Increased risk of neisserial infections in systemic lupus erythematosus

Stephen Ray Mitchell, Phong Q. Nguyen, Paul Katz

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Survival in systemic lupus erythamatosus (SLE) continues to improve because of better ancillary care, earlier diagnosis, and earlier treatment. However, infection remains a leading cause of morbidity and mortality in this disease Although corticosteroids and immunosuppressives increase the risk of opportunistic infection, the SLE patient is still most at risk from common bacterial pathogens. As the prototypic immune-complex disease, patients with active SLE have low circulating complement as well as a reticuloendothelial system (RES) saturated with immune complexes. It seems intuitive that SLE patients should be most at risk for organisms dependent for their removal on the RES or complement for opsonization or bacteriolysis. The current series presents four patients with SLE and disseminated neisseria infection and brings to 14 the number of patients in the literature with disseminated neisserial infection. They are typically young, female, with renal disease, and either congenital or acquired hypocomplementemia, and may present with all features of a lupus flare. Surprisingly, they are not all on corticosteroids or immunosuppressives and have some features that are unusual for non-SLE patients with these infections. There seems to be an over-representation of Nisseria meningitidis (despite potential reporting bias), and there ironically may be better tolerance with fewer fulminant complications in patients who have complement deficiencies. The best approach for the physician treating SLE is to immunize all SLE patients with available bacterial vaccines to N meningitidis and Streptococcus pneumonia, have a low threshold of suspicion for the diagnosis of disseminated neisserial or other encapsulated bacterial infection in the SLE patient who is sick, and to treat empirically with third generation cephalosporins after appropriate cultures.

Original languageEnglish
Pages (from-to)174-184
Number of pages11
JournalSeminars in Arthritis and Rheumatism
Volume20
Issue number3
DOIs
StatePublished - Jan 1 1990
Externally publishedYes

Fingerprint

Systemic Lupus Erythematosus
Infection
Mononuclear Phagocyte System
Immunosuppressive Agents
Adrenal Cortex Hormones
Bacteriolysis
Immune Complex Diseases
Bacterial Vaccines
Neisseria
Opportunistic Infections
Cephalosporins
Streptococcus pneumoniae
Antigen-Antibody Complex
Bacterial Infections
Early Diagnosis
Morbidity
Physicians
Kidney
Survival
Mortality

Keywords

  • complement
  • disseminated neisserial infection
  • gonococcus
  • meningococcus
  • Systemic lupus
  • vaccination

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Orthopedics and Sports Medicine
  • Rheumatology

Cite this

Increased risk of neisserial infections in systemic lupus erythematosus. / Mitchell, Stephen Ray; Nguyen, Phong Q.; Katz, Paul.

In: Seminars in Arthritis and Rheumatism, Vol. 20, No. 3, 01.01.1990, p. 174-184.

Research output: Contribution to journalArticle

Mitchell, Stephen Ray ; Nguyen, Phong Q. ; Katz, Paul. / Increased risk of neisserial infections in systemic lupus erythematosus. In: Seminars in Arthritis and Rheumatism. 1990 ; Vol. 20, No. 3. pp. 174-184.
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