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SLE and infections

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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, Fcgarama 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.

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References

  1. Petri, M. (1998), Rheum. Dis. Clin. N. Am. 24, 423–456.

    Article  CAS  Google Scholar 

  2. Fessler, B. J. (2002), Best Pract. Res. Clin. Rheumatol. 16, 281–291.

    Article  PubMed  Google Scholar 

  3. Bouza, E., Moya, J. G., and Munoz, P. (2001), Infect. Dis. Clin. N. Am. 15, 335–361.

    Article  CAS  Google Scholar 

  4. Gladman, D. D., Hussain, F., Ibanez, D., et al. (2002), Lupus 11, 234–239.

    Article  PubMed  CAS  Google Scholar 

  5. Cervera, R., Khamashta, M. A., Font, J., et al. (1999), Medicine (Baltimore), 78, 167–175.

    Article  CAS  Google Scholar 

  6. Noel, V., Lortholary, O., Casassus, P., et al. (2001), Ann. Rheum. Dis. 60, 1141–1144.

    Article  PubMed  CAS  Google Scholar 

  7. Zonana-Nacach, A., Camargo-Coronel, A., Yanez, P., et al. (2001), Lupus 10, 505–510.

    Article  PubMed  CAS  Google Scholar 

  8. Li, Z., Chen, L., Tao, R., et al. (1998), Chin. Med. J. (Engl.) 111, 913–916.

    CAS  Google Scholar 

  9. Wongchinsri, J., Tantawichien, T., Osiri, M., et al., (2002), J. Med. Assoc. Thail. 85(Suppl 1), S34-S39.

    Google Scholar 

  10. Bouza, E., Moya, J. G., Munoz, P., et al., (2000), P R Health Sci. J. 19, 335–339.

    Google Scholar 

  11. Alarcon, G. S., McGwin, G. Jr., Bastian, H. M., et al., (2001), Arthritis Rheum. 45, 191–220.

    Article  PubMed  CAS  Google Scholar 

  12. Bellomio, V., Spindler, A., Lucero, E., et al., (2000), Lupus 9, 377–381.

    PubMed  CAS  Google Scholar 

  13. Jacobsen, S., Petersen, J., Ullman, S., et al., (1999), Scand. J. Rheumatol. 28, 75–80.

    Article  PubMed  CAS  Google Scholar 

  14. Tsao, C. H., Chen, C. Y., Ou, L. S., and Huang, J. L. (2002), J. Rheumatol. 29, 1214–1218.

    PubMed  Google Scholar 

  15. Lim, E., Koh, W. H., Loh, S. F., Lam, M. S., and Howe, H. S. (2001), Lupus 10, 87–92.

    Article  PubMed  CAS  Google Scholar 

  16. El-Roiey, A., Gross, W. L., Ludeman, J., et al., (1986), Immunol. Lett. 12, 313–319.

    Article  PubMed  CAS  Google Scholar 

  17. El-Roeiy, A., Sela, O., Isenberg, D., et al., (1987), Clin. Exp. Immunol. 67, 505–515.

    Google Scholar 

  18. George, J. and Shoenfeld, Y. (1995), Lupus 4, 333–335.

    PubMed  CAS  Google Scholar 

  19. Kowal, C., Weinstein, A., and Diamond, B. (1999), Eur. J. Immunol. 29, 1901–1911.

    Article  PubMed  CAS  Google Scholar 

  20. Yun, J. E., Lee, S. W., Kim, T. H., et al., (2002), Clin, Exp. Rheumatol. 20, 127–132.

    CAS  Google Scholar 

  21. Balakrishnan, C., Mangat, G., Mittal, G., et al., (1998), J. Assoc. Physicians India 46, 682–683.

    PubMed  CAS  Google Scholar 

  22. Hernandez-Cruz, B., Sifuentes-Osornio, J., Poncede-Leon Rosales, S., et al. (1999), Clin. Exp. Rheumatol. 17, 289–296.

    PubMed  CAS  Google Scholar 

  23. Gordon, M. M., Wilson, H. E., Duthie, F.R., et al., (2002), Rheumatology (Oxford) 41, 685–690.

    Article  Google Scholar 

  24. Sela, O., el-Roeiy, A., Isenberg, D., et al., (1987), Arthritis Rheum. 30, 50–56.

    Article  PubMed  CAS  Google Scholar 

  25. Tasneem, S., Islam, N., and Ali, R. (2001), Microbiol. Immunol. 45, 841–846.

    PubMed  CAS  Google Scholar 

  26. Seta, N., Shimizu, T., Nawata, M., et al., (2002), Rheumatology 41, 1072–1073.

    Article  PubMed  CAS  Google Scholar 

  27. Lyngberg, K. K., Vennervald, B. J., Bygbjerg, I. C., et al. (1992), Ann. Med. 24, 337–340.

    PubMed  CAS  Google Scholar 

  28. Zamir, D., Amar, M., Groisman, G., et al., (1999), Mayo Clin. Proc. 74, 575–578.

    Article  PubMed  CAS  Google Scholar 

  29. Baykal, Y., Saglam, K., and Caliskaner, Z. (1998), J. Rheumatol. 25, 2038–2039.

    PubMed  CAS  Google Scholar 

  30. Hsu, T. C. and Tsay, G. J. (2001), Rheumatology (Oxford) 40, 152–157.

    Article  CAS  Google Scholar 

  31. Barash, J., Dushnitzky, D., Sthoeger, D., et al., (2002), Isr. Med. Assoc. J. 4, 763–765.

    PubMed  Google Scholar 

  32. Diaz, F., Collazos, J., Mendoza, F., et al., (2002), Clin. Microbiol. Infect. 8, 115–117.

    Article  PubMed  CAS  Google Scholar 

  33. Trapani, S., Ermini, M., and Falcini, F. (1999), Semin. Arthritis Rheum. 28, 319–325.

    Article  PubMed  CAS  Google Scholar 

  34. Sekigawa, I., Nawata, M., Seta, N., et al. (2002), Clin. Exp. Rheumatol. 20, 559–564.

    PubMed  CAS  Google Scholar 

  35. Gharavi, A. E., Pierangeli, S. S., Espinola, R. G., et al. (2002), Arthritis Rheum. 46, 545–552.

    Article  PubMed  CAS  Google Scholar 

  36. McClain, M. T., Harley, J. B., and James, J. A. (2001), Front Biosci. 6, E137-E147.

    PubMed  CAS  Google Scholar 

  37. James, J. A., Neas, B. R., Moser, K. L., et al., (2001), Arthritis Rheum. 44, 1122–1126.

    Article  PubMed  CAS  Google Scholar 

  38. Zandman-Goddard, G. and Shoenfeld, Y. (2002), Autoimmunity Reviews 1, 329–337.

    Article  PubMed  CAS  Google Scholar 

  39. Barthel, H. R. and Wallace, D. J. (1993), Semin. Arthritis Rheum. 23, 1–7.

    Article  PubMed  CAS  Google Scholar 

  40. Pontesilli, O., Kerkhof-Grade, S., Notermans, D. W., et al. (1999), J. Infect. Dis. 180, 76–86.

    Article  PubMed  CAS  Google Scholar 

  41. Erdal, D., Lipsky, P. E., and Berggren, R. E. (2000), J. Rheumatol. 27 2711–2714.

    Google Scholar 

  42. Palacios, R., Santos, J., Valdivielso, P., et al., (2002), Lupus 1, 60–63.

    Article  Google Scholar 

  43. Fox, R. A. and Isenberg, D. A. (1997), Arthritis Rheum. 40, 1168–1172.

    Article  PubMed  CAS  Google Scholar 

  44. Diri, E., Lipsky, P. E., and Berggren, R. E. (2000), J. Rheumatol. 27, 2711–2714.

    PubMed  CAS  Google Scholar 

  45. Gonzalez, C. M., Lopez-Longo, F. J., Samson, J., et al., (1998), AIDS Patient Care STDS 12, 21–28.

    Article  PubMed  CAS  Google Scholar 

  46. Adelman, M. K. and Marchalonis, J. J. (2002), Clin. Immunol. 102, 107–116.

    Article  PubMed  CAS  Google Scholar 

  47. Garred, P., Voss, A., Madsen, H. O., et al., (2001), Genes Immun. 2 442–450.

    Article  PubMed  CAS  Google Scholar 

  48. Holers, V. M. (1999), Arthritis Rheum. 42, 2023–2025.

    Article  PubMed  CAS  Google Scholar 

  49. Amadei, N., Baracho, G. V., Nudelman, V., et al., (2001), Scand. J. Immunol. 53, 615–621.

    Article  PubMed  CAS  Google Scholar 

  50. Forton, A. C., Petri, M. A., Goldman, D., and Sullivan, K. E. (2002), Hum. Mutat. 19, 459.

    Article  PubMed  CAS  Google Scholar 

  51. Suh, C. H., Jeong, Y. S., Park, H. C., Lee, C. H., Lee, J., Song, C. H., et al. (2001), Clin. Exp. Rheumatol. 19, 191–194.

    PubMed  CAS  Google Scholar 

  52. Roy, S. and Tan, K. T. (2001), Rheumatology (Oxford) 40, 349–350.

    Article  CAS  Google Scholar 

  53. Hellmich, B., Csernok, E., de Haas, M., et al., (2002), Am. J. Med. 113, 134–139.

    Article  PubMed  CAS  Google Scholar 

  54. Egerer, K., Feist, E., Rohr, U., et al., (2000), Lupus 9, 614–621.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Center for Autoimmune Disease, Sheba Medical Center, Tel Hashomer

    Gisele Zandman-Goddard & Yehuda Shoenfeld

  2. Sackler Faculty of Medicine, Tel-Aviv University, Israel

    Gisele Zandman-Goddard & Yehuda Shoenfeld

Authors
  1. Gisele Zandman-Goddard
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  2. Yehuda Shoenfeld
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Correspondence to Yehuda Shoenfeld.

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Zandman-Goddard, G., Shoenfeld, Y. SLE and infections. Clinic Rev Allerg Immunol 25, 29–39 (2003). https://doi.org/10.1385/CRIAI:25:1:29

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  • DOI: https://doi.org/10.1385/CRIAI:25:1:29

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