Retrospective study of infections in Egyptian patients with systemic lupus erythematosus [SLE]

ABSTRACT

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