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LUPUS
Vs
INFECTION整理課件Q1.
What
are
the
most
frequentinfectionsinpatientswithSLE?Q2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?整理課件Q1.
What
are
the
most
frequentinfectionsinpatientswithSLE?整理課件Infectionisresponsibleforapproximately25%ofalldeathsinpatientswithsystemiclupuserythematosus(SLE)The
main
reason
of
hospitalizationAppearstobehighestwithinthefirst5yearsofdiseaseonset整理課件InfectioninSLEClinRheumatol,2021.33(1):57-63.整理課件CharacteristicsofmajorinfectionsinSLERespiratory
tractsUrinary
tractsSkin
and
soft
tissuesThetypesofinfectionsthatSLEpatientsdevelopedwerethesameasinthegeneralpopulation整理課件Themostfrequentinfectionsinclude:Pneumonia,herpeszostervirus,andurinarytractinfectionArthritisCareRes(Hoboken),2021.67(8):1078-85.CharacteristicsofmajorinfectionsinSLE整理課件RelativerisksofhospitalizationsLupus
compared
with
general
populationArthritisCareRes(Hoboken),2021.67(8):1078-85.整理課件Pathogen
of
infection
in
SLEGram-negativebacilli,gram-positivecocci,fungalandotherbacterialinfectionsaccountedfor39.85%,31.58%,18.80%and9.77%,respectivelyofnosocomialinfections.整理課件Clinicalmanifestations
of
infectionsAtypical
!!!整理課件MycobacteriumtuberculosisThe
prevalence
of
TB
infection
in
SLE:
5-30%Characteristicshigherincidenceratemorefrequentextra-pulmonaryinvolvementmoreextensivepulmonaryinvolvementHighrelapserateeveniftreatedwithprophylacticizoniazidmorecommoninSLErenaltransplantpatientsZandman-Goddard,G.,InfectionsandSLE.Autoimmunity,2021.38(7):473-485.整理課件MycobacteriumtuberculosisTB
maypresentasamimickerofvasculitisTB
maypresentwithskindiseaseposingadiagnosticchallengeAhighindexofsuspicionwillallowprompttreatment.TB.spotData
in
China整理課件ViralinfectionsAcuteviralinfectionsinSLECMV(~50%)parvovirusB19herpessimplexEBVvaricellazostervirushepatitisAamongotherlessfrequentlyreportedviruses整理課件HZVTheannualage-adjustedincidenceofherpeszostervirusinSLEpatientsof12/1000person-yearsMostfrequentlyalate(>5yrs)complicationsofSLEOftenoccurringduringinactivityormildSLEactivity往往皮疹重而神經(jīng)系統(tǒng)表現(xiàn)輕潰瘍性角膜炎耳帶狀皰疹,Ramsay-Hunt
syndrome整理課件Cytomegalovirus〔CMV〕CMVinfectionandSLEexacerbationmaybedifficulttodistinguishDevelopmentofSLEmaybetriggeredbyaCMVinfection.ExistingSLEmayundergoanexacerbationfollowingaCMVinfectionCMV
seropositive
VS
overt
clinical
diseaseOver
90%
SLE
pts
are
seropositiveAntigenemia
18-44%Overt
clinical
disease:
uncommon整理課件PneumocystisPneumonia整理課件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整理課件PneumocystisPneumonia整理課件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
整理課件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整理課件Q2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?整理課件RiskfactorsforinfectionUseofsteroidseverUseofCYC,
MMF,
CD20
mAbOrgandamageresultingfromseverelupusSeverelupusflaresinvolvingthekidneyorcentralnervoussystemHighSLEdiseaseactivityindex(SLEDAI)Danza,A.andRuiz-Irastorza,G.,Infectionriskinsystemiclupuserythematosuspatients:susceptibilityfactorsandpreventivestrategies.Lupus,2021.22(12):1286-94.整理課件Prednisoneusetobeassociatedwithinfectionrisk,witheach10mgperdayincreaseofprednisoneincreasingtheriskofseriousinfection11-fold.Ruiz-Irastorza,G.,Predictorsofmajorinfectionsinsystemiclupuserythematosus.ArthritisResTher,2021.11(4):R109.整理課件LN:感染高危因素ArthritisRheumatol,2021.67(6):1577-85.整理課件SLE感染高危因素ArthritisRheumatol,2021.67(6):1577-85.整理課件Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?整理課件For
RheumatistEULAR
recommend
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