系统性红斑狼疮与感染

LUPUS

Vs

INFECTION整理课件Q1.

What

are

the

most

frequentinfectionsinpatientswithSLE?Q2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?整理课件Q1.

What

are

the

most

frequentinfectionsinpatientswithSLE?整理课件Infectionisresponsibleforapproximately25%ofalldeathsinpatientswithsystemiclupuserythematosus(SLE)The

main

reason

of

hospitalizationAppearstobehighestwithinthefirst5yearsofdiseaseonset整理课件InfectioninSLEClinRheumatol,2021.33(1):57-63.整理课件CharacteristicsofmajorinfectionsinSLERespiratory

tractsUrinary

tractsSkin

and

soft

tissuesThetypesofinfectionsthatSLEpatientsdevelopedwerethesameasinthegeneralpopulation整理课件Themostfrequentinfectionsinclude:Pneumonia,herpeszostervirus,andurinarytractinfectionArthritisCareRes(Hoboken),2021.67(8):1078-85.CharacteristicsofmajorinfectionsinSLE整理课件RelativerisksofhospitalizationsLupus

compared

with

general

populationArthritisCareRes(Hoboken),2021.67(8):1078-85.整理课件Pathogen

of

infection

in

SLEGram-negativebacilli,gram-positivecocci,fungalandotherbacterialinfectionsaccountedfor39.85%,31.58%,18.80%and9.77%,respectivelyofnosocomialinfections.整理课件Clinicalmanifestations

of

infectionsAtypical

!!!整理课件MycobacteriumtuberculosisThe

prevalence

of

TB

infection

in

SLE:

5-30%Characteristicshigherincidenceratemorefrequentextra-pulmonaryinvolvementmoreextensivepulmonaryinvolvementHighrelapserateeveniftreatedwithprophylacticizoniazidmorecommoninSLErenaltransplantpatientsZandman-Goddard,G.,InfectionsandSLE.Autoimmunity,2021.38(7):473-485.整理课件MycobacteriumtuberculosisTB

maypresentasamimickerofvasculitisTB

maypresentwithskindiseaseposingadiagnosticchallengeAhighindexofsuspicionwillallowprompttreatment.TB.spotData

in

China整理课件ViralinfectionsAcuteviralinfectionsinSLECMV(~50%)parvovirusB19herpessimplexEBVvaricellazostervirushepatitisAamongotherlessfrequentlyreportedviruses整理课件HZVTheannualage-adjustedincidenceofherpeszostervirusinSLEpatientsof12/1000person-yearsMostfrequentlyalate(>5yrs)complicationsofSLEOftenoccurringduringinactivityormildSLEactivity往往皮疹重而神经系统表现轻溃疡性角膜炎耳带状疱疹，Ramsay-Hunt

syndrome整理课件Cytomegalovirus〔CMV〕CMVinfectionandSLEexacerbationmaybedifficulttodistinguishDevelopmentofSLEmaybetriggeredbyaCMVinfection.ExistingSLEmayundergoanexacerbationfollowingaCMVinfectionCMV

seropositive

VS

overt

clinical

diseaseOver

90%

SLE

pts

are

seropositiveAntigenemia

18-44%Overt

clinical

disease:

uncommon整理课件PneumocystisPneumonia整理课件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整理课件PneumocystisPneumonia整理课件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

整理课件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整理课件Q2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?整理课件RiskfactorsforinfectionUseofsteroidseverUseofCYC,

MMF,

CD20

mAbOrgandamageresultingfromseverelupusSeverelupusflaresinvolvingthekidneyorcentralnervoussystemHighSLEdiseaseactivityindex(SLEDAI)Danza,A.andRuiz-Irastorza,G.,Infectionriskinsystemiclupuserythematosuspatients:susceptibilityfactorsandpreventivestrategies.Lupus,2021.22(12):1286-94.整理课件Prednisoneusetobeassociatedwithinfectionrisk,witheach10mgperdayincreaseofprednisoneincreasingtheriskofseriousinfection11-fold.Ruiz-Irastorza,G.,Predictorsofmajorinfectionsinsystemiclupuserythematosus.ArthritisResTher,2021.11(4):R109.整理课件LN:感染高危因素ArthritisRheumatol,2021.67(6):1577-85.整理课件SLE感染高危因素ArthritisRheumatol,2021.67(6):1577-85.整理课件Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?整理课件For

RheumatistEULAR

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