Prevalence of Common Infections and Flare-ups in on-treatment SLE Patients Attending Two Tertiary Care Hospitals in Kolkata

Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease. Infections are the most common complications. Early detection, proper management of infection and its differentiation from Lupus flare are of paramount importance. Objective : To find out the prevalence of infections with various etiologic agents among on-treatment SLE patients who were hospitalized for suspected infections and to differentiate infections from disease flare. Methods : This was a cross-sectional observational study with 50 patients of more than 16 years of age of both sexes fulfilling the Systemic Lupus International Collaborating Clinics (SLICC) 2012, classification criteria of SLE who were admitted for suspected infection as manifested by fever and systemic symptoms. Specific tests to identify etiological agent for infection were performed and the condition was differentiated from lupus flare with the help of the tests such as Total Leucocyte Count (TLC), C-reactive Protein (CRP), Anti-ds DNA, complements-C3 and C4. Result : Infections were evident in 42 patients (84%) with predominant monoinfection being pneumonia in 13 patients (30.9%) followed by Urinary Tract Infection (UTI) in 8 patients (19%). Streptococcus pneumoniae was the major cause of Pneumonia while Escherichia coli caused most of UTIs. The infection markers were fever, CRP and TLC. Of the 42 patients, 40 patients (95%) had fever, 28 (66.7%) had Leukocytosis and 35 (83%) had CRP 10 mg/L or more indicating infection. Anti-ds DNA antibody was raised in 4 patients out of total 6 patients with Lupus flare. The complements C3 and C4 values were low in all the 6 patients. No patient of disease flare had raised CRP or Leukocytosis Conclusion : Among 50 on-treatment SLE patients who were admitted in two Tertiary Care Hospitals of Kolkata with suspected infection it was found that 42 patients were having infections and 6 patients were suffering from Lupus flare. The predominant monoinfection was Pneumonia followed by UTI.

Cardiovascular Autonomic Neuropathy in Systemic Lupus Erythematosus.

Purpose: Objective is to evaluate cardiovascular autonomic function in SLE by simple non-invasive tests. Methods: A case control study was carried out involving 18-50 yrs old previously diagnosed SLE patients and same number of age and sex-matched controls. Parasympathetic function was assessed by heart rate (HR) response to Valsalva maneuver, deep breathing and standing. Sympathetic function was evaluated by blood pressure response to standing and sustained hand-grip test (HGT). Results: There were 50 female SLE patients. They had significantly higher minimum resting HR and diastolic blood pressure (DBP). HR variation with deep breathing, expiratory inspiratory ratio, 30:15 ratio and DBP change in response to HGT were significantly lower inpatients compared to controls. Thirty patients (60%) had at least one abnormal or two borderline test results indicating autonomic impairment of which 27 had parasympathetic dysfunction and 7 had sympathetic dysfunction. Conclusion: Autonomic dysfunction is common in SLE with higher prevalence of parasympathetic impairment.

Spirometric Evaluation in Juvenile Systemic Lupus Erythematosus.

Objective: Spirometric evaluation in juvenile systemic lupus erythematosus. Methods: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/ FVC, forced expiratory flow between 25-75% of vital capacity (FEF25-75%) and peak expiratory flow rate (PEFR) of 21 patients with juvenile SLE (jSLE) were compared to controls. Result: Reduced FVC and FEF25-75% was found in 18 and 9 patients, respectively. All had normal FEV1/FVC. None had respiratory complaint. When compared to controls, patients had significantly reduced FVC [mean (SD):1.97 (0.56) vs 2.35 (0.60), P=0.002] and FEF25-75% [2.19 (0.83) vs 2.63 (0.76), P=0.028] but similar FEV1/FVC [86.87(7.03) vs 86.72 (6.35), P=0.639]. Conclusion: jSLE patients had significant restrictive pattern and small airway involvement.

Disseminated histoplasmosis in an immunocompetent individual--a case report.

We report a rare case of disseminated histoplasmosis in a immunocompetent young adult person involving bone marrow, liver, spleen and oral cavity. He presented with oral ulcers, weight loss and pancytopenia. His bone marrow aspiration examination revealed Histoplasma capsulatum.