齐鲁医学系统性红斑狼疮与感染.pptx

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1、LUPUS Vs INFECTIONZhao jiuliangDepartment of RheumatologyPUMCH,Beijing12021/7/27 星期二Q1.What are the most frequent infections in patients with SLE?Q2 Which are the clinical factors involved in the development of infections in SLE?Q3 How can the risk of infectious complications in SLE be reduced?22021

2、/7/27 星期二Q1.What are the most frequent infections in patients with SLE?32021/7/27 星期二Infection is responsible for approximately 25%of all deaths in patients with systemic lupus erythematosus(SLE)The main reason of hospitalizationAppears to be highest within the first 5 years of disease onset42021/7/

3、27 星期二Infection in SLEClin Rheumatol,2014.33(1):57-63.52021/7/27 星期二Characteristics of major infections in SLERespiratory tractsUrinary tractsSkin and soft tissuesThe types of infections that SLE patients developed were the same as in the general population 62021/7/27 星期二The most frequent infections

4、 include:Pneumonia,herpes zoster virus,and urinary tract infection Arthritis Care Res(Hoboken),2015.67(8):1078-85.Characteristics of major infections in SLE72021/7/27 星期二Relative risks of hospitalizations Lupus compared with general populationArthritis Care Res(Hoboken),2015.67(8):1078-85.82021/7/27

5、 星期二Pathogen of infection in SLEGram-negative bacilli,gram-positive cocci,fungal and other bacterial infections accounted for 39.85%,31.58%,18.80%and 9.77%,respectively of nosocomial infections.92021/7/27 星期二Clinical manifestations of infectionsAtypical!102021/7/27 星期二Mycobacterium tuberculosisThe p

6、revalence of TB infection in SLE:5-30%Characteristicshigher incidence rate more frequent extra-pulmonary involvement more extensive pulmonary involvement High relapse rate even if treated with prophylactic izoniazidmore common in SLE renal transplant patientsZandman-Goddard,G.,Infections and SLE.Aut

7、oimmunity,2009.38(7):473-485.112021/7/27 星期二Mycobacterium tuberculosisTB may present as a mimicker of vasculitisTB may present with skin disease posing a diagnostic challenge A high index of suspicion will allow prompt treatment.TB.spotData in China122021/7/27 星期二Viral infectionsAcute viral infectio

8、ns in SLECMV(50%)parvovirus B19herpes simplexEBVvaricella zoster virushepatitis Aamong other less frequently reported viruses 132021/7/27 星期二HZVThe annual age-adjusted incidence of herpes zoster virus in SLE patients of 12/1000 person-yearsMost frequently a late(5yrs)complications of SLEOften occurr

9、ing during inactivity or mild SLE activity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 syndrome142021/7/27 星期二Cytomegalovirus（CMV）CMV infection and SLE exacerbation may be difficult to distinguish Development of SLE may be triggered by a CMV infection.Existing SLE may undergo an exacerbation following a CMV

10、 infectionCMV seropositive VS overt clinical diseaseOver 90%SLE pts are seropositiveAntigenemia 18-44%Overt clinical disease:uncommon152021/7/27 星期二Pneumocystis Pneumonia162021/7/27 星期二Pneumocystis PneumoniaA cut off for PCP prophylaxis in any particular disease:3.5%?6%？however,the frequency of PCP

11、varies greatly from disease to disease.GPASLEIIMRA?()Risk factorsLow CD4+countsLymphocyte=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 inf

12、ection;higher AEs ratesNot sufficient evidence to support universal use of prophylaxia202021/7/27 星期二Q2 Which are the clinical factors involved in the development of infections in SLE?212021/7/27 星期二Risk factors for infection Use of steroids ever Use of CYC,MMF,CD20 mAb Organ damage resulting from s

13、evere lupus Severe lupus flares involving the kidney or central nervous system High SLE disease activity index(SLEDAI)Danza,A.and Ruiz-Irastorza,G.,Infection risk in systemic lupus erythematosus patients:susceptibility factors and preventive strategies.Lupus,2013.22(12):1286-94.222021/7/27 星期二Predni

14、sone use to be associated with infection risk,with each 10 mg per day increase of prednisone increasing the risk of serious infection 11-fold.Ruiz-Irastorza,G.,Predictors of major infections in systemic lupus erythematosus.Arthritis Res Ther,2009.11(4):R109.232021/7/27 星期二LN:感染高危因素Arthritis Rheumato

15、l,2015.67(6):1577-85.242021/7/27 星期二SLE感染高危因素Arthritis Rheumatol,2015.67(6):1577-85.252021/7/27 星期二Q3 How can the risk of infectious complications in SLE be reduced?262021/7/27 星期二For RheumatistEULAR recommendations Careful titration of corticosteroids and other immuno-suppressive agents against disease activity Prompt evaluation for infections Prophylactic use of antibiotics for pts at high risk of certain infectionsImmunizations272021/7/27 星期二GCs in SLE282021/7/27 星期二具体预防措施292021/7/27 星期二