INFECTIONS IN EGYPTIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS A STUDY OF AIN SHAMS LUPUS COHORT

Abstract

Infection is a common problem and has become one of the leading causes of morbidity and mortality in patients with SLE. The reasons for the high incidence of infection are immunosuppressive therapy and immune disturbances of lupus itself. Infections may mimic exacerbations of SLE, leading to confusion over the diagnosis and appropriate treatment. It can be notoriously difficult to differentiate between infection and disease flare in some cases. Indeed they may co-exist. This prospective cohort study was designed to analyze the occurrence and characteristics of infection in Egyptian SLE patients and determine the related risks factors. Our study included 200 Egyptian SLE patients who fulfilled the American College of Rheumatology (ACR) for the diagnosis of SLE. SLE patients were prospectively followed up for one year during the period from (2011-2012) at one month intervals. All patients were examined clinically and disease activity scoring was done using SLAM score. Laboratory investigation including CBC, ESR, CRP, 24 hrs urinary proteins, ANA, anti DNA, C3, C4 levels, CMV and EBV antibodies (IgG and IgM) were done. In our studied group of SLE patients (200 patients) 170 (85%) were females, while 30 patients (15%) were males with female to male ratio 5.6:1. Their ages ranged from14-60 years with mean age of 27.8 ± 8.3 years. The mean disease duration was 37.7 ± 36.7 ms. In the present study we found that, among studied SLE patients, 110 patients (55%) developed infection (group A) along follow up period of one year. Fifty five patients (50 %) had one infectious episode, and 55 patients (50%) had multiple infections episodes (2 times in 19 patients, 3 times in 16 patients, 4 times in 11 patients, 5 time in 6 patients and 6 time in 3 patients). Fifteen patients (13.6%) had developed infection related complications, 9 patients needed ICU admissions (8.2%), 3 patients developed septicemia (2.7%) and 3 patients died (2.7%) from causes directly related to infection. Co-existing infections was found in 42 patients (38.2%). The total number of infectious episodes in group A was 233infections/year. 47.2% (110 episodes) were major and 52.8% were minor infections (123 episodes). Urinary tract was the most commonly involved site with 74 infectious episodes (31.8 %) / year and was commonly caused by E. coli (26 times).