Spectrum Of Infections In Patients Research Articles

Current Spectrum of Infections in Patients with X-Linked Agammaglobulinemia.

Outcome of patients with X-linked agammaglobulinemia (XLA) has improved with the widespread use of immunoglobulin replacement therapy (IgRT). There are few data on the spectrum of infections experienced by patients undergoing IgRT. We carried out a retrospective cross-sectional analysis of the records of XLA patients seen at Necker-Enfants Malades Hospital, Paris. For each infection, we evaluated infection site, microbial etiology, antibiotic prophylaxis, immunosuppressive treatment, IgRT route, and last known IgG trough level. Sixty patients were included, who cumulated a follow-up of 1470 patient-years. We recorded 188 infections, including 97 after initiation of IgRT. The rate of infection was highest before IgRT (0.66 vs. 0.06 per person-year (ppy), p < 0.001) and was higher after the age of 16 compared to before (0.14 vs. 0.05 ppy, p = 0.048). It was similar for patients receiving intravenous or subcutaneous Ig (0.09 vs 0.05 ppy, p = 0.54). The lungs and gastrointestinal tract accounted for 71% of infection sites. Forty-six (47%) infections occurred in patients receiving antibiotic prophylaxis. Sixteen (16.5%) infections occurred in patients receiving immunosuppressive therapy, which more frequently occurred after age 16 (35% vs. 2.4%, p < 0.001). The median IgG trough level prior to all infections was 8.4g/L. Almost half (44.3%) of infections occurred with prior IgG trough levels > 8g/L, and 16/97 (16.7%) in patients with trough levels > 10g/L. Infection remains a significant issue in patients with XLA undergoing IgRT despite adequate IgG trough levels. Chronic inflammatory manifestations of X-linked agammaglobulinemia and immunosuppressive therapies may be significant drivers of infection during adulthood.

Microbiological spectrum of nosocomial infection in patients with infectious spondylitis after sepsis

In 2015—2017, a cohort study of 72 cases of infectious spondylitis (is) with severe sepsis was conducted, which amounted, to 5,8% of all operated, patients. The study showed, that Gram. (+) bacteria -52 (55,9%) prevailed, in crops from all media. Gram. (-) bacteria were detected, in 1\3 cases 37(39.8%), and Candida infection in 4 (4,3%). The main traced, sources of NI in patients with is where bedsores (13\18,1%), infection with surgical intervention, fistula (14\19,4), uroinfection (22\30,6%), subclavian catheters (7\55.5%). Gram. (+) bacteria was 26,8% (15 cases) and was mainly found, in wounds and. catheters. Gram. (-) bacteria more prevalent in ulcers in the urine culture (56,4 per cent). In 10 cases (17,8%) the crops were sterile. An increase in the role of S. epidermitis and. K. pneumoniae in the etiology of sepsis was found, in bacteriological typing of media. High resistance of nosocomial strains of Staphylococcus spp is noted. Gram. (-) bacteria to fluoroquin.alon.es and. cephalosporins 3—4 generations, which excludes the possibility of their empirical use in the treatment of severe sepsis in patients with is.

INFECTIOUS COMPLICATIONS AS A PREDICTOR OF MORTALITY IN PATIENTS WITH NON-HODGKIN LYMPHOMA RECEIVING RITUXIMAB-CONTAINING CHEMOTHERAPY.

Rituximab is a monoclonal antibody that increases the disease-free and overall survival of patients with non-Hodgkin lymphoma (NHL) CD20+. The objective of this study is to describe the prevalence and spectrum of infections in patients with NHL receiving rituximab-containing chemotherapy and the impact on survival. From January 2011 to December 2012, all patients diagnosed with NHL who received at least one dose of rituximab were included. During the study period, 265 patients received rituximab; 108 (40.8%) males; the mean age was 60 ± 15 years. There were 177 infections in 85 patients, being the most common febrile neutropenia (n = 38; 21.5%) and mucosal barrier injury-related infections (n = 28; 15.8%). In 88 events (49%), there was a microbiologic diagnosis, being bacterial infection the most frequent (39.6%), but tuberculosis (TB) was developed in 4 cases (1.5%; incidence rate 721/100,000 person-year). During follow-up, 71 patients died (27%); in 35 cases, it was related to infection. There were no differences in follow-up between those who died due to infection versus those who died from another cause (p = 0.188). Multivariate analysis for mortality showed that age >60 years, failure to achieve a complete response, and development of an infectious complication increased the risk of death. It is important to perform a screening test for TB in all patients who will receive rituximab and maintain a constant monitoring to detect an infectious process and begin treatment as soon as possible.

Comorbid infections in rheumatic diseases (according to FSBI RIR named after V.A. Nasonova)

Aim. Study of spectrum, frequency and risk factors of comorbid infections in rheumatic diseases (RD) in the stationary contingent of patients hospitalized in the FSBI RIR named after V.A. Nasonova within 1 year.Patients and methods. The study included 245 patients with RD: 122 patients suffered from rheumatoid arthritis, 62 - systemic lupus erythematosus, 61 - systemic scleroderma. All patients were interviewed by a doctor-researcher and filled in a questionnaire. If necessary, additional information was obtained during the analysis of medical records.Results. In the spectrum of infections in patients with RD, respiratory tract and ENT infections prevailed. The frequency of serious infections (SI) during RD in the studied cohort was 23.7–38.1%. The frequency of certain infections, including SI, is influenced by the duration and variant of RD, comorbid diseases and immunosuppressive therapy.Conclusions: the data obtained indicate the importance of infections in rheumatology. A high percentage of RD exacerbation against the background of infection, the prevalence of respiratory tract infections, including SI, dictate the need for vaccine prophylaxis at the early stages of RD.

Spectrum of Infections with a Protocol of Dual T-Lymphocyte Suppression Using ATG and PTCy for Gvhd Prophylaxis in Allogeneic Transplants for High-Risk Hematological Malignancies

Introduction ATG and PTCy have been individually shown to reduce rates of GVHD in allogeneic transplants. We adopted a combination regimen of ATG and PT-Cy for GVHD prophylaxis in allogenic transplants for high risk hematological malignancies in our centre, to decrease the rates of acute and chronic GVHD. Objectives We analysed the spectrum of infections in patients who received this dual T lymphocyte suppression protocol. Patients and methods Reduced intensity conditioning consisted of iv Fludarabine, iv Busulphan, and low dose TBI. GVHD prophylaxis was with Thymoglobulin 4.5mg/kg total dose, PT-Cy 100 mg/kg total dose and cyclosporine. The stem cell source was G-CSF stimulated PBSCs. Results 197 patients (median age 57 y, range 19-74y) with high-risk hematological malignancies were treated with this protocol. The donor types were as follows-10/10 matched unrelated donor (MUD) in 76, 9/10 mismatched unrelated (MMUD) in 26, 10/10 matched related donor(MRD) in 43 and haplo-identical (HI) donors in 52 patients. The median follow-up in the entire cohort was 12 months. The 1year OS in the MUD, MMUD, MRD and HI groups were 75%, 50%, 63.3% and 56.7% respectively. The overall percentages of proven bacterial, viral, and fungal infections were 49%, 62% and 11% respectively (Table 1). The overall incidence of CMV reactivation was 48% and was significantly different among the 4 donor groups (p=0.00). We also observed high rates of EBV reactivation (33%) and BK cystitis (18%). There were 14 pathologically confirmed cases of post-transplant lympho-proliferative disorder (PTLD), of which 1 responded to discontinuation of immune-suppression and the rest needed treatment with Rituximab. There was one death attributed to PTLD. Infections were the primary cause of death in 18 patients (23% of deaths) and a contributory cause of death in an additional 16 patients (20% deaths). The overall incidence of grade 3-4 acute GVHD in our patients was 10.1 % and of moderate/severe NIH stage chronic GVHD was 11.6% which is low compared to conventional GVHD prophylaxis regimes. Only 10% of deaths were attributable to GVHD. Conclusion Our experience shows that dual T lymphocyte suppression with PT-Cy and ATG for GVHD prophylaxis results in low rates of acute and chronic GVHD, but is associated with high rates of infections, especially viral reactivation and PTLD.

1556. Infectious Disease Complications with Use of Checkpoint Inhibitors in Solid Organ Malignancies

BackgroundImmune checkpoint inhibitors (ICIs) are innovative cancer immunotherapies used for solid-organ and hematologic malignancies. ICIs are known for their immune-related adverse events (irAE) but there are limited reports on infectious complications of immunosuppression for these complications. The purpose of this study was to describe the spectrum of infections in patients with melanoma, renal cell carcinoma or non-small cell lung cancer receiving ICI.MethodsRetrospective review of City of Hope patients with melanoma, renal cell carcinoma or non-small cell lung cancer on nivolumab, pembrolizumab, and/or ipilimumab from January to November 2017 and received two or more doses of ICI. Pt characteristics assessed: age, sex, prior chemotherapy, steroid use, and type of immunosuppression for irAE. Microbiology records were used to identify infections.ResultsThirty-nine infectious episodes (35 bacterial, four viral) were identified among 111 patients. Four bacteremia (two B. cereus, coagulase-negative staphylococcus, 1 S. aureus), 12 urinary tract (10 Gram-negative rods, 2 Gram-positive cocci), one intra-abdominal, eight skin and soft-tissue infections (one S. aureus, one Actinomyces radinge, one E. faecalis, and one E. cloacae). There were two probable viral pneumonias (two rhinovirus, two enterovirus) and no fungal infections. Fourteen (12.6%) infections were defined as serious (requiring intravenous antimicrobials and/or hospitalization). There was no association between the specific malignancy or ICI used and risk of infection. Steroid use was significantly associated with serious infections: 12/14 (85.7%) vs. 27/95 (28.4%); P = 0.0003), and no patients had received infliximab or other immunosuppressant.ConclusionBacterial infections were most common, and the only risk factor associated with serious infections in our study was steroid use. Type of ICI did not impact the rate of infection.Disclosures S. Dadwal, Ansun Biopharma: Investigator, Research grant.

A Study of the spectrum of Urinary Tract infections in patients with Adult Polycystic Kidney Disease – An old problem with a better outcome

A Study of the spectrum of Urinary Tract infections in patients with Adult Polycystic Kidney Disease – An old problem with a better outcome

Acute Graft-Versus-Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Introduction Acute GVHD is one of the most common serious complications of allogeneic HSCT and remains a leading cause of mortality in HSCT recipients all over the world. Various publications showed the association of acute GVHD with higher risk of infectious complications. There is lack of data on risk factors for developing an episode of infection and spectrum of infections in patients with acute GVHD after allogeneic HSCT. Objective to determine the risk factors and spectrum of infectious complications in patients with acute GVHD after allogeneic HSCT. Methods An ambispective observational study was performed to evaluate the risk factors and characteristics of infectious complications in adult patients having acute GVHD after HSCT. Proven case of infection (bacterial, viral or fungal) was taken as a primary outcome in the study. There were totally 68 adult patients with II-IV grades of acute GVHD after allogeneic HSCT included in the study. As a covariates included in multivariate analysis were taken: procedure of MCSs transplantation; type of allogeneic HSCT (related/non-related), main disease progression, absolute neutrophil count (ANC) on the first day of infectious complication, GVHD-involved organs. Results Microbiological data concerning the causes of infectious complications in patients with acute GVHD has shown the major impact of viral infections (CMV) and invasive pulmonary aspergillosis. There were no bloodstream infections caused by Candida spp. registered in the study. Bacterial infections were mostly presented by bloodstream infections (caused by K. pneumoniae, E. faecalis, E. coli) and pneumonia. Progression of main disease (OR 5.52; 95% CI 1.21-25.06; p=0.0270) was found to be an independent risk factor for development of invasive pulmonary aspergillosis and bacterial infectious complications. Patients with hematopoietic stem cell transplant from unrelated donor remain in a group with high risk for bacterial infections in case of developing acute GVHD (OR 3.50; 95% CI 1.12-10.97; p=0.0316). The procedure of MSCs transplantation as a potential treatment of GVHD showed no influence on risk of invasive aspergillosis (OR 3.25; 95% CI 0.64-16.47; p=0.1536) or CMV-reactivation (reciprocal OR 0.42; 95% CI 0.12-1.49; p=0.1802) in the study. Conclusion Among the most frequent infections in acute GVHD we have described CMV, invasive aspergillosis and bacterial infections. Among risk factors for infectious complications in patients with acute GVHD are progression of main disease and neutropenia below 500 cells/mm3 (for aspergillosis) and unrelated HSCT in the past history and progression of main disease (for bacterial bloodstream infections and pneumonia). MSCs transplantation as a treatment strategy for acute GVHD has shown no statistically significant association with risk of infectious complications in a performed multivariate analysis.

Types and microbiological spectrum of infections in patients with cirrhosis: A single-centre experience in Upper Egypt

Background and study aimsEgypt has a high prevalence of hepatitis C virus (HCV) and high morbidity and mortality related to cirrhosis complications. Patients with cirrhosis have an increased risk of bacterial infections. Approximately 25–35% of cirrhotics had infections at admission or during hospitalisation. Data on infection among cirrhotics in Egypt are limited. This study aimed to determine the frequency and microbiological spectrum of infections in cirrhotics and possible risk factors. Patients and methodsThis study was conducted at a tertiary care hospital. The frequency and microbiological spectrum of infections in cirrhotics were determined. The risk factors for infection were evaluated. ResultsOf the 100 patients with liver cirrhosis, 61% had infection. Ascitic fluid infection (AFI) was the most common infection (44.3%), followed by urinary tract infection (UTI) (21.3%), respiratory tract infection (RTI) (19.7%), gastroenteritis (6.6%) and skin infection (4.9%). The only risk factor for infection among cirrhotics was diabetes mellitus (DM) (p=0.047). The mean value of mid-arm muscle circumference was significantly lower in the infected group (p=0.047). Among all the cirrhotics, 32.0% had mild to moderate malnutrition and 52.0% had severe malnutrition. The frequency of infection was higher in severe malnutrition (71.2%). ConclusionsThe frequency of infections among cirrhotics was 61%. Many types of infections including AFI, RTI, UTI and skin infections were present in patients with liver cirrhosis, but AFI was the most common. DM was the only risk factor for infection, and independent predictors for infection were elevated WBC count and C-reactive protein levels. The frequency of infection was related to the degree of malnutrition.

Spectrum of viral skin infections in patients attending the dermatology clinic at King Fahd Hospital of the University in Alkhobar, Kingdom of Saudi Arabia during the period 2010 – 2014

Spectrum of viral skin infections in patients attending the dermatology clinic at King Fahd Hospital of the University in Alkhobar, Kingdom of Saudi Arabia during the period 2010 – 2014

Spectrum of Infection in Patients with End Stage Renal Disease on Maintenance Haemodialysis

Spectrum of Infection in Patients with End Stage Renal Disease on Maintenance Haemodialysis

Microbiological spectrum of urinary tract infection in patients with sepsis

Microbiological spectrum of urinary tract infection in patients with sepsis

The current spectrum of infection in cancer patients with chemotherapy related neutropenia

Despite advancements in the treatment and supportive care of patients with malignant disorders, neutropenia remains the major side effect of most antineoplastic regimens. Infections occur frequently in neutropenic patients and are associated with considerable morbidity and mortality. The spectrum of infection continues to change, and is influenced by various factors including local epidemiology, the use of chemoprophylaxis, and the use of central venous catheters and other medical devices. Bacterial infections are common in the early stages of neutropenia, with fungal infections emerging if neutropenia persists beyond 7-10 days. Gram-positive organisms cause most bacteremic infections (although this trend appears to be changing), whereas infections at other sites are often caused by Gram-negative bacilli or are polymicrobial, especially if deep tissue infection is present. Candida spp., and Aspergillus spp., remain the most common fungal pathogens, although several opportunistic fungi have emerged. Resistance to antimicrobial and antifungal agents commonly used for the prevention and treatment of infections in neutropenic patients has become a significant problem. The prompt administration of appropriate, empiric, antimicrobial therapy, prior to the availability of microbiological culture results, is the standard of care. Up to date knowledge of the spectrum of infection and local susceptibility/resistance patterns, is critical. In this report, we describe the current spectrum of infection in patients with malignancies and neutropenia, and emphasize the fact that local and geographic differences are not infrequent. We recommend that individual institutions conduct periodic epidemiological surveys in order to have the latest data available for the optimal management of their patients.

BACTERIAL INFECTION PROFILES AND TUMOR BIOMARKERS IN EGYPTIAN LUNG CANCER PATIENTS

A substantial number of bacterial pathogens have been putatively linked to cancer. In patients with lung cancer, pneumonia is the most important complication and has a high mortality. However, the common pathogens causing pneumonia are not clear. Also there is a need for identification of circulating tumor biomarkers by highly specific and accurate blood tests that can be performed at any medical facility. For these reasons the aim of the present study is identifying the major bacterial species present in sputum of lung cancer patients complaining from pneumonia and to measure the serum level of tumor markers with the assessment of their clinical significance. Methods: 60 patients diagnosed for lung cancer; 44 non small cell lung cancers (NSCLC) & 16 small cell lung cancers (SCLC); as well as 10 control normal healthy adults were included. The sputum of the patients & control were cultured on different culture media for identification of bacteria. Minimum Inhibitory Concentration (MIC) was determined by Microscan. The serums of the same candidates were analyzed for angiopoietin-2 (Ang-2), survivin, Carcinoembryonic antigen (CEA) and Neuron – specific enolase (NSE). Results: E. coli was isolated from 15 sputum samples, α or non hemolytic Streptococci were isolated from 43, Staphylococcus aureus was isolated from 3, K. pneumonia was isolated from 14, P. aeruginosa in 2, other bacteria in 9, Proteus mirabilis in 1, Acintobacter sp. in 2, Enterobacter cloacae in 2, Morganella morganii in 2, Serratia sp. in 1 and Candida in 3. The isolated bacteria showed multidrug resistance to the tested antibiotics. Serum Ang-2 was significantly higher in SCLC and NSCLC groups as compared to normal group. Mean value of serum survivin was significantly higher in SCLC group as compared to normal and NSCLC groups. While there was no significant increase of serum survivin level in NSCLC group as compared to normal group. Mean value of serum NSE was significantly higher in SCLC group and NSCLC as compared to normal group. Serum NSE was higher in SCLC than in NSCLC group but the difference was not statistically significant. Mean value of serum CEA was significantly higher in SCLC group and NSCLC as compared to normal group. Also the mean value of serum CEA in NSCLC was significantly higher than the mean value of SCLC group. Conclusion: The spectrum of pulmonary infection in patients with lung cancer is wide and depends on the underlying neoplasm and the immunologic deficit or deficits related to it, and to various treatment modalities. The development of drug resistance among common respiratory pathogens is of great concern and underscores the need for the appropriate use of antimicrobial agents and the importance of infection control. Serum survivin may be a useful marker in diagnosis of SCLC and also for differentiation between SCLC and NSCLC. Serum Ang-2 may be a good marker for lung cancer.

Musculoskeletal Infections in Human Immunodeficiency Virus

Objective: To describe clinical, paraclinical and evolution’s spectrum of musculoskeletal infections in patients with human immunodeficiency virus. Methods: Descriptive and analytical cross-study carried out on the file of 23.5% presented a musculoskeletal infection among 85 who were infected with human immunodeficiency virus and hospitalized in the Rheumatology Department of Brazzaville Teaching Hospital during 3 years. Results: 7 males and 13 females all HIV/AIDS infected, average age of 35.2 years, extremes 18 - 68 years. Patients were at C and B stages of CDC Atlanta 1993 classification. We found 7 Pott’s diseases, 7 septic arthritis and 6 pyomyositis. Pott’s disease affected the lumbar spine in 4 cases, dorsolumbar curve 2 times, dorsal spine once and was complicated by paraplegia in 4 cases. Septic arthritis was exclusively localized at the knee, and myositis was located in the thigh in 3 cases, arm in 2 cases, and buttock in 2 cases, with multifocal localization in 2 cases. The most frequently isolated germ was staphylococcus aureus; this was isolated 5 times at the knee and thrice in the muscle. The evolution was favorable under antibiotic therapy with recovery periods longer than that in the HIV negative patients. Conclusion: Musculoskeletal infections of HIV related patients have a profile which appears comparable to the immunocompetent patients. Pott’s disease affected dorsal and lumbar spine, complicated by paraplegia. Septic arthritis is located on the knee and pyomyositis are frequent with unusual and multifocal localizations. The bacterial ecology is dominated by staphylococcus aureus and Mycobacterium tuberculosis. The recovery is longer in these patients.

Infections in rheumatology practice: an experience from NIMS, Hyderabad

Objective Infections are not uncommon in rheumatology practice both because of the disease by itself and the medications used especially after the advent of biological therapy. Identifying and predicting infections is crucial in managing these patients as sometimes they are indistinguishable from the disease itself. The present retrospective study evaluates the clinical spectrum of infections in patients of rheumatology. Methods Medical records of patients from the January 2007 to June 2008 were retrieved. The data of patients with serious infections requiring hospitalization or infections diagnosed after hospitalization, concomitant medications, co-morbid conditions, previous infections, and any other predisposing factors were analyzed. Inclusion criteria All patients who were admitted at the rheumatology department and have had evidence of minor or major infections were included. Results There were a total of 1236 admissions, of which 225 patients had infections. Eighty-four were systemic lupus erythematosus (SLE) patients, 72 were rheumatoid arthritis (RA) patients, 69 patients fell in the others group, and there was one patient who had RA—SLE overlap. Fever was the presenting complaint in 69 (82.1%) patients with SLE and 43 (58.9%) patients with RA. Lower respiratory tract infection comprised 22.9% of SLE infections, 32.5% of RA infections. Bacterial infections (21.27%) are common infections and Escherichia coli is the most common organism identified in SLE. Conclusions Infections are the common cause for hospital admission in RA and SLE. The commonest site of infections is the respiratory tract in both RA and SLE. The occurrence of infections in SLE is not directly proportional to the level of immunosuppression.

Susceptibility to Mycobacterial Infections in Children With X-Linked Chronic Granulomatous Disease

Chronic granulomatous disease (CGD) is a rare disorder of phagocytic oxidative bursts leading to recurrent pyogenic infections. Affected individuals are most prone to infections caused by staphylococci, Salmonella, Candida, and Aspergillus, but previously we observed a high incidence of Mycobacterium tuberculosis infection in Chinese children with CGD. To determine the spectrum of infections in patients with X-linked CGD, with an emphasis on mycobacterial infections, and to review all CYBB gene mutations identified in our center. From 1988 to 2005, 17 Chinese male children were diagnosed to have X-linked CGD. Fifteen mutations were identified, including 3 splice site defects (IVS1-1G>C, 266G>A, IVS3-1G>A), 5 missense mutations (591T>C, 627T>A, 949T>A, 1039T>A, 1512G>C), 3 nonsense mutations (882C>T, 1451C>A, 1569G>T), 1 insertion (756_757insA), and 3 deletions (660_662delTTC, 727delT, 1341delT). Eight of these were novel mutations. Recurrent pneumonia, lymphadenitis, and bacterial skin abscess were the commonest types of infection. Seven patients had tuberculosis (TB). Seven patients had prolonged scarring or abscess formation at the Calmette-Guérin bacillus (BCG) injection site, and 1 had disseminated BCG infection. Three patients had pulmonary aspergillosis. Four patients underwent hemopoietic stem cell transplantation, but 2 died of complications. Patients with CGD are susceptible to TB and BCG complications. Our observation suggests that oxidative burst is probably important in host defense against mycobacterial infections. Because interferon-gamma is the key cytokine involved in mycobacterial immunity, there may be a stronger indication for its use in CGD patients living in areas endemic for TB.

Infecção em Mieloma Múltiplo

Infecção é a principal causa de óbito em pacientes com mieloma múltiplo (MM). Na última década ocorreram mudanças substanciais no espectro de infecções em pacientes com MM, relacionadas com as mudanças no tratamento, ocorridas neste período. Embora as bactérias (particularmente encapsuladas e Gram-negativas) continuem a ser os principais agentes etiológicos, infecções fúngicas invasivas causadas por fungos filamentosos (Aspergillus sp. e Fusarium sp.) têm sido relatadas com freqüência crescente. Enquanto o aumento na intensidade do tratamento do MM resultou em melhora na sobrevida, novos problemas infecciosos emergiram. Assim, uma abordagem prática às infecções em pacientes com MM deve incluir o reconhecimento dos patógenos prováveis, de acordo com vários fatores, como a história patológica pregressa, estado da doença de base, e tratamento atual e anterior para o MM. Estratégias específicas de diagnóstico, profilaxia e terapia empírica são direcionadas de acordo com esta abordagem.

A comparison of demographic details, source of referral, and spectrum of infection in patients under 16 years attending Singleton Hospital Genitourinary Medicine Department in 1997 and 2000

A comparison of demographic details, source of referral, and spectrum of infection in patients under 16 years attending Singleton Hospital Genitourinary Medicine Department in 1997 and 2000

Immunopathogenesis and spectrum of infections in systemiclupus erythematosus

This study reviews the pertinent immunopathologic mechanisms that contribute to increased susceptibility to infection in patients with systemic lupus erythematosus (SLE) and the spectrum of infections in patients with SLE. It assesses the impact on patient care, morbidity, and mortality. The authors performed an extensive search of the literature through MEDLINE, using appropriate keywords and manual search of bibliography cited by retrieved papers. Infection is a leading cause of morbidity and mortality in SLE and may change the natural course of the disease. Patients with SLE display numerous cellular and humoral abnormalities that are expressed in a heterogeneous pattern and contribute in varying degrees to susceptibility to infectious agents. The use of corticosteroid and immunosuppressive drugs is only partially responsible for the high infection rate in lupus patients. Common as well as opportunistic pathogens are frequently encountered among patients with SLE. The susceptibility that SLE patients exhibit to certain bacteria is now better recognized, and a broadening spectrum of pathogens is being reported. The immunization of patients against influenza and pneumococcus and the administration of prophylactic therapy against Pneumocystis carinii infection in certain patients have recently been proposed. Disease activity and treatment are responsible for the extensive defects of the immune defense system in lupus patients that increase their susceptibility to an extensive range of infections. Infection imposes a serious burden on lupus patients and on the caring physician.