, and vaccinations for hepatitis B and influenza have been described.147, 148, 149 Autoimmune phenomena have been observed in response to measles, mumps, and rubella, and bacille Calmette-Guérin vaccinations. In the Carolina Lupus Study, there seemed to be no association between hepatitis B vaccination and SLE. Whether there is truly an association between immunizations and incident SLE is not well
References (150)
- et al.
TLR9/TLR7-triggered downregulation of BDCA2 expression on human plasmacytoid dendritic cells from healthy individuals and lupus patients
Clin Immunol
(2008) - et al.
Mannose binding lectin: genetics and autoimmune disease
Autoimmun Rev
(2005) - et al.
Toxicogenomics – a novel opportunity to probe lupus susceptibility and pathogenesis
Int Immunopharmacol
(2008) Structural basis of molecular mimicry
J Autoimmun
(2001)Infectious diseases in systemic lupus erythematosus: risk factors, management and prophylaxis
Best Pract Res Clin Rheumatol
(2002)- et al.
Septic arthritis in patients with systemic lupus erythematosus: salmonella and nonsalmonella infections compared
Semin Arthritis Rheum
(2006) - et al.
Human genetics of intracellular infectious diseases: molecular and cellular immunity against mycobacteria and salmonellae
Lancet Infect Dis
(2004) - et al.
Parvovirus B19 infection and systemic lupus erythematosus: activation of an aberrant pathway?
Eur J Intern Med
(2008) - et al.
Lupus-like presentation of parvovirus B19 infection
Semin Arthritis Rheum
(2005) - et al.
Lupus-like presentation of parvovirus B19 infection
Am J Med
(2001)
Successful acyclovir treatment of herpes simplex type 2 hepatitis in a patient with systemic lupus erythematosus: a case report and meta analysis
Am J Med Sci
Thrombocytopenia in systemic lupus erythematosus associated with cytomegalovirus infection
Scand J Rheumatol
Infections associated with haemophagocytic syndrome
Lancet Infect Dis
E.B. virus antibody in systemic lupus erythematosus
Lancet
Infection of autoreactive B lymphocytes with EBV, causing chronic autoimmune diseases
Trends Immunol
Expression of the Epstein-Barr virus nuclear antigen-1 (EBNA-1) in the mouse can elicit the production of anti-dsDNA and anti-Sm antibodies
J Autoimmun
Epstein-Barr virus latent membrane protein 2A and autoimmunity
Trends Immunol
Autoreactive B cells discriminate CpG-rich and CpG-poor DNA and this response is modulated by IFN-alpha
J Immunol
Gene expression in systemic lupus erythematosus: bone marrow analysis differentiates active from inactive disease and reveals apoptosis and granulopoiesis signatures
Arthritis Rheum
Recent advances and opportunities in research on lupus: environmental influences and mechanisms of disease
Environ Health Perspect
CpG DNA induces IgG class switch DNA recombination by activating human B cells through an innate pathway that requires TLR9 and cooperates with IL-10
J Immunol
Active systemic lupus erythematosus is associated with failure of antigen-presenting cells to express programmed death ligand-1
Rheumatology
T cell abnormalities in systemic lupus erythematosus
Autoimmunity
Dysfunctional interferon alpha production by peripheral plasmacytoid dendritic cells upon Toll-like receptor 9 stimulation in patients with lupus erythematosus
Arthritis Res Ther
Defective T-cell ERK signaling induces interferon-regulated gene expression and overexpression of methylation-sensitive genes similar to lupus patients
Genes Immun
Altered frequency and migration capacity of CD4+CD25+ regulatory T cells in systemic lupus erythematosus
Rheumatology
Apoptosis in the pathogenesis of systemic lupus erythematosus
Lupus
Up-regulated expression of Toll-like receptors mRNAs in peripheral blood mononuclear cells from patients with systemic lupus erythematosus
Clin Exp Immunol
Genetic susceptibility and haplotype analysis between Fcγ receptor IIB and IIIA gene with systemic lupus erythematosus in Chinese population
Lupus
B cell biology and dysfunction in SLE
Bull NYU Hosp Jt Dis
Regulatory T cells and systemic lupus erythematosus
Ann N Y Acad Sci
Complement C1q and C8β deficiency in an individual with recurrent bacterial meningitis and adult-onset systemic lupus erythematosus-like illness
Rheumatology
Nitroblue tetrazolium dye reduction by peripheral leukocytes from patients with rheumatoid arthritis and systemic lupus erythematosus measured by a histochemical and spectrophotometric method
J Lab Clin Med
Expression profile of FcγRIIb on leukocytes and its dysregulation in systemic lupus erythematosus
J Immunol
Systemic lupus erythematosus associated defects in the inhibitory receptor Fc γR IIb reduce susceptibility to malaria
Proc Natl Acad Sci U S A
Mannose-binding lectin and susceptibility to infection in Chinese patients with systemic lupus erythematosus
J Rheumatol
Complement deficiencies and systemic lupus erythematosus
Autoimmunity
Regulatory T cells in patients with systemic lupus erythematosus
J Autoimmun
The role of mannose-binding lectin in systemic lupus erythematosus
Clin Rheumatol
The genetics of SLE: an update in the light of genome-wide association studies
Rheumatology
Systemic lupus erythematosus, complement deficiency, and apoptosis
Adv Immunol
CCL3L1 gene-containing segmental duplications and polymorphisms in CCR5 affect risk of systemic lupus erythaematosus
Ann Rheum Dis
Gene-environment interactions in the aetiology of systemic lupus erythematosus
Autoimmunity
Genetics of clinical expression in SLE
Autoimmunity
Fc receptor genes and the systemic lupus erythematosus diathesis
Autoimmunity
Altered expression of Fcγ and complement receptors on B cells in systemic lupus erythematosus
Ann N Y Acad Sci
Current status of lupus genetics
Arthritis Res Ther
A compass that points to lupus: genetic studies on type I interferon pathway
Genes Immun
Distinct cell-specific control of autoimmunity and infection by FcγRIIb
J Exp Med
Genetics of susceptibility and severity in systemic lupus erythematosus
Curr Opin Rheumatol
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2021, Clinical RadiologyCitation Excerpt :The 71.4% mortality rate in the present study was notably higher than 39.1% reported in the study of Lao et al.18 Like previous studies,17–20 the most common identifiable Aspergillus spp. was A. fumigatus, and concomitant infections were common. The high susceptibility of various infections in SLE is hypothesised to be due to the aberrations of immune defences in SLE itself and the use of immunosuppressive agents.1,2,8,10,17 There were no differences in the clinical characteristics and CT findings between the IPA-alone group and the co-infection group, except for a higher frequency of alcohol consumption and haemoptysis in the IPA-alone group.
Infection in systemic lupus erythematosus patients
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