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Smiyan S, Koshak B, Komorovsky R, Slaba U, Bilukha A. Diagnostic challenge of tuberculosis in systemic lupus erythematosus: a case report and literature review. Rheumatol Int 2023; 43:2131-2139. [PMID: 37522958 DOI: 10.1007/s00296-023-05400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Patients with systemic lupus erythematosus (SLE) are at increased risk of tuberculosis (TB) infection due to immune dysfunction and immunosuppressive therapy. We present a case study of a 40-year-old woman with systemic lupus erythematosus (SLE). Initially, she was diagnosed with a lupus flare based on her clinical symptoms and laboratory results. However, upon further investigation, positive polymerase-chain reaction results for M. tuberculosis in the cerebrospinal fluid and lung parenchymal changes on chest computed tomography scan were indicative of TB infection. There was initial uncertainty regarding whether TB had triggered a flare-up of SLE or if TB was merely mimicking the symptoms of a SLE flare-up. However, as increasing the prednisolone dose did not have a positive effect and the patient's condition improved significantly with anti-TB treatment alone, it became clearer that the deterioration observed upon admission was primarily due to TB progression rather than an SLE flare-up. Additionally, we review the current literature on TB and SLE, including risk factors, diagnostic challenges, and treatment considerations, highlighting the importance of considering TB infection in patients with SLE who present with overlapping manifestations. Prompt diagnosis and treatment are essential for improving outcomes in these patients.
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Affiliation(s)
- Svitlana Smiyan
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine
| | - Bohdan Koshak
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine
| | - Roman Komorovsky
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine.
| | - Ulyana Slaba
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine
| | - Anastasia Bilukha
- 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine
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Thomas K, Tsioulos G, Kotsogianni C, Banos A, Niemela JE, Cheng A, DiMaggio T, Holland S, Rosenzweig SD, Tziolos N, Papadopoulos A, Lionakis MS, Boumpas DT. NF-kappa-B essential modulator (NEMO) gene polymorphism in an adult woman with systemic lupus erythematosus and recurrent non-tuberculous mycobacterial disseminated infections. RMD Open 2023; 9:e003149. [PMID: 37364928 PMCID: PMC10410970 DOI: 10.1136/rmdopen-2023-003149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023] Open
Abstract
Infections are among the most serious complications in patients with systemic lupus erythematosus (SLE), with bacterial and viral infections being the most common. Non-tuberculous mycobacterial (NTM) infections are quite rare and are typically seen in older patients with SLE with longstanding disease duration treated with corticosteroids. Here, we describe a 39-year-old woman with SLE and an unusual pattern of recurrent NTM disseminated infections. After excluding the presence of autoantibodies against interferon-γ, whole exome sequencing revealed a homozygous polymorphism in the NF-kappa-B essential modulator (NEMO) gene. Primary immunodeficiencies should be included in the differential diagnosis of patients with recurrent opportunistic infections, even in those with iatrogenic immunosuppression.
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Affiliation(s)
- Konstantinos Thomas
- 4th Department of Internal Medicine, University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Attica, Greece
| | - Georgios Tsioulos
- 4th Department of Internal Medicine, University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Attica, Greece
| | - Christina Kotsogianni
- 4th Department of Internal Medicine, University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Attica, Greece
| | - Agellos Banos
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Julie E Niemela
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Aristine Cheng
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Tom DiMaggio
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sergio D Rosenzweig
- Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Nikolaos Tziolos
- 4th Department of Internal Medicine, University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Attica, Greece
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Attica, Greece
| | - Michail S Lionakis
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Attica, Greece
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3
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Nossent J, Keen H, Preen DB, Inderjeeth CA. Temporal trends in hospitalisation for opportunistic infections in lupus patients in Western Australia. Lupus 2022; 31:1434-1440. [PMID: 35839098 DOI: 10.1177/09612033221115965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lupus patients often require aggressive immunosuppressive therapy, which increases the risk for infections. We studied the temporal rates for opportunistic infections (OI) and associated mortality in lupus patients hospitalised in Western Australia. METHODS All patients hospitalized in the period 1985-2015 with ≥2 ICD based diagnostic codes for SLE were included. OI was defined as a microbiologically confirmed mycobacterial, fungal, or viral infection. Descriptive data are given as median (IQR) and frequency (%) with incidence rates (IR) calculated per 1000 person years and IR trend rates analysed across 10-year periods by least square regression (R2). RESULTS The study cohort (n = 1408) contained 85.3% females with age at entry 35 years (IQR 22-51). During median follow-up of 21.1 years (IQR 17.5-29.6) hospitalisation for OI occurred in 121 (8.6%) patients with recurrent or multiple OI observed in 42 (34.7%) patients. During 29.771 thousand person years, a total of 295 OI were diagnosed for an overall IR rate of 9.91 (CI 8.82-11.09)/1000 person years which did not decrease significantly over time (R2 0.14). Significant decreases were however seen in the IR for tuberculosis (R2 0.88), cryptococcal (R2 0.98) and pneumocystis (R2 0.98) infections, with increasing IR observed for other mycobacteria (R2 0.99) and aspergillosis (R2 0.55) and little change seen for H Zoster (R2 0.18) and Varicella (R2 0.10) infections. In-hospital death during OI admission occurred in 9/121 patients (7.4%). There was no significant gender difference in IR or outcome of OI. CONCLUSIONS Hospitalization rates for OI in lupus patients have not changed significantly over time, but there has been a clear shift in the underlying OI. The decrease in mycobacterial and pneumocystis infections suggest successful prophylaxis but the increase in viral and mycotic infections indicate a sustained need to improve prevention of these OI in lupus patients.
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Affiliation(s)
- Johannes Nossent
- Dept, Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, Perth, Australia
| | - Helen Keen
- Rheumatology Group, School of Medicine, Perth, Australia.,Dept, Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, Perth, Australia
| | - Charles A Inderjeeth
- Dept, Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, Perth, Australia
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Cellular and molecular mechanisms breaking immune tolerance in inborn errors of immunity. Cell Mol Immunol 2021; 18:1122-1140. [PMID: 33795850 PMCID: PMC8015752 DOI: 10.1038/s41423-020-00626-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/11/2020] [Indexed: 02/01/2023] Open
Abstract
In addition to susceptibility to infections, conventional primary immunodeficiency disorders (PIDs) and inborn errors of immunity (IEI) can cause immune dysregulation, manifesting as lymphoproliferative and/or autoimmune disease. Autoimmunity can be the prominent phenotype of PIDs and commonly includes cytopenias and rheumatological diseases, such as arthritis, systemic lupus erythematosus (SLE), and Sjogren's syndrome (SjS). Recent advances in understanding the genetic basis of systemic autoimmune diseases and PIDs suggest an at least partially shared genetic background and therefore common pathogenic mechanisms. Here, we explore the interconnected pathogenic pathways of autoimmunity and primary immunodeficiency, highlighting the mechanisms breaking the different layers of immune tolerance to self-antigens in selected IEI.
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Fujieda Y, Ninagawa K, Matsui Y, Kono M, Kamishima T, Iwasaki N, Atsumi T. Non-tuberculosis Mycobacterium Tenosynovitis with Rice Bodies in a Patient with Systemic Lupus Erythematosus. Intern Med 2020; 59:2317-2320. [PMID: 32536648 PMCID: PMC7578613 DOI: 10.2169/internalmedicine.4671-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Infectious disease with various presentations in systemic lupus erythematosus often resembles lupus flare. A 37-year-old woman presented with a swollen left index finger that had not resolved, despite 7 years of immunosuppressive treatment. MRI showed rice-body formation in the flexor tendon sheath and tenosynovectomy demonstrated chronic synovitis with epithelioid granuloma. A mycobacterial culture confirmed invasive mycobacterial tenosynovitis due to Mycobacterium chelonae. The patient was treated with moxifloxacin and clarithromycin and completely recovered.
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Affiliation(s)
- Yuichiro Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Keita Ninagawa
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Yuichiro Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Michihiro Kono
- 3rd Department of Internal Medicine, Hokkaido P.W.F.A.C Obihiro-Kosei General Hospital, Japan
| | | | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Lopez-Luis BA, Sifuentes-Osornio J, Pérez-Gutiérrez MT, Chávez-Mazari B, Bobadilla-Del-Valle M, Ponce-de-León A. Nontuberculous mycobacterial infection in a tertiary care center in Mexico, 2001-2017. Braz J Infect Dis 2020; 24:213-220. [PMID: 32428442 PMCID: PMC9392119 DOI: 10.1016/j.bjid.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections. METHODS We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM). RESULTS A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p=0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p=0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p=0.27). CONCLUSIONS Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.
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Affiliation(s)
- Bruno Ali Lopez-Luis
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - María Teresa Pérez-Gutiérrez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Bárbara Chávez-Mazari
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Miriam Bobadilla-Del-Valle
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico.
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Takenaka S, Ogura T, Oshima H, Izumi K, Hirata A, Ito H, Mizushina K, Inoue Y, Katagiri T, Hayashi N, Kameda H. Development and exacerbation of pulmonary nontuberculous mycobacterial infection in patients with systemic autoimmune rheumatic diseases. Mod Rheumatol 2019; 30:558-563. [DOI: 10.1080/14397595.2019.1619220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Sayaka Takenaka
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
| | - Takehisa Ogura
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
| | - Hisaji Oshima
- Department of Connective Tissue Diseases, Tokyo Medical Center National Hospital Organization, Tokyo, Japan
| | - Keisuke Izumi
- Department of Connective Tissue Diseases, Tokyo Medical Center National Hospital Organization, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ayako Hirata
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
| | - Hideki Ito
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
| | - Kennosuke Mizushina
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
| | - Yuki Inoue
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
| | - Takaharu Katagiri
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
| | - Norihide Hayashi
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
| | - Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Toho University, Tokyo, Japan
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Elzein F, Elzein A, Mohammed N, Alswailem R. Miliary tuberculosis mimicking systemic lupus erythematosus flare. Respir Med Case Rep 2018; 25:216-219. [PMID: 30237973 PMCID: PMC6143694 DOI: 10.1016/j.rmcr.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
A 26-year-old woman was diagnosed with and treated for systemic lupus erythematosus (SLE) in 2002. She was admitted 11 years later with nephrotic-range proteinuria and lupus nephritis and received two doses of rituximab after failing on steroids and mycophenolate mofetil. Four months later, she presented with fever and joint pain/swelling. Gram stains, joint aspirates, and blood culture all yielded negative results for bacteria. She was discharged after treatment for a possible flare of lupus, but two weeks later, she presented again with a cough and shortness of breath in addition to the flare symptoms. Synovial fluid Smears, and cultures yielded positive results for Mycobacterium tuberculosis; similarly, sputum polymerase chain reaction test and culture confirmed pulmonary tuberculosis. Tuberculosis is difficult to diagnose in SLE patients; it may present like or precipitate SLE flare. In this patient a presumed SLE flare turned out to be an aggressive miliary, disseminated tuberculosis.
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Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, PSMMC, Riyadh, Saudi Arabia, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Ahmed Elzein
- Infectious Diseases Unit, PSMMC, Riyadh, Saudi Arabia, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Nazik Mohammed
- Infectious Diseases Unit, PSMMC, Riyadh, Saudi Arabia, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Ramiz Alswailem
- Rheumatology Division, PSMMC, Riyadh, Saudi Arabia, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
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9
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Shaharir SS, Sulaiman Sahari N, Mohamed Fuad Z, Zukiman WZHW, Mohd Yusof NH, Sulong A, Periasamy P. Non-tuberculous mycobacterium bacteraemia in a pregnant systemic lupus erythematosus (SLE) patient: a case review and pooled case analysis. Clin Rheumatol 2017; 37:837-847. [DOI: 10.1007/s10067-017-3855-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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10
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Bian SN, Zhang LF, Zhang YQ, Yang QW, Wang P, Xu YC, Shi XC, Liu XQ. Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China. Chin Med J (Engl) 2017; 129:2220-5. [PMID: 27625095 PMCID: PMC5022344 DOI: 10.4103/0366-6999.189920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Nontuberculous Mycobacterium (NTM) bloodstream infection (BSI) is relatively rare. We aimed in this study to evaluate the clinical characteristics, laboratory evaluation, and outcomes of patients with NTM BSI. Methods: We retrospectively reviewed the clinical records of inpatients with NTM BSI at our institution between January 2008 and January 2015 and recorded clinical parameters including age, gender, underlying disease, clinical manifestation, organs involved with NTM disease, species of NTM, laboratory data, treatment and outcome of these patients. We also reviewed the reported cases and case series of NTM BSI by searching PubMed, EMBASE, and Wanfang databases. Data of normal distribution were expressed by mean ± standard deviation (SD). Data of nonnormal distribution were expressed by median and interquartile range (IQR). Results: Among the ten patients with NTM BSI, the median age was 51 years (IQR 29–57 years) and three patients were males. Eight patients were immunocompromised, with underlying diseases including human immunodeficiency virus (HIV) infection (one patient), rheumatic diseases (two patients), breast cancer (one patient), myelodysplastic syndrome (two patients), and aplastic anemia (two patients). Other organ(s) involved were lung (two patients), endocardium (two patients), brain, spinal cord, and soft tissue (one each patient). The median lymphocyte was 0.66 × 109/L (IQR 0.24–1.93 × 109/L). The median cluster of differentiation 4 (CD4) cell count was 179/mm3 (IQR 82–619/mm3). Five patients died (three with hematological diseases, one with breast cancer, and one with rheumatic disease), three recovered, and two were lost to follow-up. Conclusions: We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases.
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Affiliation(s)
- Sai-Nan Bian
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li-Fan Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College, Beijing 100730, China
| | - Yue-Qiu Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qi-Wen Yang
- Laboratory Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Peng Wang
- Laboratory Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ying-Chun Xu
- Laboratory Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Chun Shi
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Qing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College, Beijing 100730, China
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11
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Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections. Int J Mol Sci 2017; 18:ijms18020293. [PMID: 28146077 PMCID: PMC5343829 DOI: 10.3390/ijms18020293] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 12/11/2022] Open
Abstract
Systemic rheumatic diseases have significant morbidity and mortality, due in large part to concurrent infections. The lung has been reported among the most frequent sites of infection in patients with rheumatic disease, who are susceptible to developing pneumonia sustained both by common pathogens and by opportunistic microorganisms. Patients with rheumatic disease show a peculiar vulnerability to infectious complications. This is due in part to intrinsic disease-related immune dysregulation and in part to the immunosuppressive treatments. Several therapeutic agents have been associated to a wide spectrum of infections, complicating the management of rheumatic diseases. This review discusses the most frequent pulmonary infections encountered in rheumatic diseases, focusing on opportunistic agents, consequent diagnostic challenges and appropriate therapeutic strategies.
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12
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Kishida D, Sato M, Kobayashi C, Ueno KI, Kinoshita T, Kodaira M, Shimojima Y, Ishii W, Ushiki A, Ikeda SI. Intractable Cutaneous Nontuberculous Mycobacteriosis (Mycobacterium abscessus) during Treatment for Systemic Lupus Erythematosus. Intern Med 2017; 56:1253-1257. [PMID: 28502947 PMCID: PMC5491827 DOI: 10.2169/internalmedicine.56.8053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mycobacterium abscessus infection tends to occur in patients with an advanced immunocompromised status. We encountered a case of intractable cutaneous M. abscessus infection that developed in a patient with systemic lupus erythematosus (SLE) during maintenance therapy. A 28-year-old woman developed a fever and redness of the skin on her buttocks. General antibacterial therapy was ineffective, and acid-fast bacteria were detected in the biopsy that was conducted to differentiate the dermal symptoms of SLE. The clinical findings eventually improved; however, the symptoms recurred multiple times during treatment. Despite recent advances in SLE treatment, M. abscessus infection remains a considerable complication of SLE.
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Affiliation(s)
- Dai Kishida
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Mitsuto Sato
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Chinatsu Kobayashi
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Ken-Ichi Ueno
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Tomomi Kinoshita
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Minori Kodaira
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Wataru Ishii
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
| | - Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Shu-Ichi Ikeda
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Japan
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13
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Yeung MW, Khoo E, Brode SK, Jamieson FB, Kamiya H, Kwong JC, Macdonald L, Marras TK, Morimoto K, Sander B. Health-related quality of life, comorbidities and mortality in pulmonary nontuberculous mycobacterial infections: A systematic review. Respirology 2016; 21:1015-25. [PMID: 27009804 DOI: 10.1111/resp.12767] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/25/2016] [Accepted: 01/30/2016] [Indexed: 11/28/2022]
Abstract
Nontuberculous mycobacterial (NTM) infections are increasing in disease frequency worldwide. This systematic review examines health-related quality of life (HRQOL), comorbidities and mortality associated with pulmonary NTM disease. We searched MEDLINE, EMBASE, CINAHL, Scopus Life Sciences, conference proceedings and Google (earliest date available to February 2015) for primary studies. Eligible studies compared populations with and without pulmonary NTM disease in high-income jurisdictions. We excluded studies on HIV/AIDS. All languages were accepted. Two reviewers followed MOOSE and PRISMA reporting guidelines and independently appraised quality using STROBE. All studies were summarized qualitatively regardless of quality. Of 3193 citations screened, we included 17 studies mostly from Taiwan (n = 5) and the USA (n = 4). Two studies assessed HRQOL; one assessed comorbidities, 11 assessed mortality, and three assessed multiple outcomes. Populations with pulmonary NTM reported significantly worse or similar HRQOL than the general population, depending on the instruments used. Some suggested greater prevalence of having bronchiectasis (n = 2) and greater risk of developing pulmonary tuberculosis (n = 1). Most (n = 7) suggested no difference in mortality, although only one was age-matched and gender-matched to the general population. Four suggested NTM populations had higher mortality-two of which compared with the general population and were deemed of high quality, while two compared with non-NTM patients from hospital. High clinical heterogeneity in study design may explain discordant results. Bias assessments and controlling for confounding were carried out poorly. No consistent trends were observed although there is suggestion of an increased health burden from respiratory diseases and increased mortality associated with pulmonary NTM disease.
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Affiliation(s)
| | - Edwin Khoo
- Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah K Brode
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,West Park Healthcare Centre, Toronto, Ontario, Canada.,University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Frances B Jamieson
- Public Health Ontario, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Hiroyuki Kamiya
- Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Ontario, Canada.,University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Liane Macdonald
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Theodore K Marras
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation at the University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) collaborative, Toronto, Ontario, Canada
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14
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Park N, Lee S, Moon C, Kim D, Gwak H, Her M. Nontuberculous Mycobacterium Arthritis and Spondylitis in a Patient with Lupus. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Nayoung Park
- Division of Rheumatology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sunjoo Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chisook Moon
- Division of Infection Disease, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dongyook Kim
- Division of Rheumatology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Heuichul Gwak
- Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Minyoung Her
- Division of Rheumatology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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15
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Research Progress on Systemic Lupus Erythematosus Complicated with Infection. INFECTION INTERNATIONAL 2015. [DOI: 10.1515/ii-2017-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIn recent years, in treatment standardization of systemic lupus erythematosus (SLE), infections and serious complications became the leading cause of death related to this disease, exceeding those of renal involvement and lupus encephalopathy. SLE coinfection is mainly related to defects in humoral immunity and cellular immunity, SLE disease activity, and doses of hormone and immune inhibitors.
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16
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Dubula T, Mody GM. Spectrum of infections and outcome among hospitalized South Africans with systemic lupus erythematosus. Clin Rheumatol 2014; 34:479-88. [PMID: 25535200 DOI: 10.1007/s10067-014-2847-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/01/2014] [Accepted: 12/08/2014] [Indexed: 11/24/2022]
Abstract
Our aim was to determine reasons for admission, the prevalence and spectrum of infections, and the outcomes in a multiethnic cohort of hospitalized systemic lupus erythematosus (SLE) patients in Durban, South Africa. We reviewed the records of hospitalized SLE patients seen over a 79-month period; the demographic data, clinical manifestations, laboratory findings, reasons for admission, nature of infection, and outcome were recorded. Our 167 patients, comprising 59.3% Indians, 33.5% African Blacks, 5.4% Coloreds, and 1.8% Whites, had 327 admissions. Active disease and infections accounted for 218 (66.7%) and 115 (35.2%) admissions respectively, with 58 (17.7%) due to both active disease and infection. Features of active disease were mucocutaneous 33.0%, hematological 30.3%, renal 28.9%, and vasculitis 27.1%. Overall, 83 patients (49.7%) had 155 infections; pneumonia (36.8%), cutaneous sepsis (18.1%), tuberculosis (13.5%), urinary tract infections (12.9%), and septicemia (7.1%) were the most common. The organisms commonly isolated were Staphylococcus aureus 25.4%, Escherichia coli 20.3%, and Klebsiella species and Mycobacterium tuberculosis in 13.6% each. Serositis (odds ratio (OR) = 2.7, p = 0.005) and seizures (OR = 4.8, p = 0.007) were associated with increased risk of infection. Twenty-four (14.4%) patients died from infection and active disease; the patients who died had higher SLEDAI scores (p = 0.02) and longer duration of hospitalization (p = 0.03) but no significant associations on multiple logistic regression analysis. Bacterial infections, including tuberculosis, are common in SLE, and they are a major cause of mortality.
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Affiliation(s)
- Thozama Dubula
- Department of Rheumatology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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17
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Lai CC, Hsueh PR. Diseases caused by nontuberculous mycobacteria in Asia. Future Microbiol 2014; 9:93-106. [PMID: 24328383 DOI: 10.2217/fmb.13.138] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The isolation rate of nontuberculous mycobacteria (NTM) species and the prevalence of NTM-associated diseases are on the rise in Asian, as well as in Western countries; however, the species distribution of NTM isolates and the types of diseases caused by NTM species vary from region to region. In this review, we present an update on the epidemiology of NTM in Asia. We demonstrate that the distribution of NTM species varies within Asia and differs from that in North America and Europe. In addition, the clinical manifestations of NTM diseases include respiratory tract infections, disseminated infections, skin and soft tissue infections, lymphadenitis, empyema, ocular infections, CNS infections and genitourinary infections. Finally, the rate of adaptive resistance of anti-NTM antimicrobial agents remains high and may be associated with a poor outcome for patients with NTM diseases.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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18
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem organ involvement, heterogeneity of clinical features, and variety in degree of severity. The differential diagnosis is a crucial aspect in SLE as many other autoimmune diseases portray clinical similarities and autoantibody positivity. Lupus mimickers refer to a group of conditions that exhibit both clinical features and laboratory characteristics, including autoantibody profiles that resemble those present in patients with SLE, and prompt a diagnostic challenge in everyday clinical practice. Thus, lupus mimickers may present as a lupus-like condition (i.e., 2 or 3 criteria) or as one meeting the classification criteria for SLE. Herein we review and classify the current literature on lupus mimickers based on diverse etiologies which include infections, malign and benign neoplasms, medications, and vaccine-related reactions.
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Affiliation(s)
- Omar-Javier Calixto
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Sebastian Franco
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia.
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19
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Esposito S, Bosis S, Semino M, Rigante D. Infections and systemic lupus erythematosus. Eur J Clin Microbiol Infect Dis 2014; 33:1467-75. [PMID: 24715155 DOI: 10.1007/s10096-014-2098-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/20/2014] [Indexed: 12/25/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that presents a protean spectrum of clinical manifestations, and may affect any organ. The typical course of SLE is insidious, slow, and progressive, with potential exacerbations and remissions, and even dramatically acute and rapidly fatal outcomes. Recently, infections have been shown to be highly associated with the onset and/or exacerbations of SLE, and their possible causative and/or protective role has been largely emphasized in the medical literature. However, the etiopathogenesis of SLE is still obscure and far from being completely elucidated. Among infections, particularly Epstein-Barr virus (EBV), parvovirus B19, retrovirus, and cytomegalovirus (CMV) infections might play a pivotal pathogenetic role. The multifaceted interactions between infections and autoimmunity reveal many possibilities for either causative or protective associations. Indeed, some infections, primarily protozoan infections, might confer protection from autoimmune processes, depending on the unique interaction between the microorganism and host. Further studies are needed in order to demonstrate that infectious agents might, indeed, be causative of SLE, and to address the potential clinical sequelae of infections in the field of autoimmunity.
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Affiliation(s)
- S Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda n. 9, 20122, Milano, Italy,
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20
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Kim SY, Yoo H, Jeong BH, Jeon K, Ha YE, Huh HJ, Ki CS, Lee NY, Shin SJ, Koh WJ. First case of nontuberculous mycobacterial lung disease caused by Mycobacterium marseillense in a patient with systemic lupus erythematosus. Diagn Microbiol Infect Dis 2014; 79:355-7. [PMID: 24768296 DOI: 10.1016/j.diagmicrobio.2014.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 02/14/2014] [Accepted: 03/24/2014] [Indexed: 11/30/2022]
Abstract
Mycobacterium marseillense was designated as a new species within Mycobacterium avium complex. We report the first case of M. marseillense lung disease in a patient with systemic lupus erythematosus. All serial isolates were identified as M. marseillense by multilocus sequence analysis, based on hsp65, 16S-23S rRNA internal transcribed spacer, and 16S rRNA fragments.
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Affiliation(s)
- Su-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Eun Ha
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Jae Shin
- Department of Microbiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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21
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Danza A, Ruiz-Irastorza G. Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus 2013; 22:1286-94. [DOI: 10.1177/0961203313493032] [Citation(s) in RCA: 224] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Infection is one of the leading causes of morbidity and mortality in systemic lupus erythematosus (SLE). Bacterial infections are most frequent, followed by viral and fungal infections. The impaired cellular and humoral immune functions seen in patients with SLE are predisposing conditions, whilst disease activity, prednisone doses over 7.5–10 mg/day, high doses of methylprednisolone or cyclophosphamide are well-recognised risk factors for infection. The first six months after rituximab treatment and the use of more than three courses are also associated with an increased susceptibility for infection. It has not been established whether belimumab, azathioprine and mycophenolate mofetil increase the risk of serious infections. Most vaccines are effective and safe in SLE patients, although vaccination should be avoided during periods of active disease. Live virus vaccines are contraindicated for immunosuppressed patients. Influenza and pneumococcal vaccines are universally recommended. Tuberculosis prophylaxis should be considered in selected cases. Therefore, it is advisable not to exceed doses of 5 mg/day of prednisone in chronic treatment. Methylprednisolone and cyclophosphamide should be used in low-dose regimens. Antimalarials have a well-known protective role against infection, in addition to other beneficial properties, thus, hydroxychloroquine is recommended for all SLE patients where no contraindication exists.
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Affiliation(s)
- A Danza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital De Cruces, University of the Basque Country, Spain
- Clinical Department of Medicine, Facultad de Medicina, Universidad de la República, Uruguay
| | - G Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital De Cruces, University of the Basque Country, Spain
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22
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Choi JJ, Ban WH, Jung YH, Bae MN, Baek IW, Kim KJ, Cho CS. Mycobacterial tenosynovitis of the hand in a patient with systemic lupus erythematosus. Int J Rheum Dis 2013; 16:364-6. [PMID: 23981763 DOI: 10.1111/1756-185x.12111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Skin Nontuberculous Mycobacterial Infection in Systemic Lupus Erythematosus: An Unusual Skin Infection Mimicking Lupus Vasculitis. Semin Arthritis Rheum 2013; 42:498-506. [DOI: 10.1016/j.semarthrit.2012.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/30/2012] [Accepted: 08/09/2012] [Indexed: 11/17/2022]
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24
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Xu Y, Xu D, Zhang T, Leng XM, Zhang FC, Zeng XF. The prevalence and clinical characteristics of systemic lupus erythematosus with infectious brain lesions in China. Scand J Rheumatol 2012; 41:466-71. [PMID: 22827530 DOI: 10.3109/03009742.2012.680607] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Infectious brain lesions (IBLs) are life-threatening in patients with systemic lupus erythematosus (SLE). The aim of this study was to determine the prevalence of IBL in SLE patients and the clinical characteristics of SLE patients with IBL. METHODS Medical charts of 15 consecutive SLE patients with IBL admitted to Peking Union Medical College Hospital (PUMCH) from January 1995 to October 2010 were reviewed systematically. A total of 150 cases were randomly selected as controls from 4115 SLE inpatients without IBL in PUMCH during the same period. RESULTS The prevalence of IBL in SLE patients was 0.4%. Significant differences were observed between SLE patients with and without IBL in the following manifestations (p < 0.05): arthritis/musculoskeletal involvement (66.7% vs. 32.0%), C-reactive protein (CRP) elevation (84.6% vs. 28.0%), anti-dsDNA antibody positivity (13.3% vs. 42.9%), and elevated SLE Disease Activity Index (SLEDAI) score (> 5) (13.3% vs. 71.3%). Fever was the most common manifestation (80%), followed by headache and focal neurological signs (73.3%). Twelve patients presented with infections in other sites, including pulmonary infection (66.7%) and meningitis (40.0%). Enhanced cranial magnetic resonance imaging (MRI) revealed point-enhancing or ring-enhancing lesions in all patients evaluated (12/12, 100%). Mycobacterium tuberculosis was the most common pathogen (10 cases, 66.7%). After administration of antibiotics targeting the pathogens, 11 patients (73.3%) recovered. CONCLUSIONS IBL is not common in SLE patients. In stable SLE patients with fever, focal neurological signs, and CRP elevation, IBL should be suspected. Enhanced cranial MRI and a thorough check-up should be performed in a timely manner. It is very important to identify the pathogens and initiate treatment as early as possible.
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Affiliation(s)
- Y Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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25
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Sebastiani GD, Iuliano A, Prevete I, Minisola G. Opportunistic infections in systemic lupus erythematosus. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ijr.12.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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[Lupus erythematosus. Wide range of symptoms through clinical variation, associated diseases and imitators]. Hautarzt 2010; 61:676-82. [PMID: 20549478 DOI: 10.1007/s00105-010-1939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The typical clinical forms of cutaneous lupus erythematosus (LE) are the butterfly rash, acute, subacute and chronic cutaneous lupus, intermediate lupus (lupus tumidus), chilblain- and bullous lupus, lupus profundus, and ulcerating lesions on the mucous membrane. Besides the typical lupus forms, nonspecific skin lesions are also observed such as dermal mucinosis, acneiform skin lesions, different variants of livedo, necrotizing vasculitis with ulcers, purpura, urticaria vasculitis, neutrophilic dermatosis, hyperpigmentation, hair and nail changes as well as overlap syndromes with erythema multiforme, scleroderma, Sjögren syndrome, Raynaud phenomenon, lichen planus, bullous pemphigoid und psoriasis. There are lupus imitators which create differential diagnostic challenges, such as infections with atypical mycobacteria or subcutaneous T-cell lymphoma both of which are similar to lupus profundus. All these skin lesions can present as maximal pathological findings seen in lupus or be caused by a variety of pathological laboratory findings such as the anti-phospholipid antibodies or a deficiency of complement factors. In the latter situation severe lupus often with complications can be expected.
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27
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Nallasivan M, Al-Allaf AW. Infections in systemic lupus erythematosus mimicking as disease flare. INDIAN JOURNAL OF RHEUMATOLOGY 2009. [DOI: 10.1016/s0973-3698(09)60119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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28
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Cuchacovich R, Gedalia A. Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheum Dis Clin North Am 2009; 35:75-93. [PMID: 19480998 DOI: 10.1016/j.rdc.2009.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Systemic lupus erythematosus (SLE) is an inflammatory and multisystemic autoimmune disorder characterized by an uncontrolled autoreactivity of B and T lymphocytes leading to the production of autoantibodies against self-directed antigens and tissue destruction. Environmental factors, such as infections, which are an important cause of morbidity and mortality, are potential triggers of the disease. This article discusses bacterial, viral, and opportunistic microorganism infections in SLE, and the role of immunosuppressive therapy and immunodeficiencies in the disease.
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Affiliation(s)
- Raquel Cuchacovich
- Section of Rheumatology, Department of Internal Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
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29
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Active and Latent Tuberculosis in Patients With Systemic Lupus Erythematosus Living in the United States. J Clin Rheumatol 2009; 15:226-9. [DOI: 10.1097/rhu.0b013e3181b0c85d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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31
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Current World Literature. Curr Opin Pulm Med 2008; 14:266-73. [DOI: 10.1097/mcp.0b013e3282ff8c19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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