Risk factors for infection in Malaysian patients with systemic lupus erythematosus

Paton, Nick; Cheong, I; Kong, Norella; Segasothy, M

doi:10.1093/qjmed/89.7.531

Cited by 52 publications

(40 citation statements)

References 11 publications

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“…These infections include: tuberculosis, fungal infections, and pneumocystis carinii and viral infections [18]. Surprisingly, we did not find any cases of tuberculosis in our series, even though there were previous reports of tuberculosis in SLE in Thailand and Malaysia [15,20]. Since Thailand is an epidemic area for tuberculosis, the routine tuberculin test was performed on our patients before they were started on prednisolone or immunosuppressive drugs.…”

Section: Discussioncontrasting

confidence: 50%

Infection in children with lupus nephritis receiving pulse and oral cyclophosphamide therapy

Opastirakul

Chartapisak

2005

Pediatr Nephrol

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Infection is the major complication of cyclophosphamide therapy in patients with lupus nephritis. The objectives of this study were to report and compare the rate of infection between children with lupus nephritis who had received intravenous pulse cyclophosphamide (IVCY) and those who had received oral cyclophosphamide (OCY) and to determine the risk factors for infection during treatment with cyclophosphamide in these groups. Records of nine patients who had received IVCY from the beginning [pure intravenous cyclophosphamide (PIVCY) group], 11 patients who had received prior oral cyclophosphamide and later switched to IVCY [combined intravenous cyclophosphamide (CIVCY) group] and 41 patients who had received OCY were reviewed. Infection occurred in 21 of 61 patients (34%). In the PIVCY group, four episodes of infection occurred in three of nine patients (33%). In the CIVCY group, six episodes of infection occurred in four of 11 patients (36%). In the OCY group, 18 episodes of infection occurred in 14 of 41 patients (34%). The rate of infection between these groups was not different (P=0.99). None of the following parameters were risk factors for infection: cumulative dose of cyclophosphamide, leukopenia and neutropenia. On the contrary, white blood cell (WBC) count and polymorphonuclear cell (PMN) count were significantly less in the no-infection group (P=<0.001, P<0.001, respectively), with odds ratios for leukopenia (WBCs <4,000 mm(3)) and neutropenia (PMNs <1,500 mm(3)) between the infection and the no-infection group equal to 0.18 (95%CI 0.05-0.63) and 0 (95%CI 0-0.19), respectively. Most of the patients who had infection received prednisolone at a dosage of more than 0.5 mg/kg per day (67% of the PIVCY group, 50% of the CIVCY group and 83% of the OCY group). Fatal infections occurred in two patients who had concomitant active systemic lupus erythematosus (SLE). Although lymphopenia (lymphocyte count <1,500/mm(3)) was not the risk factor for infection, it was observed that six of seven patients with herpes zoster had lymphopenia. Herpes zoster seemed to occur more frequently in the OCY group (15%) than in the whole IVCY group (5%), but there was no statistical difference (P=0.41). We conclude that the rate of infection in the IVCY and OCY group was not different. Infection is likely to occur in patients receiving a concomitant high dose of prednisolone. The occurrence of fatal infection in patients with active disease should be noted. No single risk factor was detected in this study.

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Section: Discussioncontrasting

confidence: 50%

Infection in children with lupus nephritis receiving pulse and oral cyclophosphamide therapy

Opastirakul

Chartapisak

2005

Pediatr Nephrol

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“…We prefer to introduce immonusuppressive agents early in severe LN than use high oral steroid doses. We also use minipulse methylprenisolone (250 mg daily x 3 days) for initial remission reduction so as to obviate increase in infection risk as reported by Paton et al in a study of local patients (50).…”

Section: Original Articlementioning

confidence: 99%

Predictors of thickened carotid intima media thickness among well controlled lupus nephritis patients in a Malaysian tertiary centre

Shaharir

Said²,

Kong

2012

Reumatismo

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summary Objectives. To investigate the prevalence of thickened carotid intima media thickness (CIMT) and its associated risk factors in patients with lupus nephritis (LN) who were in remission.Methods. This was a cross sectional study in which consecutive LN patients who were in remission and attending our Nephrology/SLE Clinic were included. Their demographic profile, traditional cardiovascular risk factors and treatment medications were evaluated by clinical interview and review of medical records. Carotid intima media thickness (CIMT) was measured using B Mode carotid ultrasonography. CIMT was considered to be abnormally thickened if it exceeded the 75 th percentile matched for age-and sex-matched normal controls. The associated factors for thickened CIMT were examined. Results. A total of 39 patients with a mean remission duration of 29±24.3 months and on a mean prednisolone dose of 9.10±7.83 mg daily completed the study. Six patients (15.4%) had thickened CIMT. On univariate analysis, male gender, patient age, older age at diagnosis, higher serum CRP levels, greater proteinuria and higher mean cumulative azathioprine dose were associated with thickened CIMT (P<0.05). Lower mean cumulative doses of cyclosporine A (CyA) and mycophenolic acid (MPA) (P<0.05) each were associated with thickened CIMT. Using regression analysis, the associated factors of CIMT were older age at diagnosis and proteinuria. Conclusions. Lupus factors particularly age at diagnosis and proteinuria were the associated factors of thickened CIMT. Larger prospective trials are indicated to confirm our findings.

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“…Major clinical predictors identified include active lupus, lupus nephritis and renal insufficiency. Use of corticosteroids at doses greater than 20 mg to 60 mg daily have been reported to increase the risk of infection (9,21,22).…”

Section: Casementioning

confidence: 99%

Invasive aspergillosis associated with systemic lupus erythematosus and cardiac postoperative complication

Macêdo¹,

Silva-Júnior²,

Souza-Motta³

et al. 2009

Braz. J. Microbiol.

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Aspergillus is a ubiquitous fungus which can cause a variety of clinical syndromes. This fungus has emerged as agent of systemic infections and has therefore gained considerable public health importance. This paper describes two cases of invasive aspergillosis caused by A. fumigatus in immuno-suppressed patients and underscores the importance of early identification of Aspergillus infection associated with systemic lupus erythematosus and cardiac postoperative complications.

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Risk factors for infection in Malaysian patients with systemic lupus erythematosus

Cited by 52 publications

References 11 publications

Infection in children with lupus nephritis receiving pulse and oral cyclophosphamide therapy

Infection in children with lupus nephritis receiving pulse and oral cyclophosphamide therapy

Predictors of thickened carotid intima media thickness among well controlled lupus nephritis patients in a Malaysian tertiary centre

Invasive aspergillosis associated with systemic lupus erythematosus and cardiac postoperative complication

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