Sometimes There Is More Than One Puzzle on the Table: Pneumococcal Bacteremia as a New Systemic Lupus Erythematosus Presentation

Triggers of Autoimmunity: The Role of Bacterial Infections in the Extracellular Exposure of Lupus Nuclear Autoantigens

Infections are considered important environmental triggers of autoimmunity and can contribute to autoimmune disease onset and severity. Nucleic acids and the complexes that they form with proteins—including chromatin and ribonucleoproteins—are the main autoantigens in the autoimmune disease systemic lupus erythematosus (SLE). How these nuclear molecules become available to the immune system for recognition, presentation, and targeting is an area of research where complexities remain to be disentangled. In this review, we discuss how bacterial infections participate in the exposure of nuclear autoantigens to the immune system in SLE. Infections can instigate pro-inflammatory cell death programs including pyroptosis and NETosis, induce extracellular release of host nuclear autoantigens, and promote their recognition in an immunogenic context by activating the innate and adaptive immune systems. Moreover, bacterial infections can release bacterial DNA associated with other bacterial molecules, complexes that can elicit autoimmunity by acting as innate stimuli of pattern recognition receptors and activating autoreactive B cells through molecular mimicry. Recent studies have highlighted SLE disease activity-associated alterations of the gut commensals and the expansion of pathobionts that can contribute to chronic exposure to extracellular nuclear autoantigens. A novel field in the study of autoimmunity is the contribution of bacterial biofilms to the pathogenesis of autoimmunity. Biofilms are multicellular communities of bacteria that promote colonization during chronic infections. We review the very recent literature highlighting a role for bacterial biofilms, and their major components, amyloid/DNA complexes, in the generation of anti-nuclear autoantibodies and their ability to stimulate the autoreactive immune response. The best studied bacterial amyloid is curli, produced by enteric bacteria that commonly cause infections in SLE patients, including Escherichia coli and Salmonella spps. Evidence suggests that curli/DNA complexes can trigger autoimmunity by acting as danger signals, molecular mimickers, and microbial chaperones of nucleic acids.

Effect of targeted nursing applied to SLE patients

The aim of the present study was to evaluate the efficacy of targeted nursing for patients with systemic lupus erythematosus (SLE). A total of 114 patients clinically diagnosed with stable SLE were prospectively selected. The patients were randomly divided into the regular special nursing group, comprising 56 patients and the targeted nursing group (i.e., taylor made according to different pathogenic conditions and treatment period), comprising 58 patients. The patients received standard medical treatment for SLE, irrespective of their group, and the efficacy of targeted nursing on disease activity, incidence of complications, therapeutic compliance, quality of life and nursing satisfaction was compared with regular special nursing. The patients were followed up for a period of 20 months. The results showed that, disease activity and injury index score and incidence of complications were significantly less in the targeted nursing group than in the regular special nursing group (P<0.05). Additionally, therapeutic compliance, quality of life score and nursing content satisfaction were significantly higher in the targeted nursing group in comparison with the regular special nursing group (P<0.05). Thus, the results indicated that targeted nursing significantly improved therapeutic compliance and quality of life, and simultaneously, reduced complications and disease activity in patients receiving standard treatment for SLE.