Invasive fungal infections in Colombian patients with systemic lupus erythematosus

Abstract

Introduction Systemic lupus erythematosus is an autoimmune disease with multi-organ involvement. Complications, such as invasive fungal infections usually occur in patients with a greater severity of the disease. Objective The objective of this study was to determine the prevalence and risk variables associated with invasive fungal infections in a Colombian systemic lupus erythematosus population. Materials and methods A cross-sectional, retrospective study that evaluated patients with systemic lupus erythematosus for six years. The primary outcome was invasive fungal infection. Descriptive, group comparison and bivariate analysis was performed using Stata 12.0 software. Results Two hundred patients were included in this study; 84.5% of the patients were women and the median age was 36 years; 68% of the subjects had haematological complications; 53.3% had nephropathy; 45% had pneumopathy and 28% had pericardial impairment; 7.5% of patients had invasive fungal infections and the most frequently isolated fungus was Candida albicans. Pericardial disease, cyclophosphamide use, high disease activity, elevated ESR, C3 hypocomplementemia, anaemia and lymphopenia had a significant association with invasive fungal infection ( P < 0.05). Conclusions We describe for the first time the prevalence of invasive fungal infection in a Colombian population with systemic lupus erythematosus, which was higher than that reported in other latitudes. In this population the increase in disease activity, the presence of pericardial impairment and laboratory alterations (anaemia, lymphopenia, increased ESR and C3 hypocomplementemia) are associated with a greater possibility of invasive fungal infections. Regarding the use of drugs, unlike other studies, in the Colombian population an association was found only with the previous administration of cyclophosphamide. In addition, patients with invasive fungal infections and systemic lupus erythematosus had a higher prevalence of mortality and hospital readmission compared with patients with systemic lupus erythematosus without invasive fungal infection.

Mortality prediction in systemic lupus erythematosus patients with pulmonary infection

“…A systematic review from the University of Calgary confirmed the severe sequelae of invasive fungal disease in SLE, with a mortality rate of 53% . But in our result only one patient with fungal PI died during hospitalization.…”

“…Previous studies showed disease activity，high anti‐dsDNA titers, low complement levels, nephritis, leucopenia, GC doses and immunosuppressants were risk factors for infections in lupus patients . A nationwide cohort of SLE patients showed that male sex and Black race were risks factors for infection, whereas hydroxychloroquine was a protective factor …”

Altered peripheral lymphocyte subsets in untreated systemic lupus erythematosus patients with infections

“…However, a study from a multiethnic lupus cohort showed that specific TNF variants and leukopenia influenced the risk of developing pneumonia, regardless of immunosuppressive therapy (12). Research from the Hospital Universitario de Santander suggested that anemia, lymphopenia, hypocomplementemia, and especially the activity of the disease are risk factors for invasive fungal infections in SLE patients (13). In addition, Balbi et al (14) reported that SLE patients with nephritis and high cumulative doses of corticosteroids may be more prone to developing tuberculosis, especially in endemic countries.…”

Frequency of Invasive Fungal Disease in Adults: Experience of a Specialized Laboratory in Medellín, Colombia (2009–2015)

“…Other IFD were identified less frequently including coccidioidomycosis and aspergillosis [12]. In Colombia, a cross-sectional, retrospective study in patients with systemic lupus reported 7.5% incidence of invasive fungal infections [13].…”