系統(tǒng)性紅斑狼瘡與感染課件

LUPUS

Vs

INFECTIONZhaojiuliangDepartmentofRheumatologyPUMCH,Beijing第一頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Q1.

What

are

the

most

frequentinfectionsinpatientswithSLE?Q2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?第二頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Q1.

What

are

the

most

frequentinfectionsinpatientswithSLE?第三頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Infectionisresponsibleforapproximately25%ofalldeathsinpatientswithsystemiclupuserythematosus(SLE)The

main

reason

of

hospitalizationAppearstobehighestwithinthefirst5yearsofdiseaseonset第四頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染InfectioninSLEClinRheumatol,2014.33(1):57-63.第五頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染CharacteristicsofmajorinfectionsinSLERespiratory

tractsUrinary

tractsSkin

and

soft

tissuesThetypesofinfectionsthatSLEpatientsdevelopedwerethesameasinthegeneralpopulation第六頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Themostfrequentinfectionsinclude:Pneumonia,herpeszostervirus,andurinarytractinfectionArthritisCareRes(Hoboken),2015.67(8):1078-85.CharacteristicsofmajorinfectionsinSLE第七頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染RelativerisksofhospitalizationsLupus

compared

with

general

populationArthritisCareRes(Hoboken),2015.67(8):1078-85.第八頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Pathogen

of

infection

in

SLEGram-negativebacilli,gram-positivecocci,fungalandotherbacterialinfectionsaccountedfor39.85%,31.58%,18.80%and9.77%,respectivelyofnosocomialinfections.第九頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Clinicalmanifestations

of

infectionsAtypical

!!!第十頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染MycobacteriumtuberculosisThe

prevalence

of

TB

infection

in

SLE:

5-30%Characteristicshigherincidenceratemorefrequentextra-pulmonaryinvolvementmoreextensivepulmonaryinvolvementHighrelapserateeveniftreatedwithprophylacticizoniazidmorecommoninSLErenaltransplantpatientsZandman-Goddard,G.,InfectionsandSLE.Autoimmunity,2009.38(7):473-485.第十一頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染MycobacteriumtuberculosisTB

maypresentasamimickerofvasculitisTB

maypresentwithskindiseaseposingadiagnosticchallengeAhighindexofsuspicionwillallowprompttreatment.TB.spotData

in

China第十二頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染ViralinfectionsAcuteviralinfectionsinSLECMV(~50%)parvovirusB19herpessimplexEBVvaricellazostervirushepatitisAamongotherlessfrequentlyreportedviruses第十三頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染HZVTheannualage-adjustedincidenceofherpeszostervirusinSLEpatientsof12/1000person-yearsMostfrequentlyalate(>5yrs)complicationsofSLEOftenoccurringduringinactivityormildSLEactivity往往皮疹重而神經(jīng)系統(tǒng)(shénjīngxìtǒng)表現(xiàn)輕潰瘍性角膜炎耳帶狀皰疹，

Ramsay-Hunt

syndrome第十四頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Cytomegalovirus（CMV）CMVinfectionandSLEexacerbationmaybedifficulttodistinguishDevelopmentofSLEmaybetriggeredbyaCMVinfection.ExistingSLEmayundergoanexacerbationfollowingaCMVinfectionCMV

seropositive

VS

overt

clinical

diseaseOver

90%

SLE

pts

are

seropositiveAntigenemia

18-44%Overt

clinical

disease:

uncommon第十五頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染PneumocystisPneumonia第十六頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染PneumocystisPneumoniaA

cut

off

for

PCP

prophylaxisin

any

particular

disease:

3.5%?

6%？however,thefrequencyofPCPvariesgreatlyfromdiseasetodisease.GPA>SLE>IIM>RA?()Risk

factorsLow

CD4+

countsLymphocyte<350+GCs

and

cytotoxic

therapyGCs:

meandailydose,cumulativedose,and/orpulsedosing第十七頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染PneumocystisPneumonia第十八頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染PneumocystisPneumoniaClinical

ManifestationsHigh

rate

of

co-infection

with

other

OI,

including

CMV,

Aspergillus,

and

Candida

species.High

mortality:

32%(CTD-PCP),

but

only

~1/4

were

solely

attributable

to

PCP

第十九頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染PneumocystisPneumoniaProposed

PCP

prophylaxis

in

Pts

with

CTD2

or

more

of

the

followingGCs>=20mg/d

for

>4weeksCurrent

use

of

>=2

DMARDsAbsolute

lymphocyte

count=<350

cell/mm3Underlying

ILDTMP-SMZ：85%

reduction

in

PCP

infectionReal

world

survey,

50%

SLE

pts

on

CYC

using

prophylaxia15.88/1W

pts

reports

PCP

infection;

higher

AEs

ratesNot

sufficient

evidence

to

support

universal

use

of

prophylaxia第二十頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Q2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?第二十一頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染RiskfactorsforinfectionUseofsteroidseverUseofCYC,

MMF,

CD20

mAbOrgandamageresultingfromseverelupusSeverelupusflaresinvolvingthekidneyorcentralnervoussystemHighSLEdiseaseactivityindex(SLEDAI)Danza,A.andRuiz-Irastorza,G.,Infectionriskinsystemiclupuserythematosuspatients:susceptibilityfactorsandpreventivestrategies.Lupus,2013.22(12):1286-94.第二十二頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染Prednisoneusetobeassociatedwithinfectionrisk,witheach10mgperdayincreaseofprednisoneincreasingtheriskofseriousinfection11-fold.Ruiz-Irastorza,G.,Predictorsofmajorinfectionsinsystemiclupuserythematosus.ArthritisResTher,2009.11(4):R109.第二十三頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染LN:感染(gǎnrǎn)高危因素ArthritisRheumatol,2015.67(6):1577-85.第二十四頁，共三十頁。系統(tǒng)性紅斑狼瘡與感染SLE感染高危(ɡāowēi)因素ArthritisRheumatol,2015.67(6):1577-85.第二十五頁，共三十頁