RESUMO
Infections are one of the leading causes of morbidity and mortality in patients with systemic lupus erythematosus [SLE], therapeutic, dose-related and genetic factors all contribute to a lupus patient's increased susceptibility to infections. Although bacterial pathogens are the most common cause of infections, a wide variety of pathogens have been reported. Multiple risk factors for infection in SLE have been reported. These include disease activity, renal disease, gluco-corticoid use and cytotoxic therapies. The objective was to analyze infection risk factors in Egyptian lupus patients; the influence of these factors on disease activity, organ damage, disease development and the type of micro-organisms involved. The study included forty patients with SLE [37 females and 3 males] They were selected from those attending the SLE clinic in Ain Shams University hospital outpatient. Lupus disease activity had been established according to SLAM score. They were subjected to a retrospective study to : Complete medical history with special interest on duration of the disease, current treatment for lupus and dosage of prednisone, antimalarial drugs and immunosuppressive agents, number of infections whatever the cause during One year and number of admission due to episodes of infection whatever the cause. It included also symptoms of urinary tract infection [UTI] upper respiratory tract infection [URTT] as well as any complaint of the patient proved to be due to infection Laboratory assays included: CBC, ESR, serum creatinine, urine analysis, 24 hours protein in urine and culture when necessary. Increased incidence of infection in lupus patients which was 83 infections during the one year study. the incidence of Upper Respiratory Tract Infections was 8 infections [9.64%], Urinary Tract Infections 70 infections [84.34%], and Skin Infections 5 infections [6.02%] 83% of the cultures had had obtained from lupus patients. 83% of the urine were G- ve organisms. E. coli was the most common uropathogen encountered in this study [47%] which was resistant to most antibiotics but was sensitive to aminoglycosides. Skin infections were presented by abscesses 4 times [80%] -with predominance of staphylococci- and Herpes Zoster once [20%] There was a significant increase in the number of infection in relation to corticosteroids dose. There was a statistical significance between incidence of infection and addition of immunosupressive drugs to corticosteroids. There was a strong relation between incidence of infection and disease activity. SLE itself, increased dose of corticosteroids, use of immunosuppressive drugs and activity of the disease all are risk factors in incidence of infection in patients with SLE. UTI followed by URTI and skin infections including HZ were the most frequent infections in Egyptian SLE patients
RESUMO
To compare between serum neopterin level in rheumatoid arthritis [RA] patients [active and nonactive], patients with some parasitic intestinal nematodes infestation and with normal controls. The patient groups were chosen to represent diseases in which cell mediated immunity is involved in the disease process. Also, to correlate changes in serum neopterin level with status of disease activity in patients with rheumatoid arthritis [RA] and with the load of some intestinal nematodes infestation. This study was done on the following groups. Group I included 20 inactive RA patients [8 males and l2females, 18-50 years old], Group II which included 20 active RA patients [7 males and 13 fema1es, 18-60 years old], Group III included 16 patients with enterobiasis [6 males and 10 females, 5-35 years old], group IV included 12 patients with ascariasis [8 males and 4 females, 4-30 years old], group V included 12 patients with ancylostomiasis [10 males and 2 females, 12-50 years old] and group VI which included 10 normal subjects [5 males and 5 females, 10-35 years old] with no evidence of any rheumatological disorder or parasitic infestation as a control group. RA disease activity was assessed according to the presence or absence of morning stiffness, pain, grip strength, and articular index. Group I, II and VI were subjected to full medical history and clinical examination, CBC and ESR, assay of rheumatoid factor [RF] by Rose-Waaler test, and X-ray on the affected joints and graded by modified Larsen et al. [1977] index .Group III, IV, V, and VI were subjected to full medical history and clinical examination, repeated stool analysis, perianal swab for suspected cases of pinworm infestation, and estimation of parasitic load. Quantitative measurement of serum neopterin was done for all persons included in the study. In RA patients both groups [I and II] were matched regarding age and disease duration. ESR and serum neopterin levels were higher in active disease group [highly significant difference]. In all RA patients there was a positive correlation between ESR and serum neopterin, and between ESR and serum RF levels. In group I, a positive correlation was found between ESR and serum neopterin levels. In group II, a positive correlation was found between age and disease duration, ESR and serum neopterin levels, ESR and serum RF levels, and between serum neopterin and serum RF levels. Also, serum neopterin was significantly elevated in groups III, IV, and V when compared to group VI. A highly significant difference was found on comparing serum neopterin level between patients with active RA and all parasitic patients, active RA and controls, inactive RA and controls, and all parasitic patients and controls [being higher in the former groups], while it was insignificant on comparing inactive RA and all parasitic patients. Furthermore, serum neopterin was significantly increased with increased parasitic load. Serum neopterin is significantly higher in sera of active RA patients and correlates with disease activity and also it is significantly higher in sera of patients with intestinal nematodes infestation and its level progressively rises with the increase in the parasitic load