Infection in systemic lupus erythematosus.

BACKGROUND: Infections are common in patients with systemic lupus erythematosus (SLE) throughout the course of their disease and remain a source of mortality. The aim of this study was to determine the prevalence of infections, to describe their nature, and analyze their risk factors in adults with SLE. PATIENTS AND METHODS: We performed a descriptive study, at the Farhat-Hached Hospital in Sousse, and retrospectively analyzed the charts of 75 patients with SLE seen between 1990 and 2004. The group of patients with documented infections was compared to a control group. A logistic regression analysis was performed to determine risk factors associated with infection. RESULTS: Our study included 64 women and 11 men (median age of 31.4 years). Forty-three patients (57.5%) had 82 infectious episodes: 23 patients had at least two infectious episodes. Most infections were community acquired, and 80% were severe. The most common infections involved the urinary tract (28%), the skin and soft tissue (26.8%), and the respiratory tract (18.3%). Documented pathogens were: 45 common bacteria, 11 Candida albicans and four Mycobacterium tuberculosis. Localized herpes zoster was noted in three cases. Factors associated with infection, found in univariate analysis, were renal involvement, serum albumin lower than 25 g/l, and corticosteroids treatment. Only corticosteroids therapy remained statistically significant after multivariate analysis.

[Infectious endocarditis with negative blood cultures]. / Endocardites infectieuses à hémocultures négatives. A propos de 48 cas.

Blood culture is a key investigation for the diagnosis of infectious endocarditis (IE). When negative, there are diagnostic and therapeutic problems. The aim of this study was to determine the frequency, the clinical features and the aetiological factors of IE with negative blood cultures compared with IE with positive blood cultures compared with IE with positive blood cultures. The authors undertook a retrospective review of 98 cases of patients admitted for IE from 1991 to 2000 to the Department of Infectious Diseases and Cardiology of Sousse (Tunisia). Of the 98 patients, 48 (48.9%), 29 men and 19 women with an average age of 34.3 years, had negative blood cultures. An infectious agent was identified in 7 cases (14.5%) by serology, valve culture or cerebrospinal fluid including Brucella (2), Coxiella (1) and Candida (1). Therefore, in 41 cases (42%), the cause of IE was not determined. Transthoracic echocardiography was of diagnostic value in 96% of cases and transoesophageal echocardiography showed disease not observed on transthoracic echocardiography in 5 cases. The main complication was cardiac failure (27 cases). The mortality was 14.5%. Comparison of the two groups showed that negative blood cultures were associated with a higher incidence of previous antibiotic therapy, extracardiac signs of IE and cardiac failure. Early surgical indications and mortality were the same in both groups. This report confirmed the high frequency of IE with negative blood cultures. Previous antibiotic therapy seems to be an important aetiological factor but cannot explain this high frequency. Methodological problems of blood cultures and the absence of systematic investigation for rare infectious agents are other possible factors.

[Pyomyositis in adults in central Tunisia. Apropos of 10 cases]. / La pyomyosite chez l'adulte en Tunisie centrale. A propos de dix cas.

Ten adult patients treated for pyomyositis between 1988 and 1994 in Sousse's university hospital (Tunisia) were retrospectively reviewed. Due to the non specific symptoms, the diagnosis was often delayed (mean = 17 days) and other primary diagnoses were considered, mainly including synovitis. The muscles around hip and thigh were most commonly involved (ten patients), and Staphylococcus aureus was the most common pathogen (nine patients). Ultrasonography was very helpful in the accurate diagnosis of the infection. Incision, drainage, and antibiotic therapy eradicated the infection in all patients. No residual functional limitations and no residual symptoms were noted. Our study showed that pyomyositis is present in central Tunisia and not associated with HIV infection. Clinical features and prognosis are similar to those previously described in the literature.