A Multicenter Study of Invasive Fungal Infections in Patients with Childhood-onset Systemic Lupus Erythematosus

Silva, Marco F.; Ferriani, Mariana Paes Leme; Terreri, Maria Teresa; Pereira, Rosa Maria Rodrigues; Magalhães, Cláudia Saad; Bonfá, Eloísa; Campos, Lúcia Maria Arruda; Okuda, Eunice Mitiko; Appenzeller, Simone; Ferriani, Virgínia P.; Barbosa, Cássia Maria Passarelli Lupoli; Ramos, Valéria C.; Lotufo, Simone; Silva, Clóvis A.

doi:10.3899/jrheum.150142

Cited by 43 publications

(47 citation statements)

References 37 publications

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“…We observed lower rates of serious fungal infections in our population compared with a prior report of invasive fungal infections affecting almost 4% of childhood‐onset SLE patients followed by 10 pediatric rheumatology services in Brazil . The difference may be due, in part, to the fact that our study excluded systemic candidiasis from the fungal infection outcome definition, whereas candidiasis accounted for 61% of the invasive fungal infection cases observed in the Brazilian study .…”

Section: Discussioncontrasting

confidence: 73%

“…In studies of patients followed at tertiary care centers, it was observed that 37–57% of SLE patients had at least 1 serious infection requiring prolonged parenteral, antimicrobial therapy and/or hospitalization over an average observation period of 5 to 7 years , with an estimated annual incidence of 17 infections per 100 person‐years . We observed lower rates of serious fungal infections in our population compared with a prior report of invasive fungal infections affecting almost 4% of childhood‐onset SLE patients followed by 10 pediatric rheumatology services in Brazil . The difference may be due, in part, to the fact that our study excluded systemic candidiasis from the fungal infection outcome definition, whereas candidiasis accounted for 61% of the invasive fungal infection cases observed in the Brazilian study .…”

Section: Discussioncontrasting

confidence: 61%

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Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Hiraki

Feldman

Marty

et al. 2017

Arthritis Care & Research

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Objective To investigate the nationwide prevalence and incidence of serious infections among children with systemic lupus erythematosus (SLE) enrolled in Medicaid, the U.S. health insurance program for low-income patients. Methods From Medicaid claims (2000–2006) we identified children 5 to <18 years old with SLE (≥3 ICD-9 codes of 710.0, each >30 days apart) and lupus nephritis (LN; ≥2 ICD-9 codes for kidney disease on/after SLE codes). From hospital discharge diagnoses, we identified infection subtypes (bacterial, fungal, viral). We calculated incidence rates (IR) per 100 person-years (PY), mortality rates, and hazard ratios adjusted for sociodemographic factors, medications, and preventive care. Results Among 3,500 children with SLE identified, 1,053 serious infections occurred over 10,108 person-years; the IR was 10.42/100 PY (95% CI 9.80, 11.07) among all those with SLE and 17.65/100 PY (95% CI 16.29, 19.09) among those with LN. Bacterial infections were most common (87%; of which 39% were bacterial pneumonias). In adjusted models, African Americans and Native Americans had higher rates of infections compared with white children, and those with comorbidities or receiving corticosteroids had higher infection rates than those without. Males had lower rates of serious infections compared to females. The 30-day post-discharge mortality rate was 4.4%. Conclusions Overall, hospitalized infections were very common in children with SLE, with bacterial pneumonia being the most common infection. Highest infection risks were among African and Native American children, those with LN, comorbidities, and those taking corticosteroids.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussioncontrasting

confidence: 61%

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Hiraki

Feldman

Marty

et al. 2017

Arthritis Care & Research

View full text Add to dashboard Cite

show abstract

“…Twenty-two cases were proven IFI, and six of them were Aspergillosis involving the lungs, CNS, and myocardium. e most important types of IFI leading to death in these series were eight cases of aspergillosis and six cases of candidiasis [5]. Some researchers focused specifically on evaluating invasive aspergillosis (IA) in SLE patients.…”

Section: Discussionmentioning

confidence: 99%

Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus

Hardie

James-Goulbourne

Rashid

et al. 2020

Case Reports in Infectious Diseases

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Patients with systemic lupus erythematosus (SLE) are at increased risk for infection including opportunistic infections. Fungal infection in particular can be difficult to diagnose and treat and often can be life-threatening in the immunocompromised patient. We present a case in which a patient with SLE presented to the hospital with shortness of breath and cough. Throughout the hospital course, the patient’s condition continued to decline leading to acute respiratory failure, and eventually, the patient expired. Postmortem autopsy revealed invasive fungal aspergillosis infection involving the heart, lungs, and brain. Earlier diagnosis and treatment with empiric antifungals may improve survival in these patients.

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“…Among all immunosuppressants, our study found that only steroid use—including intravenous administration and a daily oral dose of over 7.5 mg—represented an independent risk factor for severe HSV infection. Several studies have referred to systemic glucocorticoid as a risk factor for SLE infection through many pathogens, including bacteria, fungi and viruses 20–22. Among viruses, systemic steroid use has been associated with HZV,23 human papillomavirus21 and human cytomegalovirus,24 whereas little attention has been given to HSV.…”

Section: Discussionmentioning

confidence: 99%

Risk of severe herpes simplex virus infection in systemic lupus erythematosus: analysis of epidemiology and risk factors analysis in Taiwan

Lai

Wang

et al. 2019

Ann Rheum Dis

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ObjectivePatients with systemic lupus erythematosus (SLE) are susceptible to herpes simplex virus (HSV) infection, which occasionally leads to severe complications including meningoencephalitis and keratitis. However, few attempts to analyse the associated incidence and risk factors have been made.MethodsWe enrolled patients with SLE recorded between 1997 and 2012 and compared the incidence rate (IR) of severe HSV infection, including meningoencephalitis, septicaemia, ocular and visceral involvement, and other specific complications demanding hospitalisation, with that of a non-SLE cohort. A Cox multivariate proportional hazards model was applied to analyse the risk factors of severe HSV infection in patients with SLE.ResultsA total of 122 520 subjects (24 504 patients with SLE and 98 016 age-matched and sex-matched non-SLE controls) were included, and a higher IR of severe HSV infection was revealed in the SLE group (IR ratio=3.93, p<0.001). In patients with SLE, previous oral and genital infection (HR=2.29, p=0.049), intravenous steroid pulse therapy (HR=5.32, p<0.001) and daily oral dose of over 7.5 mg of prednisolone (HR=1.59, p=0.024) were independent risk factors for severe HSV infection, whereas age of ≤18 (HR=0.45, p=0.029) was a protective factor.ConclusionsPatients with SLE are at higher risk of severe HSV infection, and related risk factors include being older than 18 years, having a history of HSV mucocutaneous infection, recent receipt of steroid pulse therapy and a daily oral dose of steroid over 7.5 mg prednisolone.

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A Multicenter Study of Invasive Fungal Infections in Patients with Childhood-onset Systemic Lupus Erythematosus

Cited by 43 publications

References 37 publications

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus

Risk of severe herpes simplex virus infection in systemic lupus erythematosus: analysis of epidemiology and risk factors analysis in Taiwan

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