Infections and Systemic Lupus Erythematosus
Infections and Systemic Lupus Erythematosus
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DOI：
10.5772/27509
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发表时间：
2012-03
期刊：
影响因子：
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通讯作者：
C. A. Arce-Salinas;P. Villaseñor-Ovies
中科院分区：
文献类型：
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作者：
C. A. Arce-Salinas;P. Villaseñor-Ovies
尽管在过去的几十年里，系统性红斑狼疮（SLE）患者的预期寿命逐渐提高，但其死亡率仍然是普通人群的三倍（Uramoto等人，1998年）。世界各地报告的死亡原因各不相同，但这些患者死亡率的双峰曲线是一致的，在诊断后早期出现最初的高峰，与疾病活动和感染密切相关，后来的升级也与心血管疾病、累积损伤和感染相关（Rubin等，1985）。可能是由于其复杂性，感染性疾病在SLE中常常被认为是一个严峻的话题，但不可否认的是，在疾病的每个阶段，感染都是导致死亡率的重要因素。狼疮患者的感染范围差异很大，从在某种程度上归因于免疫功能障碍的机会性感染到典型或非典型表现的常见细菌和病毒感染。此外，狼疮患者比其他诊断的住院患者更容易发生医院获得性感染。一些作者强调了某些条件与狼疮患者感染风险的关联。其中包括：疾病活动性高，特异性免疫失调；药物性免疫缺陷；器官衰竭是由于不可逆的损伤。另一方面，一些临床表现，如发热、淋巴结病、不明原因的精神错乱、肺浸润、皮肤和粘膜损伤、凝血功能障碍等，对临床医生来说是真正的诊断挑战，他们可能把它们作为狼疮发作的线索，或者可能被迫开始抗菌治疗的试验，因为这些也可能是危及生命的感染的临床表现，或者，因为它经常发生在现场同时处理这两种情况。一些证据表明，某些感染，特别是病毒性感染，可能参与疾病的开始、疾病的爆发或活动性狼疮病情的恶化。在本章中，我们将回顾目前关于SLE患者感染的信息，以及预防和治疗SLE的建议。
Notwithstanding that life expectancy in patients with systemic lupus erythematosus (SLE) has improved progressively in the last few decades, the mortality rates remain three times higher as compared with the general population (Uramoto et al, 1998). Reported causes of death vary according to the region of the world, yet there is agreement on the bimodal curve of mortality rate in these patients, with an initial peak occurring early after diagnosis, strongly related with disease activity and infections, and a later escalade associated with cardiovascular disease, accrued damage, and infections too (Rubin et al, 1985). It may be due to its complexity that infectious disease is often considered a grim topic in SLE, but it is undeniable that infections are important contributors of mortality in every stage of the disease. The range of infections in lupus patients varies widely, from opportunistic infections attributable in some level to immunological dysfunctionto common bacterial and viral infections with typical or atypical presentations. Moreover, patients with lupus exhibit increased proclivity to hospital acquired infections than hospitalized patients with other diagnosis. Some authors have stressed out the association that certain conditions have with the risk of infections in patients with lupus. Some of these include: high disease activity, specific immune dysregulation; drug-induced immune deficiency; and organ failure due to irreversible damage. On the other hand, several clinical manifestations like fever, lymphadenopathy, unexplained confusion, pulmonary infiltrates, skin and mucosal injuries, coagulation disorders, and others, represent true diagnostic challenges for the clinician who may take them as clues of a lupus flare, or may be compelled to commence a trial of antimicrobial treatment because these may also be the clinical expression of a life-threatening infection, or perhaps, as it often occurs in the field treat both conditions simultaneously. Some evidence suggests that certain infections, particularly of viral nature, might participate in disease initiation, disease flare or worsening of an active lupus condition. In this chapter we will review the current information regarding infections in patients with SLE, and recommendations to prevent and treat them.