Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies
Abstract
Infection is one of the leading causes of morbidity and mortality in systemic lupus erythematosus (SLE). Bacterial infections are most frequent, followed by viral and fungal infections. The impaired cellular and humoral immune functions seen in patients with SLE are predisposing conditions, whilst disease activity, prednisone doses over 7.5-10 mg/day, high doses of methylprednisolone or cyclophosphamide are well-recognised risk factors for infection. The first six months after rituximab treatment and the use of more than three courses are also associated with an increased susceptibility for infection. It has not been established whether belimumab, azathioprine and mycophenolate mofetil increase the risk of serious infections. Most vaccines are effective and safe in SLE patients, although vaccination should be avoided during periods of active disease. Live virus vaccines are contraindicated for immunosuppressed patients. Influenza and pneumococcal vaccines are universally recommended. Tuberculosis prophylaxis should be considered in selected cases. Therefore, it is advisable not to exceed doses of 5 mg/day of prednisone in chronic treatment. Methylprednisolone and cyclophosphamide should be used in low-dose regimens. Antimalarials have a well-known protective role against infection, in addition to other beneficial properties, thus, hydroxychloroquine is recommended for all SLE patients where no contraindication exists.
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SLE patients are on lifetime immunosuppressants and at high risk for viral infections, especially VZV.
“SLE patients are on lifetime immunosuppressants and at high risk for viral infections, especially VZV (40).”
From Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay (2020) · cites this paper as [40]
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Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay
Aldriweesh, M. A., Shafaay, E. A., Alwatban, S. M., Alkethami, O. M., Aljuraisi, F. N., Bosaeed, M., & Alharbi, N. K. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.602267 · Cited by 30 · see citing works
- Authors
- Danza, A., & Ruiz-Irastorza, G.
- Affiliations
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital De Cruces, University of the Basque Country, Spain
- Venue
- Lupus
- Publisher
- SAGE Publications
- Published
- 2013-10
- Volume
- 22
- Issue
- 12
- Pages
- 1286-1294
- ISSN
- 0961-2033 (ISSN-L)
- 1477-0962
- OpenAlex
- W2021201394
- Cited by
- 359
- References
- 79
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 22 · 2023: 28 · 2022: 46 · 2021: 63 · 2020: 50 · 2019: 32 · 2018: 30 · 2017: 27 · 2016: 11 · 2015: 20 · 2014: 8
- FWCI
- 10.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Lupus (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
- Keywords
- systemic lupus erythematosus, infection risk, bacterial infection, viral infection, fungal infection, immunosuppressive therapy, prednisone dose, methylprednisolone, cyclophosphamide, rituximab, belimumab, azathioprine, mycophenolate mofetil, vaccination, live attenuated vaccine, tuberculosis prophylaxis, hydroxychloroquine, antimalarial drugs, disease activity
- MeSH terms
- Bacterial Infections, Humans, Immunity, Cellular, Immunosuppressive Agents, Lupus Erythematosus, Systemic, Mycoses, Opportunistic Infections, Risk Factors, Vaccines, Virus Diseases, Immunocompromised Host, Immunity, Humoral
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