系统性红斑狼疮与感染.pptx

系统性红斑狼疮与感染.pptx

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LUPUSVsINFECTION,ZhaojiuliangDepartmentofRheumatologyPUMCH,Beijing,Q1.WhatarethemostfrequentinfectionsinpatientswithSLE?

Q2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?

Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?

Q1.WhatarethemostfrequentinfectionsinpatientswithSLE?

Infectionisresponsibleforapproximately25%ofalldeathsinpatientswithsystemiclupuserythematosus（SLE）ThemainreasonofhospitalizationAppearstobehighestwithinthefirst5yearsofdiseaseonset,InfectioninSLE,ClinRheumatol,2014.33

（1）:

57-63.,CharacteristicsofmajorinfectionsinSLE,RespiratorytractsUrinarytractsSkinandsofttissues,ThetypesofinfectionsthatSLEpatientsdevelopedwerethesameasinthegeneralpopulation,Themostfrequentinfectionsinclude:

Pneumonia,herpeszostervirus,andurinarytractinfection,ArthritisCareRes（Hoboken）,2015.67（8）:

1078-85.,CharacteristicsofmajorinfectionsinSLE,Relativerisksofhospitalizations,Lupuscomparedwithgeneralpopulation,ArthritisCareRes（Hoboken）,2015.67（8）:

1078-85.,PathogenofinfectioninSLE,Gram-negativebacilli,gram-positivecocci,fungalandotherbacterialinfectionsaccountedfor39.85%,31.58%,18.80%and9.77%,respectivelyofnosocomialinfections.,Clinicalmanifestationsofinfections,Atypical!

Mycobacteriumtuberculosis,TheprevalenceofTBinfectioninSLE:

5-30%Characteristicshigherincidenceratemorefrequentextra-pulmonaryinvolvementmoreextensivepulmonaryinvolvementHighrelapserateeveniftreatedwithprophylacticizoniazidmorecommoninSLErenaltransplantpatients,Zandman-Goddard,G.,InfectionsandSLE.Autoimmunity,2009.38（7）:

473-485.,Mycobacteriumtuberculosis,TBmaypresentasamimickerofvasculitisTBmaypresentwithskindiseaseposingadiagnosticchallengeAhighindexofsuspicionwillallowprompttreatment.TB.spotDatainChina,Viralinfections,AcuteviralinfectionsinSLECMV（50%）parvovirusB19herpessimplexEBVvaricellazostervirushepatitisAamongotherlessfrequentlyreportedviruses,HZV,Theannualage-adjustedincidenceofherpeszostervirusinSLEpatientsof12/1000person-yearsMostfrequentlyalate（5yrs）complicationsofSLEOftenoccurringduringinactivityormildSLEactivity往往皮疹重而神经系统表现轻溃疡性角膜炎耳带状疱疹，Ramsay-Huntsyndrome,Cytomegalovirus（CMV）,CMVinfectionandSLEexacerbationmaybedifficulttodistinguishDevelopmentofSLEmaybetriggeredbyaCMVinfection.ExistingSLEmayundergoanexacerbationfollowingaCMVinfectionCMVseropositiveVSovertclinicaldiseaseOver90%SLEptsareseropositiveAntigenemia18-44%Overtclinicaldisease:

uncommon,PneumocystisPneumonia,PneumocystisPneumonia,AcutoffforPCPprophylaxisinanyparticulardisease:

3.5%?

6%？

however,thefrequencyofPCPvariesgreatlyfromdiseasetodisease.GPASLEIIMRA?

（）RiskfactorsLowCD4+countsLymphocyte350+GCsandcytotoxictherapyGCs:

meandailydose,cumulativedose,and/orpulsedosing,PneumocystisPneumonia,PneumocystisPneumonia,ClinicalManifestationsHighrateofco-infectionwithotherOI,includingCMV,Aspergillus,andCandidaspecies.Highmortality:

32%（CTD-PCP）,butonly1/4weresolelyattributabletoPCP,PneumocystisPneumonia,ProposedPCPprophylaxisinPtswithCTD2ormoreofthefollowingGCs=20mg/dfor4weeksCurrentuseof=2DMARDsAbsolutelymphocytecount=350cell/mm3UnderlyingILDTMP-SMZ：

85%reductioninPCPinfectionRealworldsurvey,50%SLEptsonCYCusingprophylaxia15.88/1WptsreportsPCPinfection;higherAEsratesNotsufficientevidencetosupportuniversaluseofprophylaxia,Q2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?

Riskfactorsforinfection,UseofsteroidseverUseofCYC,MMF,CD20mAbOrgandamageresultingfromseverelupusSeverelupusflaresinvolvingthekidneyorcentralnervoussystemHighSLEdiseaseactivityindex（SLEDAI）,Danza,A.andRuiz-Irastorza,G.,Infectionriskinsystemiclupuserythematosuspatients:

susceptibilityfactorsandpreventivestrategies.Lupus,2013.22（12）:

1286-94.,Prednisoneusetobeassociatedwithinfectionrisk,witheach10mgperdayincreaseofprednisoneincreasingtheriskofseriousinfection11-fold.,Ruiz-Irastorza,G.,Predictorsofmajorinfectionsinsystemiclupuserythematosus.ArthritisResTher,2009.11（4）:

R109.,LN:

感染高危因素,ArthritisRheumatol,2015.67（6）:

1577-85.,SLE感染高危因素,ArthritisRheumatol,2015.67（6）:

1577-85.,Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?

ForRheumatist,EULARrecommendationsCarefultitrationofcorticosteroidsandotherimmuno-suppressiveagentsagainstdiseaseactivityPromptevaluationforinfectionsProphylacticuseofantibioticsforptsathighriskofcertaininfectionsImmunizations,GCsinSLE,具体预防措施,