Approach to Fever in SLE
- Difficult to differentiate between lupus flare and active infection
- Systemic lupus is also reported as a cause of fever of unknown origin (FUO) (at least 1/3 of all causes)
- Adjustment of lupus treatment or initiation of a trial of empiric antibiotics should be determined based on the initial findings and patient status
- In newly diagnosed patients, if steroids produces a rapid disappearance of fever, its SLE Flare; when fever persists, the search of an infectious source is mandatory
- No specific biomarkers to differentiate between both
Common causative organism
Bacterial
- Pneumonia and respiratory tract infections are the most recognized
- S. aureus and Streptococcus pyogenes persist as the most frequent etiology of respiratory infections
- In outpatient setting, common gram-negative bacteria are Klebsiella sp, Pseudomonas aeruginosa, and E. coli
- Streptococcus pneumoniae has been reported as a cause of septicemia;(lower rate after routine vaccination)
- Urinary tract infections are very common among women with SLE commonly due to E coli and Streptococcus agalactiae
- Infections due to Salmonella species are important cause of bacteremia after ingestion of contaminated food
Mycobacterium
- Infections as a consequence of Mycobacterium species are of two groups
- infections due to M tuberculosis, that trend to occur early in the course of lupus, related to disease activity and treatment, and usually resulting mainly from reactivation of latent infection or to reinfection
- infections to non-tuberculous Mycobacterium (NTM), presenting later in the course of disease and predominantly as a new infection, including M. avium complex, M. chelonae, M. haemophilum or M. fortitum
Viral
- SLE was the most important risk factor to develop Herpes Zoster at population level
- Epstein-Barr virus (EBV) infection importance resides in its temporal relationship with lupus initiation
- Coexistence of SLE and HCV infection is therefore not an unusual treat
- Other viral infections in lupus patients such as mumps, measles, herpesvirus-6, or herpes simplex virus are seldom reported and seem not to have relevance interactions of these viral agents and SLE
Fungal
- Candida species, which may affect pharynx, esophagus, and the urinary tract or may present themselves as a primary bloodstream infection
- fatal cases of lupus patients with meningeal infection are caused by C. neoformans
Reference:
Infection and systemic Lupus Erythematous. www.inthechopen.com
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